Skilled Nursing Facility Care Coordinator
2 months ago
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.
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.
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 Central.
This role is based out of the employee’s home and will require travel to skilled nursing facilities throughout the O’Fallon, MO area 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 carePerform Skilled Nursing Facility (SNF) assessments on patients using clinical skills and utilizing CMS criteria upon admission to SNF and periodically through the patient staysReview targets for Length of Stay (LOS), target outcomes, and discharge plans with providers and familiesComplete all SNF concurrent reviews, updating authorizations on a timely basisCollaborate 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 barriersParticipate weekly in SNF Rounds providing accurate and up to date information to the naviHealth Sr. Manager or Medical DirectorAssure appropriate referrals are made to the Health Plan, High-Risk Case Manager, and/or community-based servicesEngage with patients, families, or caregivers either telephonically or on-site weekly and as neededAttend patient/family care conferencesAssess and monitor patients’ continued appropriateness for SNF setting (as indicated) according to CMS criteriaWhen 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 appropriateCoordinate peer to peer reviews with naviHealth Medical DirectorsSupport new delegated contract start-up to ensure experienced staff work with new contractsManage assigned caseload in an efficiently and effectively utilizing time management skillsEnter timely and accurate documentation into nH coordinateDaily review of census and identification of barriers to managing independent workload and ability to assist othersReview monthly dashboards, readmission reports, quarterly, and other reports with the assigned Clinical Team Manager, as needed, to assist with the identification of opportunities for improvementAdhere to organizational and departmental policies and proceduresMaintain confidentiality of all PHI information in compliance with HIPPA, federal and state regulations, and lawsComplete cross-training and maintain knowledge of multiple contracts/clients to support coverage needs across the businessKeep 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 proceduresPromote a positive attitude and work environmentAttend naviHealth meetings as requestedHold patients’ protected health information confidential as required by applicable laws, regulations, or agency/institution proceduresPerform other duties and responsibilities as required, assigned, or requestedYou’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.
Required Qualifications:
Active, unrestricted registered clinical license in Missouri - Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist5+ years of clinical experience as a Registered Nurse, Physical Therapist, Occupational Therapist, or Speech TherapistProficient with Microsoft Office applications including Outlook, Excel, and PowerPoint Reside in or near O'Fallon, MOAccess to reliable transportation to travel to skilled nursing facilities throughout the O’Fallon, MO area up to 50% of the timeAccess to high-speed internet at home (Broadband Cable, DSL, Fiber)Dedicated, distraction-free space in home for home officePreferred Qualifications:
Experience working with geriatric populationExperience with patient education, rehabilitation, and/or home health nursingExperience prioritizing, planning, and managing multiple tasks/demands simultaneouslyFamiliarity with care management, utilization/resource management processes, and disease management programsUnderstanding/knowledge of CMS, Medicare, and Medicaid guidelines/regulationsDemonstrated exceptional verbal and written interpersonal and communication skillsProven solid problem solving, conflict resolution, and negotiating skillsProven independent problem identification/resolution and decision-making skillsProven ability to be detail-orientedProven ability to be a team playerAt 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: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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