Field Care Coordinator

About This Role

This field-based role involves coordinating care for an identified group of patients, focusing on their self-sufficiency and independence. The coordinator assesses needs, develops care plans, and acts as a liaison between the health plan, the Commonwealth, enrollees, and their families. The position requires travel to enrollees' homes and various facilities.

Responsibilities

• Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs
• Develop and implement person-centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines
• Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan
• Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health
• Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission
• Advocate for members and families as needed to ensure the members' needs and choices are fully represented and supported by the health care team

Requirements

• Bachelor's degree in Social Work or Human Services (or related field)
• 3+ years of experience in care coordination, behavioral health experience, and/or work in a healthcare environment
• 3+ years of experience working with members who have medical needs, the elderly, individuals with physical disabilities

About the Company

United Healthcare is dedicated to simplifying the health care experience, creating healthier communities, and removing barriers to quality care.