Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.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. Service Coordinator Level1 is responsible for overall management of member's case within the scope of licensure; provides supervision and direction to non-RN clinicians participating in the member's case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, conducts additional assessments with the goal of optimizing member health care across the care continuum.Primary Responsibilities:
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 insure cost effective and efficient utilization of health benefit
Assess, plan, and implement care strategies that are individualized for each member and directed toward the most appropriate, least restrictive level of care
Utilize both company and community-based resources to establish a safe and effective case management plan for members
Collaborate with member, 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
Manage care plan throughout the continuum of care as a single point of contact
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
Monitor 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
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:
Graduate of an accredited school of nursing
Current unrestricted RN license in Texas
3+ years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities as a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background
2+ years of experience working in a clinical, hospital, acute care, direct care, community health or case management setting
1+ years of experience working within the community health setting in a health care role
1+ years of experience working with MS Word, Excel, and Outlook
Ability to travel in assigned region to visit Medicaid members in their homes and/or other settings, including community centers, hospitals etc.
Access to reliable transportation.
Preferred Qualifications:
Bilingual
Bachelor’s degree
CCM/RUG certified
2+ years of experience working with Medicaid waiver populations
Experience with electronic charting
Experience with arranging community resources
Field-based work experience
Behavioral Health experience
Background in managing populations with complex medical or behavioral needs
Knowledge and Skills:
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
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.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.
