RN Service Coordinator - El Paso STAR+Plus
Company: Optum
Location: El Paso
Posted on: April 24, 2024
Job Description:
$1,000 Sign-on Bonus for external candidates
Optum is a global organization that delivers care, aided by
technology to help millions of people live healthier lives. The
work you do with our team will directly improve health outcomes by
connecting people with the care, pharmacy benefits, data and
resources they need to feel their best. Here, you will find a
culture guided by diversity and inclusion, talented peers,
comprehensive benefits and career development opportunities. Come
make an impact on the communities we serve as you help us advance
health equity on a global scale. Join us to start Caring.
Connecting. Growing together.
Functions as a member of the interdisciplinary healthcare team in
the provision of RN (Registered Nurse) Service Coordination Level 1
member care with the underlying objectives of enhancing the quality
of clinical and financial outcomes and member satisfaction while
managing the plan of care. Service Coordinator Level1 is
responsible for overall management of member's case within the
scope of licensure; provides supervision and direction to non-RN
clinicians participating in the member's case in accordance with
applicable state law and contract; develops, monitors, evaluates,
and revises the member's care plan to meet the member's needs,
conducts additional assessments with the goal of optimizing member
health care across the care continuum.
Primary Responsibilities:
- Responsible for conducting telephonic or face to face holistic
evaluations of Member's individual dynamic needs and preferences
gathering relevant data and obtaining further information from
Member/family identification, evaluation, coordination, and
management of member's needs, including physical health, behavioral
health, social services, and long-term services and supports
- Provides education and support to Member/LAR on options of
Consumer Directed, or Service-Related delivery models as
applicable
- Performs initial assessments and follow-up assessments and
outreach calls within the time specified as part of contractual
guidelines or per Member/family/provider request
- Identifies members for high-risk complications and coordinates
care with the member and the health care team
- Manages members with chronic illnesses, co-morbidities, and/or
disabilities, to insure cost effective and efficient utilization of
health benefit
- Assess, plan, and implement care strategies that are
individualized for each member and directed toward the most
appropriate, least restrictive level of care
- Utilize both company and community-based resources to establish
a safe and effective case management plan for members
- Collaborate with member, family, and healthcare providers to
develop an individualized plan of care
- Identify and initiate referrals for social service programs,
including financial, psychosocial, community, and state supportive
services
- Manage care plan throughout the continuum of care as a single
point of contact
- 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
- Utilize approved clinical criteria to assess and determine
appropriate level of care for members
- Document all member assessments, care plan and referrals
provided
- Participate in Interdisciplinary team meetings and Utilization
Management rounds and provide information to assist with safe
transitions of care
- Understand insurance products, benefits, coverage limitations,
insurance, and governmental regulations as it applies to the health
plan
- Monitor services being delivered to ensure timeliness,
appropriateness, and satisfaction in meeting Member needs
- Reports medically complex cases to appropriate roles as
necessary for review and problem solving
- Maintains status on face-to face- and telephonic visit
requirements for assigned Members 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:
- Graduate of an accredited school of nursing
- Current unrestricted RN license in Texas
- 3+ years of experience in working with individuals with chronic
illnesses, co-morbidities, and/or disabilities as a Service
Coordinator, Case Management, or similar role; or any combination
of education and experience, which would provide an equivalent
background
- 2+ years of experience working within the community health
setting in a health care role
- 2+ years of experience working in a community health, clinical,
hospital, acute care, direct care, or case management setting
- 2+ years of experience working with MS Word, Excel, and
Outlook
- Bilingual - Spanish
- Ability to travel in assigned region to visit Medicaid members
in their homes and/or other settings, including community centers,
hospitals etc.
- Access to reliable transportation with valid driver's license
with good driving record Preferred Qualifications:
- Bachelor's degree
- CCM/RUG certified
- 2+ years of experience working with Medicaid waiver
populations
- Experience with electronic charting
- Experience with arranging community resources
- Field-based work experience
- Behavioral Health experience
- Background in managing populations with complex medical or
behavioral needs
Knowledge and Skills:
- Knowledge of specific case management processes, and
person-centered care practice
- Excellent verbal and written communication skills
- Analytical decision making and judgment skills
- Demonstrated ability to function as a clinical care team
leader
- Knowledgeable of all clinical resources available to patients
both inpatient and outpatient
- Data entry and word processing skills 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.
Keywords: Optum, El Paso , RN Service Coordinator - El Paso STAR+Plus, Healthcare , El Paso, Texas
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