Field Transition Care Coordination
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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 benefits
- Incorporates 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 and services
- 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 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 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
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