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Skilled Nursing Facility Care Coordinator

1 month ago

Eden Prairie, United States Optum Full time

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 completes weekly functional assessments and engages the PAC inter-disciplinary care team providing them with the proprietary nH Outcome tool to align expectations for discharge planning. 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. The schedule is Monday - Friday, 8AM - 5PM CT. This role is based out of the employee's home and will require travel to facilities throughout the southwest Twin Cities metro, including Shakopee and Edina, up to 50% of the time. 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. 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 CMS criteria. When naviHealth is delegated for utilization management, review referral requests that cannot be approved for continued stay and are forwarded to licensed physicians for review. 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 efficiently utilizing time management skills. Enter timely and accurate documentation into nH coordinate. Review census daily and identify barriers to managing independent workload. Review monthly dashboards, readmission reports, and 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. Complete cross-training and maintain knowledge of multiple contracts/clients to support coverage needs. Keep current on federal and state regulatory policies related to utilization management and care coordination. 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. Required Qualifications: Active, unrestricted registered clinical license in state of hire - Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist. 5+ years of clinical experience as a Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist. Proficient with Microsoft Office applications including Outlook, Excel, and PowerPoint. Access to reliable transportation to travel to facilities throughout the southwest metro. Access to high-speed internet at home. Dedicated, distraction-free space in home for home office. Preferred Qualifications: Experience working with the geriatric population. Experience with patient education, rehabilitation, and/or home health nursing. Experience prioritizing, planning, and managing multiple tasks/demands simultaneously. Familiarity with care management, utilization/resource management processes, and disease management programs. Understanding/knowledge of CMS, Medicare, and Medicaid guidelines/regulations. 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. Proven ability to be detail-oriented. Proven ability to be a team player. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone... Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer... UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. #J-18808-Ljbffr