Field HSS Clinical Coordinator RN - Fairbanks-NW Crossing or Spring Branch, TX ID-19264

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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. 

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In this RN HSS Clinical Coordinator role, you will be an essential element of an Integrated Care Model by relaying the pertinent information about the member needs and advocating for the best possible care available, and ensuring they have the right services to meet their needs.  Our team is made up of RNs, LVN’s, and CACs dedicated to helping members achieve their health care goals. We work closely with the nursing facilities in which our members reside.

If you are within Fairbanks - NW Crossing or Spring Branch, TX, or ideal areas within these zip codes 77092, 77018, 77080, 77091 and can travel locally, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

Travel required in local areas about 75% of the time based on business needs.

This is a field-based position with a home-based office.

Primary Responsibilities: 

  • Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care
  • Utilize both company and community-based resources to establish a safe and effective case management plan for members
  • Collaborate with patient, family, and healthcare providers to develop an individualized plan of care
  • Identify and initiate referrals for social service programs, including financial, psychosocial, community, and state supportive services
  • Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
  • Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team
  • Utilize approved clinical criteria to assess and determine appropriate level of care for members
  • Document all member assessments, care plan and referrals provided
  • Participate in Interdisciplinary team meetings and Utilization Management rounds and provide information to assist with safe transitions of care
  • Understand insurance products, benefits, coverage limitations, insurance, and governmental regulations as it applies to the health plan
  • Accountable to understand role and how it affects utilization management benchmarks and quality outcomes
  • You’ll need to be flexible, adaptable and, above all, patient in all types of situations

What are the reasons to consider working for UnitedHealth Group?  Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
  • More information can be downloaded at: http://uhg.hr/uhgbenefits

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 and unrestricted RN license in the state of Texas
  • 2+ years of experience working within the community health setting or in a health care role
  • Intermediate level of proficiency with Microsoft Office, including Word, Excel, and Outlook
  • Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
  • Reside in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
  • Access to reliable transportation and the ability to travel in this ‘assigned region’ to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, nursing facilities or providers' offices
  • Valid US driver’s license

Preferred Qualifications:

  • 1+ years of experience with long term care services and support, Medicaid, or Medicare
  • Ability to create, edit, save and send documents, spreadsheets and emails
  • Knowledge of the principles of most integrated settings, including federal and state requirements like the federal home and community-based settings regulations
  • Reside within commutable distance of assigned duties 
  • Bilingual English/Spanish 
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