Clinical Review Coordinator

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.

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.

The Skilled Inpatient Care Coordinator (SICC) plays an integral role in optimizing patients’ recovery journeys. The SICC 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 SICC is responsible for ensuring efficient, smooth, and prompt transitions of care.

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 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.

Required Qualifications :

• Active, unrestricted registered clinical license required in 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 30-mile maximum radius of home location based on manager discretion
• 5+ years of clinical experience
• Reside within or near Tucson, AZ

Preferred Qualifications :

• Familiarity with care management, utilization / resource management processes and disease management programs
• Proficient with Microsoft Office applications including Outlook, Excel and PowerPoint
• Experience working with the geriatric population
• Patient education background, rehabilitation, and / or home health nursing experience
• Detail-oriented
• Ability to prioritize, plan, and handle multiple tasks / demands simultaneously
• Team player
• Exceptional verbal and written interpersonal and communication skills
• Solid problem solving, conflict resolution, and negotiating skills
• Independent problem identification / resolution and decision-making skills

Work Conditions and Physical Requirements :

• Ability to establish a home office workspace
• Ability to manipulate laptop computer (or similar hardware) between office and site settings
• Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard period of time
• Ability to communicate with clients and team members including use of cellular phone or comparable communication device
• Ability to remain stationary for extended time periods (1 2 hours)
• Ability to mobilize to and within sites within an assigned local or regional market / area, including car transport, up to 85% of the time

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.

We believe everyone of every race, gender, sexuality, age, location and income deserves the opportunity to live their healthiest life.

Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes.

We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere : UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.