Field Case Manager - Choices
UnitedHealth Group - Knoxville, TN

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United HealthGroup 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 care coordinator is responsible for facilitating, promoting and advocating for the member's ongoing self-sufficiency and independence. Additionally, the care coordinator is responsible for sustaining the natural supports of the member. This includes but is not limited to assessing the availability of natural supports, representative or family members to ensure the ongoing mental and physical health of those natural supports.

Grand Region Travel - ≥90%
Statewide Travel - 5-10%
Territory: Sullivan, Johnson, Carter, Greene, Hawkins, Hancock, Claiborne, Washington, Unicoi, Cocke, Hamblen, and Sevier Counties.

Conduct thorough and objective initial and ongoing face-to-face assessments of the member within specific mandated intervals 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 other additional assessments as needed to address member change in condition, on HCBS members

Conduct quarterly telephonic or on-site grand rounds on Nursing Facility (NF) members experiencing changes in condition

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

Develops member specific Plan of Care that will be utilized to obtain authorizations for appropriate home and community based services, collaborating with CMA staff to obtain authorization for those services and confirms that services are being provided and the member's needs are being met while transitioning from nursing facility to home

Management of critical transitions, supporting legacy discharge planning staff with member transition to the home setting

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

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;

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

Requirements

Requirements:
Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse License Compact Law; or master level Social Worker with active license in the state of Tennessee (LCSW, LMSW, LAPSW)

3+ years of clinical experience

5+ years of experience working in a healthcare environment

Proficient computer skills including the ability to type and talk at the same time and toggle between multiple screens

Additional Assets Preferred:
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

Working knowledge of Medicare/Medicaid regulations

Case management of Medicaid Waiver populations

Previous field based work experience

Bilingual English/Spanish
UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.

We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Key words: icu, intensive care unit, er, emergency room, assess, ltc, long term care, home health, case management, care management, ccm, certified case manager, travel

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