HSS Clinical Coordinator RN - ED Navigator - Remote in Louisiana - UnitedHealth Group : Job Details

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.

This position requires a nursing degree or license (RN). This position may include health promotion and services, clinical services, delivery of quality initiatives and clinical care, population health, case management, nurse line, claims review, patient delivery, risks assessments, affordability promotion to include cost analysis, utilization, and quality data improvements, social needs and social determinants of health needs.

This position requires an RN with current licensure. This function includes RN (with current licensure) roles which manage development and implementation of initiatives surrounding emergency room utilization. Through this, this employee will work with higher-risk case management populations to address coordination of needed services to support the member in increasing the value of their care.

This position requires one to establish or maintain any clinical relationships and engagement with physician practices, members, and pharmacies while partnering internally (with areas such as network contract ACO mgrs., Health Care Economics and Analytics, Medical Directors, Reporting, Health Plan market leaders) with the goal of improving health outcomes, well-being, quality and practice performance while reducing medical costs. Positions are accountable for the full range of clinical continuum which may include but is not limited to, facilitating effective education and reporting, effective super utilizer engagement (e.g. members with complex and/or chronic conditions), and proactively identifying performance improvement opportunities through the use of data analytics, technology, workflow changes and clinical support. The ultimate goals in this role would be to increase a member's use of their PCP, compliance with medications, and assisting the member achieve better health overall.

If you reside in the state of Louisiana, you'll enjoy the flexibility to work remotely * as you take on some tough challenges.

Primary Responsibilities:

• Assesses and interprets member needs and requirements

• Identifies solutions to non-standard requests and problems

• Solves moderately complex problems and/or conducts moderately complex analyses

• Works with minimal guidance; seeks guidance on only the most complex tasks

• Translates concepts into practice

• Provides explanations and information to others on difficult issues

• Mentors, provides feedback, and guides others

• Acts as a resource for others with less experience

• Utilizes provided lists to outreach members who use the ED for inappropriate services

• Coordinates services with the member's PCP and/or needed specialist care

• Assist the member with any needed social determinants of health

• Participates in the MCIP program through LDH

• Seeks out, using sometimes real-time data, members who missing opportunities to receive high quality care

• Assists with performance improvement projects (when needed)

• Special projects as assigned

• Works with all clinical teams as a resource for the health management of all members. Works with all clinical teams as a resource for the health management of all identified patients

• May be asked to assist other clinical teams in bridging gaps for members

• Affordability promotion to include cost analysis, utilization, and quality data improvements

Additional Responsibilities:

• Responsible for ongoing member management and education

• Work with team members to coordinate an interdisciplinary approach to increased member adherence and disease management

• Coordinates follow up with any referrals made

• Focus on tasks that occur in accordance with State, CMS or other requirements as applicable

• Role assists contracted providers (offices or hospital systems) with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support members in receiving high quality healthcare

• Assist in the development and implementation of disease specific population health programs

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:

• Undergraduate degree

• Current unrestricted RN licensure in state of Louisiana

• 3+ years clinical nursing experience, preferable in managed care environment

• Louisiana driver's license with clean driving record

• Experienced presenting to others

• Access to high-speed internet

Preferred Qualifications:

• Proficient with in a Windows environment, utilizing Outlook and advanced skills with Microsoft Excel.

• Ability to created spreadsheets in Excel

• Experience working with case management

• Experience working with the Medicaid/Medicare Population

• Comfort with reading reports and analyzing data

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

The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with al minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.