Registered Nurse (RN) - Clinical Coordinator, Pediatrics
UnitedHealth Group Inc
Horsham, PA

Maternal Child Health Clinical Coordinator RN - Pennsylvania - Remote

At UnitedHealthcare, 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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Maternal Child Health a Clinical Coordinator R.N takes responsibility for the delivery of quality and affordability results for the Health Plan's maternal child health program known as Healthy First Steps (HFS). This position is responsible for ensuring the efficiency of the HFS program through various management, oversight, and program development activities. The Clinical coordinator R.N. works closely with the Health Plan clinical leaders including the CMO, Health Services director and the Quality Director to achieve the goals and objectives of the HFS program. Positions in this function address efforts focused on medical, behavioral, and social determinants of health factors that improve the well-being of individuals, families, and communities. Candidate must live in the state of Pennsylvania. If you reside in Pennsylvania, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: * Developing strategic relationships with community-based organizations that provide maternal and/or child health related services to Medicaid populations * Working on quality improvement projects related to maternal child health * Ensuring all components of the program, delivered by the Call Center Advocates, Optum CHWs, external providers and community-based organizations tie together into a comprehensive and seamless member experience * Assesses and interprets customer needs and requirements * Identifies solutions to non-standard requests and problems * Solves moderately complex problems and/or conducts moderately complex analyses * Works with minimal guidance; seeks guidance on only the most complex tasks * Translates concepts into practice * Provides explanations and information to others on difficult issues * Coaches, provides feedback, and guides others * Acts as a resource for others with less experience Program Oversight Responsibilities: * Work closely with cross-functional owners to complete required work * Review NICU admissions, as well as prenatal and postpartum quality metrics and health outcomes * Track and maintain data on pregnant members and newborns * Ensure contract compliance and NCQA accreditation requirements are met * Initiate program improvement projects and activities to drive outcomes for pregnant women and children * Serve as an external facing liaison among various stakeholders supporting Maternity / NICU services to drive partnerships (e.g. public health departments, school - based health centers, behavioral health organizations, FQHCs / ACOs) and innovative strategies that will promote and enhance maternal and child health * Ensure member and provider materials specific to the HFS program meet all state and regulatory guidelines * Promote preventive care and family planning services through various communication mediums and events * Identify and implement population health strategies (e.g. inter-conception care, chronic condition management, smoking cessation, safe sleep for infants, breast feeding advantages, substance use avoidance, etc.) Clinical Responsibilities: * Manage highly complex members as part of an inter-disciplinary care team approach in collaboration with Care Coordinators (CCs), Community Health Workers (CHWs), OB providers, behavioral health providers, etc. * Handle escalated or high-risk cases received from the state, providers or members of the internal care team * Ensure effective transitions of care occur and referrals to community-based services and resources are addressed * Consult with care team to address specialty care services, community-based resources and other member complex care needs * Assist in identification of pregnant women and children including those with special health care needs and access / linkages to appropriate care * Provide development of care plans with measurable goals and outcomes * Generally, work is self-directed and not prescribed * Works with less structured, more complex issues * Serves as a resource to others 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: * Current and unrestricted Pennsylvania RN License * 4+ years of Maternal and/or Pediatric clinical experience * 3+ years of Care coordination and/or utilization management experience * 2+ years of experience working in Medicaid * Intermediate level of proficiency with Microsoft Office Suite * Must reside in the state of Pennsylvania Preferred Qualifications: * Advanced degree (BSN, R.N.) * Community and/or Public Health experience * Proven excellent communication and Writing skills * Proven excellent telephonic assessment skills * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy 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.