Skilled Nursing Facility Care Coordinator

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

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.

The Skilled Inpatient Care Coordinator (SICC) plays an integral role in optimizing patients' recovery journeys. The SICC travels to the skilled nursing facility to complete 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.

This role is based out of the employee's home and will require travel to facilities throughout the Winston Salem, NC area up to 50% of the time.

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.

• 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 in state of North Carolina - 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 Microsoft Office (Teams, Outlook, Excel and Word)
• Access to reliable transportation to travel to facilities throughout Winston Salem, NC
• Dedicated, distraction-free space in home for home office
• Access to high-speed Internet at home (Broadband Cable, DSL, Fiber)

• Case Management experience
• Experience working with geriatric population
• Experience prioritizing, planning, and managing multiple tasks/demands simultaneously
• Understanding/knowledge of CMS, Medicare, and Medicaid guidelines/regulations
• Patient education background, rehabilitation, and/or home health nursing experience
• Understanding/knowledge of CMS, Medicare, and Medicaid guidelines/regulations
• Proven ability to be detail-oriented
• Proven ability to be a team player
• Demonstrated exceptional verbal and written interpersonal and communication skills
• Proven solid problem solving, conflict resolution, and negotiating skills
• Proven independent problem identification/resolution and decision-making skills

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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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