Title: Field Care Coordinator (HIDE SNP) - Berrien County, MI and Surrounding Location: Saint Joseph MI United States Overtime status: Non-exempt Travel: Yes, 75 % of the Time Full time The Field Care Coordinator- HIDE SNP is an essential element of an Integrated Care Model and is responsible for establishing a set of person-centered goal-oriented, culturally relevant, and logical steps to ensure that the person receiving LTSS receives services in a supportive, effective, efficient, timely and cost-effective manner. Care coordination includes case management, disease management, discharge planning, transition planning, and addressing social determinants of health and integration into the community. This position is Field Based with a Home-Based office. The expected travel time for member home visits is typically 75% within a 50-mile radius and/or 50-minute drive from your home pending business needs. If you reside in or near Berrien County, MI or surrounding areas, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: - Develop and implement care plan interventions 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 persons and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team - Assess, plan, and implement care strategies that are individualized by the individual and directed toward the most appropriate, least restrictive level of care - Identifies problems/barriers to care and provide appropriate care management interventions - Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services - Provides resource support to members for local resources for services (e.g., Children with Special Health Care Services (CSHCS), employment, housing, independent living, foster care) based on service assessment and plans, as appropriate - Manage the person-centered service/support plan throughout the continuum of care - Conduct home visits in coordination with the person and care team - Conduct in-person visits, which may include nursing homes, assisted living, hospital or home - Gathers, documents, and maintains all member information and care management activities to ensure compliance with current state and federal guidelines What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include: - Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays - Medical Plan options along with participation in a Health Spending Account or a Health Saving account - Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage - 401(k) Savings Plan, Employee Stock Purchase Plan - Education Reimbursement - Employee Discounts - Employee Assistance Program - Employee Referral Bonus Program - Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) 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: - Must possess one of the following - Current, unrestricted independent licensure as a Registered Nurse (RN) in state of Michigan - Master's degree and current, unrestricted independent licensure as a Social Worker (e.g., LMSW, LCSW, LLMSW) - Bachelor's degree and current, unrestricted independent licensure as a Social Worker (e.g. LLBSW, LBSW) - 2+ years of experience working within the community health setting in a health care role - 1+ years of experience with local behavioral health providers and community support organizations addressing SDoH (e.g., food banks, non-emergent transportation, utility assistance, housing/rapid re-housing assistance, etc.) - 1+ years of experience working with persons with long-term care needs and/or home and community-based services - 1+ year experience working in electronic documentation systems and with MS Office (Outlook, Excel, Word) - Access to reliable transportation and the ability to travel within assigned territory to meet with members and providers up to 75% of the time depending on member and business needs - Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI) - Ability to travel to Southfield, MI office for quarterly team meetings - Must reside within the state of Michigan Preferred Qualifications: - RN or LMSW; LCSW, LLMSW - 1+ years of medical case management experience - Demonstrated experience/additional training or certifications in Motivational Interviewing, Stages of Change, Trauma-Informed Care, Person-Centered Care - Experience in serving individuals with co-occurring disorders (both mental health and substance use disorders) - Experience with MI Health Link (MMP) - Experience working in Managed Care - Working knowledge of NCQA documentation standards - All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable.