Care Coordinator
7 days ago
At UnitedHealth Group, we are committed to transforming the healthcare experience for our patients and communities. As a Skilled Nursing Facility Care Coordinator, you will play a critical role in optimizing patients' recovery journeys and ensuring seamless transitions of care.
Key Responsibilities- Conduct weekly functional assessments at skilled nursing facilities to identify patients' needs and develop personalized care plans.
- Collaborate with the post-acute care inter-disciplinary care team to coordinate discharge planning and ensure efficient transitions of care.
- Engage patients and families to share information and facilitate informed decisions, ensuring patients receive the best possible care.
- Serve as the link between patients and healthcare personnel, ensuring smooth and prompt transitions of care.
- Review targets for Length of Stay (LOS), target outcomes, and discharge plans with providers and families to ensure optimal care.
- Complete all skilled nursing facility concurrent reviews, updating authorizations on a timely basis to ensure compliance with regulatory requirements.
- Collaborate effectively with patients' healthcare teams to establish optimal discharge plans, 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 to ensure successful transitions of care.
- Participate in skilled nursing facility rounds, providing accurate and up-to-date information to the naviHealth Sr. Manager or Medical Director.
- Ensure appropriate referrals are made to the Health Plan, High-Risk Case Manager, and/or community-based services to support patients' ongoing care needs.
- Engage with patients, families, or caregivers telephonically or on-site weekly and as needed to ensure ongoing support and education.
- Attend patient/family care conferences to ensure patients receive comprehensive care and support.
- Assess and monitor patients' continued appropriateness for skilled nursing facility setting according to CMS criteria.
- When delegated for utilization management, review referral requests that cannot be approved for continued stay and forward to licensed physicians for review and issuance of the NOMNC when appropriate.
- Coordinate peer-to-peer reviews with naviHealth Medical Directors to ensure high-quality care and compliance with regulatory requirements.
- Support new delegated contract start-up to ensure experienced staff work with new contracts, ensuring seamless transitions of care.
- Manage assigned caseload efficiently and effectively, utilizing time management skills to prioritize tasks and ensure timely completion.
- Enter timely and accurate documentation into nH coordinate to ensure compliance with regulatory requirements.
- Daily review of census and identification of barriers to managing independent workload and ability to assist others, ensuring efficient transitions of care.
- 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, ensuring compliance with regulatory requirements.
- 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, ensuring a collaborative and supportive team culture.
- Attend naviHealth meetings as requested, ensuring ongoing education and training.
- 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.
- Active, unrestricted registered clinical license in Virginia - Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Language Pathologist.
- 5+ years of clinical experience as a Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist.
- Experience working with the adult or geriatric population.
- Proficient with Microsoft Office (Teams, Outlook, Excel, and Word).
- Access to reliable transportation to travel to facilities throughout Richmond, VA.
- Dedicated, distraction-free space in home for home office with access to high-speed internet.
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