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Job Details
Optum Home & Community Care Transitions, 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 Home and Community Care Transitions 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. Why Home and Community Care Transitions? At Home and Community Care Transitions 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. Home and Community Care Transitions 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. If you are located in Philadelphia, you will have the flexibility to work remotely*, as well as work in the office as you take on some tough challenges. Primary Responsibilities:
- By serving as the link between patients and the appropriate health care personnel, the SICC is responsible for ensuring efficient, smooth, and prompt transitions of care
- Perform Skilled Nursing Facility (SNF) assessments on patients using clinical skills and utilizing CMS criteria upon admission to SNF and periodically through the patient stays
- Review targets for Length of Stay (LOS), target outcomes, and discharge plans with providers and families
- Complete all SNF concurrent reviews, updating authorizations on a timely basis
- Collaborate effectively with the patients’ 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
- Participate weekly in SNF Rounds providing accurate and up to date information to the Home and Community Care Transitions Sr. Manager or Medical Director
- Assure appropriate referrals are made to the Health Plan, High-Risk Case Manager, and/or community-based services
- Engage with patients, families, or caregivers either telephonically or on-site weekly and as needed
- Attend patient/family care conferences
- Assess and monitor patients’ continued appropriateness for SNF setting (as indicated) according to CMS criteria
- When Home and Community Care Transitions 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 Home and Community Care Transitions Medical Directors
- Support new delegated contract start-up to ensure experienced staff work with new contracts
- Manage assigned caseload in an efficiently and effectively utilizing time management skills
- 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 Home and Community Care Transitions 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
- Active, unrestricted registered clinical license required in state of hire - Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Language Pathologist
- 5+ years of clinical experience
- Proven ability to support specific location(s) for on-site facility needs within 20-mile maximum radius of home location based on manager discretion
- Reside within or near the Philadelphia, PA area
- 2+ years of case management experience
- Patient education background, rehabilitation, and/or home health nursing experience
- Experience working with geriatric population
- Experience in a Skilled Nursing Facility
- Demonstrated detail-oriented
- Demonstrated team player
- Proven solid problem solving, conflict resolution, and negotiating skills
- Demonstrated exceptional verbal and written interpersonal and communication skills
- Proven independent problem identification/resolution and decision-making skills
- Demonstrated ability to prioritize, plan, and handle multiple tasks/demands simultaneously
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