Post-Discharge Care Coordinator (Remote TX)

Optum; United States; Remote; USD 33,000 - 59,000; Full time

Benefits offered by this job

Telecommuting policy adherence

Benefits package and 401(k)

Job summary

UnitedHealth Group is seeking an HSS Clinical Quality Coordinator to coordinate post-discharge care for members transitioning from inpatient settings to home or other levels of care. You will develop individualized care plans, identify barriers, and reduce readmissions through proactive assessment and education.

Applicants must hold an active LVN license in Texas and have 2+ years in EHRs and Medicaid/Medicare with complex needs, plus MS Office proficiency.

Qualifications

• Active LVN license in the state of Texas.
• 2+ years of experience working with electronic health records.
• 2+ years of experience working with Medicaid/Medicare members with complex medical or behavioral needs.
• Intermediate level of proficiency with MS Office applications.

Responsibilities

• Conduct post-discharge outreach and interventions to reduce potentially preventable readmissions while meeting contractual obligations per state regulatory requirement
• Assess, plan and implement care strategies that are individualized by member and directed toward the most appropriate, lease restrictive level of care
• Discuss discharge planning to ensure understanding and assist in ensuring all ordered services are arranged prior to discharge Assist members with obtaining necessary HCBS support and services
• Coordinate with physicians, hospital case managers, discharge planners, caregivers and community resources to ensure continuity of care
• Utilize both company and community-based resources to establish a safe and effective case management plan for members while leveraging evidence-based guidelines
• Collaborate with member, family, and healthcare providers to develop an individualized plan of care
• Work with members to identify potential barriers to achieving healthcare goals and outcomes
• Identify and initiate referrals for specialized case management programs, social service programs, including financial, psychosocial, community, and state supportive services
• Resolve barriers to in-home care, transportation, medical or medications and find alternatives for additional support if needed
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team
• Document all member assessments, care plan and referrals provided
• Participate in Interdisciplinary team meetings/rounds and provide information to support members individualized needs
• Understand insurance products, benefits, coverage limitations, and governmental regulations as it applies to the health plan
• Understand role and how it affects utilization and quality outcomes including reducing potentially preventable events
• Provide, arrange, and coordinate preventive, primary, acute care, behavioral health and pharmacy services that contribute to the well-being of the member
• Review medical records for compliance with regulatory guidelines (e.g., NCQA, state Medicaid contracts, and compliance)
• Work with internal partners to create a culture of health and wellness that promotes member health
• Provide individualized education on preventative healthcare measures (e.g., immunization, healthcare screening) to close quality gaps in care

Skills

LVN license

Electronic Health Records

Medicaid/Medicare knowledge

MS Office

Tools

EHR systems

Job description

UnitedHealth Group is seeking an HSS Clinical Quality Coordinator to coordinate post-discharge care for members transitioning from inpatient settings to home or other levels of care. You will develop individualized care plans, identify barriers, and reduce readmissions through proactive assessment and education.

Applicants must hold an active LVN license in Texas and have 2+ years in EHRs and Medicaid/Medicare with complex needs, plus MS Office proficiency.