Join Our Team: Clinical Review Coordinator - Skilled Inpatient Care
Embark on a rewarding career journey with UnitedHealth Group, a leading health care company dedicated to helping people live healthier lives and making the health system work better for everyone. We are seeking a highly skilled and compassionate Clinical Review Coordinator - Skilled Inpatient Care to join our team in Owasso, Claremore, OK. As a Clinical Review Coordinator, you will play a vital role in optimizing patients' recovery journeys, ensuring seamless transitions of care, and delivering exceptional patient experiences.
About UnitedHealth Group and naviHealth
UnitedHealth Group, a family of businesses, is revolutionizing health care by uniting industry-leading solutions to address individuals' physical, mental, and social needs. Our naviHealth product is at the forefront of this mission, supporting patients transitioning from hospital to home and providing them with the care and resources they need to thrive.
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. We do health care differently, and we are changing health care one patient at a time. With a focus on innovation, teamwork, and patient-centered care, we are creating a new standard in health care delivery.
Key Responsibilities:
- Perform Skilled Nursing Facility (SNF) assessments on patients using clinical skills and appropriate measurement tools, such as nH Predict, nH Outcome, InterQual, and CMS criteria.
- 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 patients' health care teams to establish an optimal discharge plan.
- 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 according to InterQual criteria or the nH Outcome.
- When naviHealth is delegated for utilization management, review referral requests that cannot be approved for continued stay and 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 contract.
- Manage assigned caseload efficiently and effectively, utilizing time management skills.
- Enter timely and accurate documentation into the CM Tool application.
- Daily review of census and identification of barriers to managing independent workload and ability to assist others.
- Review monthly dashboards, readmission reports, 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 HIPAA, federal and state regulations, and laws.
Requirements:
Essential Qualifications:
- Active, unrestricted registered clinical license in the state of hire - Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Language Pathologist.
- Candidate hired will support specific location(s) for on-site facility needs within a 30-mile maximum radius of home location. You must reside within 30 miles of zip codes 74017, 74018, 74019, 74021, 74055.
- 5 years of clinical experience.
- Experience working with the adult or geriatric population.
- Proficient with Microsoft Office applications, including Outlook, Excel, and PowerPoint.
Preferred Qualifications:
- Familiarity with care management, utilization/resource management processes, and disease management programs.
- Patient education background, rehabilitation, and/or home health nursing experience.
Work Environment and Culture:
At UnitedHealth Group, we are committed to creating a work environment that is inclusive, diverse, and supportive of all employees. We believe that a diverse and inclusive workplace is essential to delivering exceptional patient care and achieving business success.
As a remote worker, you will have the flexibility to work from home and collaborate with our team through digital communication tools. You will also have access to ongoing training and development opportunities to help you grow in your career.
Benefits and Compensation:
We offer a comprehensive benefits package, including:
- Competitive salary and bonus structure.
- Comprehensive health, dental, and vision insurance.
- Retirement savings plan with company match.
- Paid time off and holidays.
- Ongoing training and development opportunities.
Career Growth Opportunities:
At UnitedHealth Group, we are committed to helping our employees grow and develop in their careers. We offer:
- Career advancement opportunities within the company.
- Ongoing training and development programs.
- Mentorship and coaching opportunities.
- Cross-functional training and development.
Why Join Our Team?
By joining our team as a Clinical Review Coordinator - Skilled Inpatient Care, you will have the opportunity to:
- Make a positive impact on patients' lives.
- Work with a talented and dedicated team.
- Develop your skills and expertise.
- Enjoy a flexible and remote work environment.
- Be part of a leading health care company.
Take the Next Step:
Are you ready to embark on a rewarding career journey with UnitedHealth Group? Apply now and let's discuss how you can become a vital part of our success story.
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