HSS Clinical Coordinator - Telecommute

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

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)

United Community, CHOICES program offers person-centered care planning, service coordination and support services for members receiving long-term care (LTC) and home and community (HCBS) services. The CHOICES Care Coordinator (CC) is responsible for facilitating, promoting and advocating for the member's ongoing self-sufficiency and independence. The care coordinator will conduct face-to-face and/or telephonic assessments to assess the member's need for support to alleviate functional deficits. This supported self care in their activities of daily living allows the member to remain independently functioning in the community. This allows for the member to age in place, by improving or maintaining the social, emotional, functional and physical health of the member.

For members who elect residence within a nursing facility, the care coordinator is responsible for educating the member on home and community-based alternatives, assessing the member's potential for and interest in transitioning from nursing facility-to-community. If a member chooses or it is determined that the member is best served in the facility, the care coordinator is responsible for ongoing assessment and care planning to ensure quality of life services to meet any indentified gaps in service.

Additionally, the care coordinator is responsible for sustaining the natural supports of the member. This includes but is not limited to assessing support caregivers, representative or family members to ensure the ongoing mental and physical health of those natural supports.

You'll enjoy the flexibility to telecommute* from anywhere within U.S as you take on some tough challenges.

Primary Responsibilities:
  • Conduct thorough and objective face-to-face assessments of the member to determine current status and needs, including physical, behavioral, functional, psychosocial and financial and health status expectation
  • Conduct monthly telephonic, quarterly face-to-face and change in condition screenings, assessments and/or encounters on HCBS members
  • Conduct quarterly telephonic or on-site grand rounds on Nursing Facility (NF) members experiencing changes in condition
  • Assess clinical information to develop individual plan of care for members
  • Identify members with the potential for high-risk complications and coordinate the appropriate supported self care in conjunction with the member and care coordination team
  • Act as an advocate for an individual's care needs by identifying and communicating opportunities for care interventions, including identifying and addressing functional deficits and gaps in care
  • Utilize criteria for authorizing appropriate home and community-based services, obtain authorization for those services and confirm that services are being provided and the member's needs are being met
  • Monitor and ensure that provision of covered physical health, behavioral health, and/or home and community-based services are provided as a cost-effective alternative
  • Management of critical transitions, such as hospital discharge planning
  • For members transitioning to a setting other than a community-based residential alternative (CBRA) setting, monitor the initiation and daily provision of services in accordance with the member's plan of care and take the immediate action to resolve gaps in care
  • Develop and implement targeted strategies to improve health, functional or quality of life outcomes, such as disease management or pharmacy management
  • Serve as a point of contact for coordination of all physical health, behavioral health and other home and community-based services
  • Proactively educate members about the program, including opportunities for consumer direction of HCBS and obtain necessary consents for participation
  • Coordinate with the Fiscal Employer Agent (FEA) for consumer direction members, as needed
  • Conduct, review and revises, as necessary, member's risk assessment and risk agreement
  • Maintain appropriate and ongoing communication and collaboration with members, their authorized representations, physicians and health team members and payer representatives
  • Monitor hospitalizations and institutional facility admissions and re-admissions to identify issues and implement strategies to improve outcomes
  • Provide assistance in resolving concerns about service delivery or providers
  • Coordinate with member's primary care provider, specialists and other providers and care programs to ensure comprehensive, holistic, person-centered approach to care
  • Provider members with education about the ability to use advance directives
  • Compare member's plan of care to establish pathways to determine variances and then intervene as indicated
  • Routinely assess and monitor member's status, needs and progress; if progress is static or regressive, determine reason and proactively encourage appropriate adjustments to their plan of care, providers and/or services to promote better outcomes
  • Report quantifiable impact, quality of care and/or quality of life improvements as measured against the care coordination goals
  • Establish and maintain professional working relations with referral sources, community resources and care providers
  • Collaborates with the peers on member admissions, transitioning and/or discharge planning

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:
  • Registered Nurse with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating the Nurse License Compact Law; or master or BSW level Social Worker with active license in the state of Tennessee (LCSW, LMSW or LAPSW, LBSW)
  • 5+ years of health care experience with 4 years clinical experience
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Preferred Qualifications:
  • 3+ years of experience providing care coordination to persons receiving long-term care and/or home and community-based services and an additional 2 years work experience in managed and/or long-term care settings
  • Exceptional skills of critical thinking, follow through, independent self-starter, fully integrated team member, organization, written and verbal communication, computer-literate, problem-solving, professional acumen, human relation skills and analytical skills
  • Ability to work within highly structure contractual time compliance requirements with occasional short turn around times
  • Demonstrated ability to work effectively in vertically-matrix organizations

To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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)

Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $25.63 to $45.72. The hourly range for Connecticut / Nevada residents is $28.27 to $50.29. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

*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: Health and Social Services Coordinator, Health, Social Services, Care Coordination Telecommute, Telecommuter