HSS Clin Coordinator RN - Telecommute in Florida

Miami Neuroscience Institute Baptist Health South Florida; Inverness (FL); Hybrid; USD 83.097.000 - 149.001.000; Vollzeit

Zusammenfassung

UnitedHealth Group’s UnitedHealthcare division is seeking a Clinical Care Manager to oversee a panel of members with primary complex medical needs. The role emphasizes telephonic care coordination, evidence-based guidelines, and liaison work with providers to reduce fragmentation in the care ecosystem.

Strong clinical judgment and Medicare/Medicaid knowledge are essential. The position is field-based with a home office, travel up to 15%, and a schedule Monday–Friday 8am–5pm, with remote work

Qualifikationen

• RN licensed in good standing with a valid license
• 4+ years of clinical experience in healthcare settings
• 3+ years managing needs of complex populations (Medicare/Medicaid)
• 1+ year in community case management coordinating care for complex needs
• Ability to travel up to 15% for the role
• Access to a quiet home workspace with reliable internet

Aufgaben

• Serve as primary care manager for members with primary complex medical needs
• Conduct comprehensive needs assessments across medical, behavioral, functional, cultural, socioeconomic and SDOH factors
• Develop person-centered care plans addressing chronic conditions, health promotion, and medication management
• Collaborate with internal care teams, providers and community partners to implement care plans
• Monitor and update care plans, tracking progress and adjusting interventions as needed
• Provide education to support self-management and healthy lifestyle changes
• Support care transitions and discharge planning following ER, hospital, or SNF stays
• Coordinate Medicaid benefits to support care needs and document all activities

Kenntnisse

Care coordination

Clinical documentation

Communication skills

Travel readiness

Remote work setup

Team collaboration

Cultural competency

Bilingual in Spanish

Ausbildung

RN license

Jobbeschreibung

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities andremoving barriers to quality care. The work you do here impacts the lives of millions of people for thebetter. Come build the health care system of tomorrow, making it more responsive, affordable andoptimized. Ready to make a difference? Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

This position will be the primary care manager for a panel of members with primary complex medical needs. The Care Management / coordination activities will focus on supporting member's medical, behavioral and socioeconomic needs to promote appropriate utilization of services and improved quality of care. All case management/ coordination activities will be in alignment with evidence-based guidelines. This position will liaison with the members' provider community to help reduce fragmentation within the care ecosystem. The role will provide medically oriented clinical consults/guidance within the team and to other area within the health plan. The Clinical Care Manager will approach their member work with an understanding of how inequities drive health disparities.

Working Schedule: Schedule is Monday through Friday between the hours of 8 am to 5 pm. This position is a field-based position with a home-based office. You will work from home when not in the field.

This position is primarily telephonic however if there is a need for a member visit, the visit will be scheduled closest to RN's zip code. These are the following counties Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union, Hardee, Highlands, Hillsborough, Manatee, Polk, Miami-Dade and Monroe

Local travel up to 15% and mileage is reimbursed at current government rate.

Primary Responsibilities:

• Serve as primary care manager for members with primary complex medical needs
• Engage members through a variety of modalities (face and/or telephonically) to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, socioeconomic and SDOH needs
• Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines
• Partner and collaborate with internal care team, providers, community resources/partners and leverage expertise to implement care plan
• Monitor and update care plan, incorporating feedback from member to monitor compliance with interventions to achieve care plan goals
• Provide education and coaching to support:
• Member self-management of care needs in alignment with evidence-based guidelines
• Lifestyle changes to promote health, i.e. smoking cessation, weight management, exercise
• Assist member in development of personal wellness plan / health crisis plan
• Perform targeted activities and provide education to support HEDIS/STAR gap closure, including scheduling, reminding and verification of appointment to receive specific services Monitor compliance with medication regimen and make referrals to Pharmacist for medication review and recommendations
• Reassess and update care plan with change in condition or care needs
• Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission
• Access and Coordinate Medicaid Benefits to support care needs
• Document all care management/coordination activity in clinical care management record

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Current, unrestricted, independent licensure as a Registered Nurse
• 4+ years of relevant clinical work experience
• 3+ years of experience managing needs of complex populations (eg. Medicare, Medicaid)
• 1+ years of community case management experience coordinating care for individuals with complex needs
• Demonstrated knowledge of Medicare and Medicaid benefits
• Ability to travel 15% of time for role
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information and live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:

• Master's degree in nursing or related clinical field
• Experience working with behavioral health issues that can be applied to help guide and support member's with behavioral health needs
• Experience working in team-based care
• Experience working in Managed Care
• Lived experience (self or family) in managing or overcoming a chronic health, behavioral health or substance use condition
• Bilingual in [Spanish]

Soft Skills:

• Possess a strong work ethic
• Ability to listen skillfully, collect relevant information, build rapport and respond to customers in a compassionate manner
• Ability to adapt to change in the workplace
• Ability to work independently and as a part of a team
• Ability to interact with internal and external customers in a corporate environment
• Must possess a positive and motivated attitude
• Willingness to adapt to multiple external environments and settings

Physical Requirements and Work Environment

• Ability to transition from office to field locations multiple times a day
• Must possess transportation to visit clients in various locations
• Ability to travel varied distances and multiple terrains to visit assigned client locations
• Ability to carry equipment to and from field locations needed for face to face member visits (ex. laptop, stethoscope, blood pressure cuff, etc.)

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.