- Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care
- Discuss discharge planning to ensure understanding and assist in ensuring all ordered services are arranged prior to discharge
- Utilize both company and community-based resources to establish a safe and effective discharge case management plan for members
- Collaborate with patient, family, and healthcare providers to develop an individualized plan of care
- Work with members to identify potential barriers to achieving healthcare goals and outcomes
- Identify and initiate referrals for specialized case management programs, social service programs, including financial, psychosocial, community, and state supportive services
- Resolve barriers to in-home care, transportation, medical or medications and find alternatives for additional support if needed
- 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
- Document all member assessments, care plan and referrals provided
- Participate in Interdisciplinary team meetings/rounds and provide information to support members individualized needs
- Understand insurance products, benefits, coverage limitations, and governmental regulations as it applies to the health plan
- Understand role and how it affects utilization and quality outcomes
- Provide, arrange, and coordinate preventive, primary, behavioral health and pharmacy services that contribute to the well-being of the member
- Review medical records for compliance with regulatory guidelines (e.g., NCQA, state Medicaid contracts, and compliance)
- Work with internal partners to create a culture of health and wellness that promotes member health
- Provide individualized education on preventative healthcare measures (e.g., immunization, healthcare screening) to close quality gaps in care
- Active LVN license in the State of Texas or Non-4 year degree AND 5+ years of experience working with ABD/SSI population within a clinical health care role
- 3+ years of clinical experience in a healthcare setting (preferably inpatient)
- Familiarity with Microsoft Office, including Word, Excel, and Outlook
- Reliable transportation and the ability to travel in this 'assigned region' to visit Medicaid members in within other settings, including community centers, hospitals, nursing facilities or providers' offices
- High-speed internet at residence
- Experience in discharge planning
- Experience in managed care
- Experience with electronic charting
- Background in managing populations with complex medical or behavioral needs
- Knowledge of quality metrics, pay for quality or HEIDIS measures
- Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance, and achieve targets
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HSS Clinical Coordinator - Houston, United States - UnitedHealth Group
Description
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.
In this HSS Clinical Coordinator- Hospital Transition Coordinator role, 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 the Houston, TX market and can travel locally to Memorial Hermann North Loop W. Fwy Houston TX (Heights) and Chi St Lukes Bates Ave Houston, TX locations, you will have the flexibility to work in a hybrid role as you take on some tough challenges. Travel required in local areas about 75% of the time based on business needs.
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:
Preferred Qualifications:
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
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.
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