Remote Clinical Review Coordinator – Hybrid – Suffolk County, NY

Optum

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Requisition Number: 2217205
Job Category: Medical & Clinical Operations
Primary Location: Holbrook, NY
(Remote considered)

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. 

This position is full-time. Employees are required to work Monday-Friday business hours Eastern Standard Time (EST) including the flexibility and willingness to work an early or late shift and/or longer than normal hours to accommodate peaks in volume of work based on business need.

We offer weeks of paid training. The hours of the training will be based on schedule or will be discussed on your first day of employment.

Why Home & Community?

At Home & Community 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 & Community 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.

By serving as the link between patients and the appropriate health care personnel, the Clinical Review Coordinator is responsible for ensuring efficient, smooth, and prompt transitions of care

Why naviHealth? 

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. 

If you live within a commutable distance of Suffolk County, NY you will have the flexibility to work from home and in the community in this hybrid role* as you take on some tough challenges.

Primary Responsibilities: 

  • 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 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 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
  • Coordinate peer to peer reviews with Medical Directors
  • Support new delegated contract start-up to ensure experienced staff work with new contracts
  • Manage assigned caseload 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 dashboards and 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 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

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:

  • Active, unrestricted registered clinical license – Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist
  • 3+ years of clinical experience as a Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist
  • Proficient with Outlook, Excel and Word
  • Dedicated, distraction-free space in home for home office
  • Access to reliable transportation to travel to facilities within identified region
  • Access to high-speed internet from home (Broadband Cable, DSL, Fiber)

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

New York Residents Only: The hourly range for this role is $33.75 to $66.25 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.