HSS Clinical Quality Coordinator - Telephonic

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - HSS Clinical Quality Coordinator
- Telephonic in Texas (2391425)

HSS Clinical Quality Coordinator
- Telephonic in Texas - 2391425

At United Healthcare, 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 optimized. Ready to make a difference? Join us to start
Caring. Connecting. Growing together.

This function is for UHC C & S. Positions in this function address efforts focused on medical, behavioral, and social determinants of health that improve the well-being of individuals, families, and communities.

As an HSS Clinical Quality Coordinator, you will be responsible for, coordinating care for members transitioning from an inpatient hospital setting to home or another level of care. The role focuses on developing individualized plans of care, identifying barriers to successful recovery, and reducing potentially preventable hospital readmissions through proactive assessment, education, and care coordination. This is a fast-paced working environment that requires the ability to multitask with attention to detail and excellent organizational skills.

If you reside within the state of Texas, you will enjoy the flexibility to telecommute
* as you take on some tough challenges.

• Conduct post-discharge outreach and interventions to reduce potentially preventable readmissions while meeting contractual obligations per state regulatory requirement
• Assess, plan and implement care strategies that are individualized by member and directed toward the most appropriate, lease restrictive level of care
• Discuss discharge planning to ensure understanding and assist in ensuring all ordered services are arranged prior to discharge Assist members with obtaining necessary HCBS support and services
• Coordinate with physicians, hospital case managers, discharge planners, caregivers and community resources to ensure continuity of care
• Utilize both company and community-based resources to establish a safe and effective case management plan for members while leveraging evidence-based guidelines
• Collaborate with member, family, and healthcare providers to develop an individualized plan of care
• Work with members to identify potential barriers to achieving healthcare goals and outcomes
• Identify and initiate referrals for specialized case management programs, social service programs, including financial, psychosocial, community, and state supportive services
• Resolve barriers to in-home care, transportation, medical or medications and find alternatives for additional support if needed
• 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
• Document all member assessments, care plan and referrals provided
• Participate in Interdisciplinary team meetings/rounds and provide information to support members individualized needs
• Understand insurance products, benefits, coverage limitations, and governmental regulations as it applies to the health plan
• Understand role and how it affects utilization and quality outcomes including reducing potentially preventable events
• Provide, arrange, and coordinate preventive, primary, acute care, behavioral health and pharmacy services that contribute to the well-being of the member
• Review medical records for compliance with…