Care Coordinator for Skilled Nursing Facilities
3 weeks ago
As a Skilled Nursing Facility Care Coordinator at UnitedHealth Group, you will play a vital role in optimizing patients' recovery journeys. You will complete weekly functional assessments and engage the PAC inter-disciplinary care team to provide them with the proprietary nH Outcome tool to align expectations for discharge planning.
Key Responsibilities- Ensure efficient, smooth, and prompt transitions of care by serving as the link between patients and the appropriate healthcare personnel.
- 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' healthcare 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 (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 HIPAA, 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.
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