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Care Coordinator Per Diem Specialist

2 months ago

Eden Prairie, Minnesota, United States UnitedHealth Group Full time
About the Role

UnitedHealth Group is seeking a highly skilled Care Coordinator Per Diem Specialist to join our team. As a Care Coordinator Per Diem Specialist, you will play a critical role in optimizing patients' recovery journeys by completing weekly functional assessments and engaging the post-acute care (PAC) inter-disciplinary care team to coordinate discharge planning.

Key Responsibilities
  • Perform Skilled Nursing Facility (SNF) clinical documentation reviews on patients using clinical skills and utilizing CMS criteria upon admission to SNF and periodically through the patient stays.
  • Complete SNF concurrent reviews from a team queue, updating authorizations on a timely basis.
  • Collaborate effectively with the members' healthcare teams to establish an optimal discharge, including physicians, referral coordinators, discharge planners, social workers, physical therapists, and other healthcare professionals.
  • Assure patients' progress toward discharge goals and assist in resolving barriers.
  • Assure appropriate referrals are made to the Health Plan, High-Risk Case Manager, and/or community-based services.
  • Engage with patients, families, or caregivers telephonically as needed.
  • 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.
  • Enter timely and accurate documentation into 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 operational 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 such as MDS closure, NOMNC validation.
Requirements
  • Active, unrestricted registered clinical license - Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Language Pathologist.
  • Ability to obtain additional state licensures (in addition to a compact license if applicable) based on business needs.
  • 3+ years of clinical experience.
  • Dedicated, distraction-free space in home for home office.
  • Access to high-speed internet from home (Broadband Cable, DSL, Fiber).
Preferred Qualifications
  • Experience working with the geriatric population.
  • Patient education background, rehabilitation, and/or home health nursing experience.
  • Proficient with Microsoft Office applications including Outlook, Excel, and PowerPoint.
  • Familiarity with care management, utilization/resource management processes, and disease management programs.
  • 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.