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UnitedHealth Group Health & Social Services Clinical Coordinator - Smithville, TN in Brentwood, Tennessee

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

In this role, you will work in the field and coordinate care on behalf of health plan enrollees who are receiving Long Term Services and Supports (LTSS), Medicare and home and community services and Medicaid Home Health Agency and PDN services. Your experience with home health agency, hospital and long-term care facilities will be essential in relaying the pertinent information about the patient needs and advocating for the best possible care available. At times, your patience may be challenged. But in the end, your confidence, decisiveness and perseverance will help you positively impact the lives of the people we serve, and ensure more positive outcomes for all. This position is Field Based which requires travel in various counties:

If you are located in the Smithville, Tennessee area, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary responsibilities:

  • Assess, plan and participate in the implementation of care strategies that are individualized and directed toward the most appropriate, least restrictive setting

  • Utilize both company and community-based resources to establish a safe and effective support plan for the people we serve

  • Collaborate with people enrolled in the Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP), DSNP, LTSS and Medicaid programs, and healthcare providers to develop, modify, and update Individualized Care Plans inclusive of measurable goals and outcomes

  • Work with the Case Manager to identify and initiate referrals for social service programs; including financial, psychosocial, community, and state supportive services

  • Advocate for the people we serve, and their families as needed to ensure their needs are assessed and choices are fully represented and supported by the healthcare team

  • Utilize approved clinical criteria to assess and determine appropriate level of care, document all telephonic and in-person encounters, assessments, and referrals.

  • Participate in Interdisciplinary Care Team meetings and assist with safe transitions of care

  • Understand health insurance products, benefits, coverage limitations, and governmental regulations as it applies to the health plan

  • Accountable to understand role and how it affects utilization management benchmarks and quality outcomes

  • Conduct field assessments around LTSS HCBS needs, SDOH, ADL/IADL needs, and skilled needs

  • Conduct field review visits for authorization purposes around LTSS and Home Health/PDN requested services

This role involves approximately 75% travel and you’ll need to be comfortable dealing with a full range of in-home and facility-based environments. Most of the time you’ll work autonomously, so the ability to stay focused and motivated is essential.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction 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 unrestricted RN licensure in TN or Licensed Social Worker

  • 3+ years of clinical experience

  • 1+ year of home care/home health and/or other case management experience

  • Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications

  • Reliable transportation to travel to the person’s home or other locations within service delivery area

Preferred Qualifications:

  • Bachelor's Degree in Nursing

  • Medicaid experience – specifically LTSS

  • Medicare experience

  • Experience working in a health plan or other managed care setting

  • Experience with community health and/or public health

  • Experience with utilization review or home health assessment work

  • Bilingual skills

  • Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

  • Ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: RN, Registered Nurse, case management, case manager, behavioral health, Care Coordinator, social services, community health, Medicaid, home care, community health, managed care, home health, public health, hospice, health care, long term care, mental health, LTC, LTSS, Medicaid, Medicare, ID, IDD, Smithville, TN, Tennessee