HSS Clinical Coordinator RN - ED Navigator - Remote in Louisiana

UnitedHealth Group; Metairie (LA); Remote; Confidential; Full time

Job summary

An established industry player is seeking a dedicated Registered Nurse to enhance healthcare delivery and member engagement. In this role, you will assess member needs, coordinate care with healthcare providers, and implement initiatives to improve health outcomes. You'll have the opportunity to work flexibly from Louisiana, tackling challenges that directly impact the health of communities. This position not only offers a chance to make a significant difference in people's lives but also provides a supportive environment where your contributions are recognized and rewarded. If you're passionate about nursing and want to be part of a transformative healthcare journey, this role is perfect for you.

Qualifications

• Requires an RN with current licensure to manage clinical initiatives.
• Involves coordination with physician practices and member services.

Responsibilities

• Assess and interpret member needs and requirements.
• Coordinate services with the member’s PCP and specialists.
• Participate in performance improvement projects.

Skills

Nursing Degree

Clinical Care

Case Management

Data Analytics

Patient Engagement

Education

Registered Nurse (RN) License

Job description

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

This position requires a nursing degree or license (RN). This position may include health promotion and services, clinical services, delivery of quality initiatives and clinical care, population health, case management, nurse line, claims review, patient delivery, risks assessments, affordability promotion to include cost analysis, utilization, and quality data improvements, social needs and social determinants of health needs.

This position requires an RN with current licensure. This function includes RN (with current licensure) roles which manage development and implementation of initiatives surrounding emergency room utilization. Through this, this employee will work with higher-risk case management populations to address coordination of needed services to support the member in increasing the value of their care.

This position requires one to establish or maintain any clinical relationships and engagement with physician practices, members, and pharmacies while partnering internally (with areas such as network contract ACO mgrs., Health Care Economics and Analytics, Medical Directors, Reporting, Health Plan market leaders) with the goal of improving health outcomes, well-being, quality and practice performance while reducing medical costs. Positions are accountable for the full range of clinical continuum which may include but is not limited to, facilitating effective education and reporting, effective super utilizer engagement (e.g. members with complex and/or chronic conditions), and proactively identifying performance improvement opportunities through the use of data analytics, technology, workflow changes and clinical support. The ultimate goals in this role would be to increase a member’s use of their PCP, compliance with medications, and assisting the member achieve better health overall.

If you reside in the state of Louisiana, you’ll enjoy the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

• Assesses and interprets member needs and requirements
• Identifies solutions to non-standard requests and problems
• Solves moderately complex problems and/or conducts moderately complex analyses
• Works with minimal guidance; seeks guidance on only the most complex tasks
• Translates concepts into practice
• Provides explanations and information to others on difficult issues
• Mentors, provides feedback, and guides others
• Acts as a resource for others with less experience
• Utilizes provided lists to outreach members who use the ED for inappropriate services
• Coordinates services with the member’s PCP and/or needed specialist care
• Assists the member with any needed social determinants of health
• Participates in the MCIP program through LDH
• Seeks out, using sometimes real-time data, members who are missing opportunities to receive high quality care
• Assists with performance improvement projects (when needed)
• Special projects as assigned
• Works with all clinical teams as a resource for the health management of all identified patients
• May be asked to assist other clinical teams in bridging gaps for members
• Affordability promotion to include cost analysis, utilization, and quality data improvements

Additional Responsibilities:

• Responsible for ongoing member management and education
• Work with team members to coordinate an interdisciplinary approach to increased member adherence and disease management
• Coordinates follow up with any referrals made
• Focus on tasks that occur in accordance with State, CMS or other requirements as applicable
• Role assists contracted providers (offices or hospital systems) with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support members in receiving high quality healthcare
• Assist in the development and implementation of disease specific population health programs

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