Field Transition Care Coordination

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The primary purpose of this position is the application of clinical knowledge to coordinate member transitions from nursing facility to community or between community-based settings for assigned members who are primarily medically complex and require intensive medical and psychosocial support.
The Transition Care Coordinator works directly with members to ensure appropriate access to services and providers. Coordination of member care needs across the continuum begins with early identification of health risk factors, education, and prevention using the six essential activities of case management as per CMSA.
Coordination also assures the provision of appropriate services as they transition between residential settings, to meet member needs in the most cost-effective manner available. Collaborates with all members of the Care Coordination team including Care Coordinator, Case Management, Utilization Review and Behavioral Health team members.
If you are located in or within commutable driving distance to Wilson, Smith, and Davidson Counties, you'll enjoy the flexibility to work remotely
* as you take on some tough challenges. This is a field-based role.
Primary

Responsibilities:
Application of clinical knowledge to effect efficient case management for those accessing their Medicare/Medicaid benefitsIncorporates evidence-based clinical practices into care coordination activitiesDelivers member-centered, individualized self-management support and patient educationEnsure appropriate utilization and consistent application of the health benefits and servicesConduct telephonic and face to face assessments according to Health Plan policy and procedure, including system documentation and State prescribed timeframesServe as member advocate and facilitator to resolve issues that may be perceived as barriers to careProvide education and coordination of community resource referrals to members and providersDevelop and implement 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 providersCollaborate 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 membersMonitor hospital encounters of assigned members and evaluate continued safety for transition between residential settingsRefer clinical decisions beyond level of authority for members who do not meet established criteria to manager for review and decisionParticipate in the Health Plan Quality Improvement process including recognition of quality-of-care issues and forwarding information to appropriate staff for review and resolutionUtilize Health Plan software to enter service requests, document, and monitor all aspects of member care coordination and service deliveryMaintain time sensitive documentation to assure compliance with regulatory agenciesCoordinate services for members following Health plan policyPerform other duties as assigned You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required

Qualifications:
Current Nursing License (RN) or LBSW License2+ years of clinical experience as an RN or LBSW1+ years of experience with MS Office, including Word, Excel, and OutlookExcellent organization, communication and time management skillsReside in or within a commutable driving distance to Wilson, Smith, and Davidson CountiesAccess to reliable transportation and valid US driver's license with the ability to travel up to 50% within an assigned territory to meet with members and providersPreferred

Qualifications:
BSN, Master's degree in Clinical Field or Master degree MSWCCM certification1+ years of community case management experience coordinating care for individuals with complex needsLong term care experienceExperience working in team-based careWorking knowledge of Medicare/Medicaid regulationsWorking knowledge of medical terminology*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary,

we offer
benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (