Licensed Field Care Coordinator - Middle TN

The primary purpose of this position is the application of clinical knowledge to coordinate member care needs for assigned members who are primarily medically complex and require intensive medical and psychosocial support. 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 Installs appropriate equipment or supplies as needed and educates member on safe and effective use Facilitates and participates in group visit strategies as defined by site, member and/or provider needs 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 CommunityCare 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 assure smooth transition of care coordination activities to other team members Coordinates care with UnitedHealthcare Inpatient Care Manager when member becomes hospitalized or seeks Emergency Room Services 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 and/or Team Leader 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 patient 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 Required Qualifications: BSN, Master's Degree or Higher in Clinical Field CCM certification 1+ years of community case management experience coordinating care for individuals with complex needs Long term care experience Experience working in team-based care Working knowledge of Medicare/Medicaid regulations Working knowledge of medical terminology At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.