Remote RN Care Coordinator - Complex Medicare Cases

UnitedHealth Group; Knoxville (TN); Remote; USD 40,000 - 72,000; Full time

Job summary

UnitedHealth Group's UnitedHealthcare team is seeking a Care Coordinator with an active Tennessee RN license to coordinate care for medically complex members. This role focuses on applying clinical knowledge to manage Medicare/Medicaid benefits, provide education, and collaborate with Case Management, Utilization Review, and Behavioral Health teams.

This field-based position requires up to 75% travel and offers remote work flexibility near Knox County.

Qualifications

• Must possess active Registered Nurse license for Tennessee.
• 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.
• Ability to travel up to 75% within an assigned territory to meet with members and providers.
• Reside in or within a commutable driving distance to Knox County.
• Access to reliable transportation and valid US driver's license.

Responsibilities

• Apply clinical knowledge to efficient case management for those accessing their Medicare/Medicaid benefits.
• Incorporate 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

Excellent organization

Time management

Communication

Travel ability up to 75%

Reliable transportation

Education

Active Tennessee RN license

Tools

MS Office (Word, Excel, Outlook)

Job description

UnitedHealth Group's UnitedHealthcare team is seeking a Care Coordinator with an active Tennessee RN license to coordinate care for medically complex members. This role focuses on applying clinical knowledge to manage Medicare/Medicaid benefits, provide education, and collaborate with Case Management, Utilization Review, and Behavioral Health teams.

This field-based position requires up to 75% travel and offers remote work flexibility near Knox County.