Field Care Coordinator - Social Worker - CHOICES - Tipton and Shelby Counties - Memphis, Tennessee - 524420

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United HealthGroup Community, CHOICES program offers person-centered care planning, service coordination and support services for members receiving long-term care (LTC) and home and community (HCBS) services. The care coordinator is responsible for facilitating, promoting and advocating for the member's ongoing self-sufficiency and independence. Additionally, the care coordinator is responsible for sustaining the natural supports of the member. This includes but is not limited to assessing the availability of natural supports, representative or family members to ensure the ongoing mental and physical health of those natural supports.

Grand Region Travel - â‰¥90%

Statewide Travel - 5-10%

Territory: Tipton, Shelby and Surrounding Counties

Conduct thorough and objective initial and ongoing face-to-face assessments of the member within specific mandated intervals to determine current status and needs, including physical, behavioral, functional, psychosocial and financial and health status expectation
Conduct monthly telephonic, quarterly face-to-face and other additional assessments as needed to address member change in condition, on HCBS members
Conduct quarterly telephonic or on-site grand rounds on Nursing Facility (NF) members experiencing changes in condition
Identify members with the potential for high-risk complications and coordinate the appropriate supported self care in conjunction with the member and care coordination team
Act as an advocate for an individual's care needs by identifying and communicating opportunities for care interventions, including identifying and addressing functional deficits and gaps in care
Develops member specific Plan of Care that will be utilized to obtain authorizations for appropriate home and community based services, collaborating with CMA staff to obtain authorization for those services and confirms that services are being provided and the member's needs are being met while transitioning from nursing facility to home
Management of critical transitions, supporting legacy discharge planning staff with member transition to the home setting
For members transitioning to a setting other than a community-based residential alternative (CBRA) setting, monitor the initiation and daily provision of services in accordance with the member's plan of care and take the immediate action to resolve gaps in care
Develop and implement targeted strategies to improve health, functional or quality of life outcomes, such as disease management or pharmacy management
Serve as a point of contact for coordination of all physical health, behavioral health and other home and community based services
Proactively educate members about the program, including opportunities for consumer direction of HCBS and obtain necessary consents for participation
Coordinate with the Fiscal Employer Agent (FEA) for consumer direction members, as needed
Monitor hospitalizations and institutional facility admissions and re-admissions to identify issues and implement strategies to improve outcomes
Provide assistance in resolving concerns about service delivery or providers
Coordinate with member's primary care provider, specialists and other providers and care programs to ensure comprehensive, holistic, person-centered approach to care;
Compare member's plan of care to establish pathways to determine variances and then intervene as indicated
Routinely assess and monitor member's status, needs and progress; if progress is static or regressive, determine reason and proactively encourage appropriate adjustments to their plan of care, providers and/or services to promote better outcomes
Report quantifiable impact, quality of care and/or quality of life improvements as measured against the care coordination goals
Establish and maintain professional working relations with referral sources, community resources and care providers
Collaborates with the peers on member admissions, transitioning and/or discharge planning

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