[Hiring] Registered Nurse STAR Plus Field Coordinator @UnitedHealth Group
Role Description
This position functions as a member of the interdisciplinary healthcare team in the provision of RN (Registered Nurse) Service Coordination Level 1 member care with the underlying objectives of enhancing the quality of clinical and financial outcomes and member satisfaction while managing the plan of care.
• Conducting telephonic or face-to-face holistic evaluations of Member's individual dynamic needs and preferences.
• Gathering relevant data and obtaining further information from Member/family.
• Identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services, and long-term services and supports.
• Provides education and support to Member/LAR on options of Consumer Directed, or Service-Related delivery models as applicable.
• Performs initial assessments and follow-up assessments and outreach calls within the time specified as part of contractual guidelines or per Member/family/provider request.
• Identifies members for high-risk complications and coordinates care with the member and the health care team.
• Manages members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of health benefits.
• Assesses, plans, and implements care strategies that are individualized for each member and directed toward the most appropriate, least restrictive level of care.
• Utilizes both company and community-based resources to establish a safe and effective case management plan for members.
• Collaborates with member, family, and healthcare providers to develop an individualized plan of care.
• Identifies and initiates referrals for social service programs, including financial, psychosocial, community, and state supportive services.
• Manages care plan throughout the continuum of care as a single point of contact.
• Communicates with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members.
• Advocates for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the healthcare team.
• Utilizes approved clinical criteria to assess and determine appropriate level of care for members.
• Documents all member assessments, care plan, and referrals provided.
• Participates in Interdisciplinary team meetings and Utilization Management rounds and provides information to assist with safe transitions of care.
• Understands insurance products, benefits, coverage limitations, insurance, and governmental regulations as it applies to the health plan.
• Monitors 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.
Qualifications
• 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.
Requirements
• Current unrestricted RN license in Texas, Graduate of an accredited school of nursing.
• 2+ years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities within a community health, clinical, hospital, acute care, direct care, or case management setting.
• 2+ years of experience working with MS Word, Excel, and Outlook.
• Bilingual - Spanish.
• Ability to travel in assigned region to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, etc.
• Reliable transportation with valid driver’s license with good driving record.
Preferred Qualifications
• Bachelor’s Degree.
• CCM/RUG/PDPM Certified.
• 2+ years of experience working with Medicaid Waiver populations.
• 2+ years of experience working within the community health setting in a health care role.
• STAR+PLUS Service Coordination Experience.
• Experience with electronic charting.
• Experience with arranging community resources.
• Field-based work experience.
• Behavioral Health Experience.
• Proven background in managing populations with complex medical or behavioral needs.
Benefits
• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).
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This position functions as a member of the interdisciplinary healthcare team in the provision of RN (Registered Nurse) Service Coordination Level 1 member care with the underlying objectives of enhancing the quality of clinical and financial outcomes and member satisfaction while managing the plan of care.
• Conducting telephonic or face-to-face holistic evaluations of Member's individual dynamic needs and preferences.
• Gathering relevant data and obtaining further information from Member/family.
• Identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services, and long-term services and supports.
• Provides education and support to Member/LAR on options of Consumer Directed, or Service-Related delivery models as applicable.
• Performs initial assessments and follow-up assessments and outreach calls within the time specified as part of contractual guidelines or per Member/family/provider request.
• Identifies members for high-risk complications and coordinates care with the member and the health care team.
• Manages members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of health benefits.
• Assesses, plans, and implements care strategies that are individualized for each member and directed toward the most appropriate, least restrictive level of care.
• Utilizes both company and community-based resources to establish a safe and effective case management plan for members.
• Collaborates with member, family, and healthcare providers to develop an individualized plan of care.
• Identifies and initiates referrals for social service programs, including financial, psychosocial, community, and state supportive services.
• Manages care plan throughout the continuum of care as a single point of contact.
• Communicates with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members.
• Advocates for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the healthcare team.
• Utilizes approved clinical criteria to assess and determine appropriate level of care for members.
• Documents all member assessments, care plan, and referrals provided.
• Participates in Interdisciplinary team meetings and Utilization Management rounds and provides information to assist with safe transitions of care.
• Understands insurance products, benefits, coverage limitations, insurance, and governmental regulations as it applies to the health plan.
• Monitors 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.
Qualifications
• 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.
Requirements
• Current unrestricted RN license in Texas, Graduate of an accredited school of nursing.
• 2+ years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities within a community health, clinical, hospital, acute care, direct care, or case management setting.
• 2+ years of experience working with MS Word, Excel, and Outlook.
• Bilingual - Spanish.
• Ability to travel in assigned region to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, etc.
• Reliable transportation with valid driver’s license with good driving record.
Preferred Qualifications
• Bachelor’s Degree.
• CCM/RUG/PDPM Certified.
• 2+ years of experience working with Medicaid Waiver populations.
• 2+ years of experience working within the community health setting in a health care role.
• STAR+PLUS Service Coordination Experience.
• Experience with electronic charting.
• Experience with arranging community resources.
• Field-based work experience.
• Behavioral Health Experience.
• Proven background in managing populations with complex medical or behavioral needs.
Benefits
• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).
Apply tot his job
Apply To this Job