Remote Field Based RN Clinical Coordinator Knoxville, TN

Requisition Number: 2187384
Job Category: Medical & Clinical Operations
Primary Location: Knoxville, TN
(Remote considered)

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. 

The HSS Clinical Coordinator (CC) is responsible for functions in areas such as health services, clinical services, and delivery of clinical care. The CC will focus on medical, behavioral, and social determinants of health factors that improve the well-being of individuals, families, and communities. This role is self-directed with less structured work, dealing with complex issues while serving as a resource for others. The tasks vary according to the needs of the individual(s) being served. Proficiency with computers, a detailed understanding of the full Microsoft Office suite, as well as excellent verbal and written communication are requirements. The CC will demonstrate flexibility and eagerness to learn and create new processes.

If you are located in TN, you will have the flexibility to work remotely* as you take on some tough challenges

Primary Responsibilities: 

• Work independently to identify priorities, make decisions, and complete work to meet established objectives; Works with minimal guidance; seeks guidance on only the most complex tasks
• Assess customer needs and requirements focusing on the customer as an individual while identifying support solutions for standard, and non-standard requests and problems
• Complete assessments as defined in Job Aids, and timely at appropriate intervals
• Make referrals to internal/external partners based on assessment/need/individual request per process
• Solves moderately complex problems and/or conducts moderately complex analyses applying clinical knowledge/skills to a range of moderately complex activities
• Translate concepts into practice
• Attend rounds including PDN rounds, Continuum of Care Rounds, as defined by individual role
• Provide information for, and/or attend appeals hearings, pre-hearing collaboration discussions
• Provide explanations and information to others on difficult issues
• Coach, provide feedback and guide others
• Work on new projects or team functions as needed
• Work cross-functionally and coordinate with others internally or externally to gather information; overcome challenges to obtaining needed information, (i.e. DIDD/Katie Beckett (KB) waiver program) as needed (Examples may include updating the average cost of care for KB individuals, update KB individual’s SSI application compliance status when applicable, securing a signed KB Enrollment – Cost of Care Acknowledgement for case files)
• Adhere to applicable internal and external/governmental guidelines and requirements (e.g., legal, regulatory compliance)
• Able to participate in significant travel, for example, but not limited to individual homes, provider locations, agencies, State partner locations, or others where there is a business need
• Perform other related functions as assigned

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:

• Must hold current unrestricted RN licensure in the State of Tennessee
• Registered Nurse (RN), undergraduate degree or equivalent experience
• 4+ years of Clinical Experience
• 2+ years of Case Management Experience
• 2+ years of Managed Care Experience
• Working knowledge of State rules for program-specific eligibility and requirements
• Proficient (or higher) level of experience with Microsoft Office (PowerPoint, Word, Excel, & Outlook)
• Proficient with relevant computer systems and platforms and ability to operate and integrate those systems (Intranet, Internet, SharePoint; ICUE, Microsoft Teams, Cisco WebEx)
• Able to travel throughout the assigned region as needed
• Must reside in Tennessee

Preferred Qualifications: 

• CCM certification
• Experience with Medicare and/or Medicaid
• Complex Clinical and/or Case Management Experience

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy