Registered Nurse STAR Plus Field Coordinator - Remote

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.

This position 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 Level 1 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.

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