RN Service Coordinator
5 days ago
UnitedHealth Group Inc is seeking a skilled RN Service Coordinator to join our team. As a RN Service Coordinator, you will play a critical role in enhancing the quality of clinical and financial outcomes and member satisfaction while managing the plan of care.
Key Responsibilities:- Conduct holistic evaluations of members' individual dynamic needs and preferences, gathering relevant data and obtaining further information from members/family.
- Provide education and support to members/LAR on options of Consumer Directed, or Service-Related delivery models as applicable.
- Perform initial assessments and follow-up assessments and outreach calls within the time specified as part of contractual guidelines or per member/family/provider request.
- Identify members for high-risk complications and coordinate care with the member and the healthcare team.
- Manage members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost-effective and efficient utilization of health benefits.
- Assess, plan, and implement care strategies that are individualized for each member and directed toward the most appropriate, least restrictive level of care.
- Utilize both company and community-based resources to establish a safe and effective case management plan for members.
- Collaborate with member, family, and healthcare providers to develop an individualized plan of care.
- Identify and initiate referrals for social service programs, including financial, psychosocial, community, and state supportive services.
- Manage care plan throughout the continuum of care as a single point of contact.
- 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.
- Utilize approved clinical criteria to assess and determine appropriate level of care for members.
- Document all member assessments, care plan, and referrals provided.
- Participate in Interdisciplinary team meetings and Utilization Management rounds and provide information to assist with safe transitions of care.
- Understand insurance products, benefits, coverage limitations, insurance, and governmental regulations as it applies to the health plan.
- Monitor services being delivered to ensure timeliness, appropriateness, and satisfaction in meeting Member needs.
- Reports medically complex cases to appropriate roles as necessary for review and problem-solving.
- Maintains status on face-to-face- and telephonic visit requirements for assigned Members.
- Graduate of an accredited school of nursing.
- Current unrestricted RN license in Texas.
- 3+ years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities as a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background.
- 2+ years of experience working in a clinical, hospital, acute care, direct care, community health or case management setting.
- 1+ years of experience working within the community health setting in a healthcare role.
- 1+ years of experience working with MS Word, Excel, and Outlook.
- Ability to travel in assigned region to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, etc.
- Bilingual - Spanish.
- Access to reliable transportation with valid driver's license with good driving record.
- Bachelor's degree.
- CCM/RUG certified.
- 2+ years of experience working with Medicaid waiver populations.
- Experience with electronic charting.
- Experience with arranging community resources.
- Field-based work experience.
- Behavioral Health experience.
- Background in managing populations with complex medical or behavioral needs.
- Knowledge of specific case management processes, and person-centered care practice.
- Excellent verbal and written communication skills.
- Analytical decision-making and judgment skills.
- Demonstrated ability to function as a clinical care team leader.
- Knowledgeable of all clinical resources available to patients both inpatient and outpatient.
- Data entry and word processing skills.
- All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes.
We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere:
UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
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