Requisition Number: 2198220
Job Category: Medical & Clinical Operations
Primary Location: Charleston, WV
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 Cross-Market Care Coordinator (CMCC) functions as a telephonic/remote Skilled Inpatient Care Coordinator (SICC). The Cross-Market Care Coordinator plays an integral role in the patient’s recovery journey. The CMCC 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 CMCC is responsible for ensuring efficient, smooth, and prompt transitions of care.
A successful Cross-Market Care Coordinator demonstrates a high degree of adaptability and flexibility and is one whose skills and proficiency allow for quick integration – in part or in whole – into an existing market or client model.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
- 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 naviHealth 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 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
- 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 nH 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 naviHealth 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.
- Active, unrestricted registered clinical license required in state of hire – Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Language Pathologist
- Ability to pursue and maintain multi-state licensure to meet business needs
- 3+ years of clinical experience as a Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Language Pathologist
- Access to high-speed internet from home (Broadband Cable, DSL, Fiber)
- Distraction-free, dedicated workspace in home for home office
- Licensed in West Virginia OR willing to become licensed in West Virginia
- Experience working with the geriatric population
- Patient education background, rehabilitation, and/or home health nursing experience
- Familiarity with care management, utilization/resource management processes and disease management programs
- Proficient with Microsoft Office applications including Outlook, Excel and PowerPoint
- Proven detail-oriented
- Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously
- Proven team player
- Proven exceptional verbal and written interpersonal and communication skills
- Demonstrated solid problem solving, conflict resolution, and negotiating skills
- Demonstrated independent problem identification/resolution and decision-making skills
Being a pioneer in post-acute management and care transitions with 19 years of experience, naviHealth is uniquely positioned to manage patients, improve clinical and financial outcomes, and share risk with payors and providers. We provide clinical service support alongside proprietary technology and advisory solutions that empower health systems, health plans and post-acute providers to navigate care episodes across the continuum, with the goal of reducing waste and improving patient outcomes.
California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $32.60 to $63.99 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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