Clinical Review Coordinator - National Remote

Description

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

naviHealth , part of Optum and the UnitedHealth Group family of businesses, combines the talents of our dedicated staff and leading-edge technology to deliver compassionate care to seniors nationwide. With millions of lives touched, we are innovating the way health care is delivered from hospital to home so seniors can lead more fulfilling lives. A career with us means making an impact in the lives of those we serve, including vulnerable populations who benefit from care that is more efficient, more effective and more human. Our environment empowers our team members to elevate our interactions with each other and the experiences we deliver to our patients, giving them more days at home. Join our team, it’s your chance to improve the lives of millions while doing your life’s best work. SM

The Pre-Service Coordinator plays an integral role in optimizing the patient’s recovery journey. The Pre-Service Coordinator is responsible for reviewing pre-authorization requests for skilled nursing and rehabilitative services and determining if requests meet medical necessity for the requested level of care. The position coordinates the transition of patients from the community or acute setting to the next appropriate level of care while following established facility policies and procedures.

This position is full-time, Saturday to Tuesday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 6:00pm CST. It may be necessary, given the business need, to work occasional overtime.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Perform in a hybrid role as either clinical “gatherer and authorization document creator” or solely as a clinical and authorization “reviewer” for all prospective, concurrent, and retrospective requests within established parameters.
• Perform review for all direct admits to SNF via physician office, ED or HH.
• Perform all expedited prospective reviews, including patient oral and/or written notifications.
• Perform all standard prospective reviews, including patient oral and/or written notifications.
• May have EMR access to mirror Inpatient Care Coordinator partner access.
• Coordinator peer to peer reviews with naviHealth Medical Directors.
• Notify hospitals and SNFs of review outcomes for non-engaged patients.
• Partner with Medical Directors for Pre-Service Coordinator training as needed.
• Complete processes as it relates to pre-service authorizations.
• Educate facilities on the pre-service denial process.
• Participate in the clinical phone queue to ensure customer SLA’s are met.
• Support new delegated contract start-up to ensure experienced staff work with new contracts.

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:

• Associates Degree (or higher)
• 3+ years of clinical experience
• Experience in oversight and supervision of assistants (CNAs, PTAs, OTAs).
• Active, unrestricted registered clinical license required – Registered Nurse
• Flexible and willing to work an early or late shift and/or longer than normal hours to accommodate peaks in volume of work.
• Ability to work full-time, Saturday to Tuesday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 6:00pm CST

Preferred Qualifications:

• Bachelor’s Degree (or higher)

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, Washington or New York City Residents Only: The salary range for California / Colorado / Connecticut / Nevada / Washington / New York City residents is $32.60 - $63.99.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.

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.

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