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Job Details
Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere. As a team member of our naviHealth product, we help change the way health care is delivered from hospital to home supporting patients transitioning across care settings. This life-changing work helps give older adults more days at home. We’re connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together. At naviHealth, our mission is to work with extraordinarily talented people who are committed to making a positive and powerful impact on society by transforming health care. naviHealth is the result of almost two decades of dedicated visionary leaders and innovative organizations challenging the status quo for care transition solutions. We do health care differently and we are changing health care one patient at a time. Moreover, have a genuine passion and energy to grow within an aggressive and fun environment, using the latest technologies in alignment with the company’s technical vision and strategy. The per diem Care Coordinator plays an integral role in optimizing patients’ recovery journeys. The per diem Care Coordinator completes weekly functional assessments and engages the post-acute care (PAC) inter-disciplinary care team to coordinate discharge planning to support the members PAC journey. The position engages patients and families to share information and facilitate informed decisions. By serving as the link between patients and the appropriate health care personnel, the per diem Care Coordinator is responsible for ensuring efficient, smooth, and prompt transitions of care. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:
- Perform Skilled Nursing Facility (SNF) clinical documentation reviews on patients using clinical skills and utilizing CMS criteria upon admission to SNF and periodically through the patient stays
- Complete SNF concurrent reviews from a team queue, updating authorizations on a timely basis
- Collaborate effectively with the members’ health care teams to establish an optimal discharge. The health care team includes physicians, referral coordinators, discharge planners, social workers, physical therapists, etc.
- Assure patients’ progress toward discharge goals and assist in resolving barriers
- Assure appropriate referrals are made to the Health Plan, High-Risk Case Manager, and/or community-based services
- Engage with patients, families, or caregivers telephonically as needed
- Assess and monitor patients’ continued appropriateness for SNF setting (as indicated) according to CMS criteria
- When naviHealth is delegated for utilization management, review referral requests that cannot be approved for continued stay and are forward to licensed physicians for review and issuance of the NOMNC when appropriate
- Coordinate peer to peer reviews with naviHealth Medical Directors
- Enter timely and accurate documentation into Coordinate
- Daily review of census and identification of barriers to managing independent workload and ability to assist others
- Review monthly dashboards, readmission reports, quarterly, and other reports with the assigned Clinical Team Manager, as needed, to assist with the identification of opportunities for improvement
- Adhere to organizational and departmental policies and procedures
- Maintain confidentiality of all PHI information in compliance with HIPPA, federal and state regulations, and laws
- Complete cross-training and maintain knowledge of multiple contracts/clients to support coverage needs across the business
- Keep current on federal and state regulatory policies related to utilization management and care coordination (CMS guidelines, Health Plan policies, and benefits)
- Adhere to all local, state, and federal regulatory policies and procedures
- Promote a positive attitude and work environment
- Attend operational meetings as requested
- Hold patients’ protected health information confidential as required by applicable laws, regulations, or agency/institution procedures
- Perform other duties and responsibilities as required, assigned, or requested such as MDS closure, NOMNC validation
- Active, unrestricted registered clinical license– Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Language Pathologist
- Ability to obtain additional state licensures (in addition to a compact license if applicable) based on business needs
- 3+ years of clinical experience
- Dedicated, distraction-free space in home for home office
- Access to high-speed internet from home (Broadband Cable, DSL, Fiber)
- Patient education background, rehabilitation, and/or home health nursing experience
- Experience working with the geriatric population
- Proficient with Microsoft Office applications including Outlook, Excel and PowerPoint
- Familiarity with care management, utilization/resource management processes and disease management programs
- Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously
- Proven to be a team player
- Proven exceptional verbal and written interpersonal and communication skills
- Proven solid problem solving, conflict resolution, and negotiating skills
- Proven independent problem identification/resolution and decision-making skills
About the Company
UnitedHealth Group
Minnetonka, MN, United States
UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are... Read more