Field-Based Care Coordinator & Member Advocate

UnitedHealth Group; Johnson City (TN); Hybrid; USD 83,097,000 - 149,001,000; Full time

Job summary

UnitedHealth Group is seeking a Care Coordinator to apply clinical knowledge to coordinate care for medically complex members, ensuring access to services and providers. This field-based role begins with early risk identification and education, following CMSA case management activities.

The position requires a Bachelor’s degree in a health field, 2+ years in case management, and ability to travel up to 75% within the assigned territory near Washington County.

Qualifications

• Bachelor's degree in Social Work, Nursing or other health care profession including LPN.
• 2+ years of clinical case management experience.
• 1+ years of experience with MS Office, including Word, Excel, and Outlook.
• Excellent organization, communication and time management skills.
• Reside in or within a commutable driving distance to Washington county.
• Access to reliable transportation and valid US driver's license with the ability to travel up to 75% within an assigned territory to meet with members and providers.

Responsibilities

• Application of clinical knowledge to effect efficient case management for those accessing their Medicare/Medicaid benefits.
• Incorporates evidence-based clinical practices into care coordination activities.
• Delivers member-centered, individualized self-management support and patient education.
• Ensure appropriate utilization and consistent application of the health benefits.
• Conduct telephonic and face to face assessments according to Health Plan policy and procedure, including system documentation and State prescribed timeframes.
• Serve as member advocate and facilitator to resolve issues that may be perceived as barriers to care.
• Provide education and coordination of community resource referrals to members and providers.
• Develop, implement, maintain and evaluate a member centered, individual care plan when services are indicated, based on member care needs identified through proactive collaboration and communication with members, families and providers.
• Collaborate and communicate with other members of the Care Coordination Team to improve the quality and efficiency of health care delivery and ensure smooth transition of care coordination activities to other team members.
• Monitor hospital encounters of assigned members and provide education and/or interventions as necessary to reduce frequency.
• Refer clinical decisions beyond level of authority for members who do not meet established criteria to manager for review and decision.
• Participate in the Health Plan Quality Improvement process including recognition of quality-of-care issues and forward information to appropriate staff for review and resolution.
• Utilize Health Plan software to enter service requests, document, and monitor all aspects of member care coordination and service delivery.
• Maintain time sensitive documentation to assure compliance with regulatory agencies.
• Coordinate services for members following Health plan policy.
• Perform other duties as assigned

Skills

Strong communication

Time management

Organization

Transportation & driving

Education

Bachelor's degree in Social Work or Nursing

Master's degree or higher in clinical field

CCM certification

Tools

MS Office

Job description

UnitedHealth Group is seeking a Care Coordinator to apply clinical knowledge to coordinate care for medically complex members, ensuring access to services and providers. This field-based role begins with early risk identification and education, following CMSA case management activities.

The position requires a Bachelor’s degree in a health field, 2+ years in case management, and ability to travel up to 75% within the assigned territory near Washington County.