If you are within a 30-mile commutable distance of 711 Lukas Drive, Athens, TX, 75751, including the ability to attend on - site for 1 - 2 days a week, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.

　　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 our team, it’s your chance to improve the lives of millions while doing your life’s best work. SM

　　The Skilled Inpatient Care Coordinator plays an integral role in optimizing the patient’s recovery journey. The Skilled Inpatient Care Coordinator is responsible for reviewing continued stay authorization requests for skilled nursing and rehabilitative services and determining if requests meet medical necessity for the requested level of care. The position coordinates the transition of patients from the community or acute setting to the next appropriate level of care while following established facility policies and procedures.

　　This position is full-time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 AM - 5:00 PM CST. It may be necessary, given the business need, to work occasional overtime or an early or late shift and / OR longer than normal hours to accommodate peaks in volume of work.

　　Our office is located at 711 Lukas Drive, Athens, TX, 75751. Employees will be required to work 1 - 2 days on - site and some days from home.

　　We offer 7- 8 weeks of paid on-the-job training (2 weeks of virtual training and once completed, 5 - 6 weeks of mentorship program with another individual in the same role). The hours during training will be 8:00 AM - 5:00 PM CST from Monday - Friday.

　　*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

　　Primary Responsibilities:

　　Perform Skilled Nursing Facility (SNF) assessments on patients using clinical skills and appropriate measurement tools, such as nH Predict, nH Outcome, InterQual and 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; 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 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 InterQual criteria or the nH Outcome

　　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 contract

　　Manage assigned caseload in an efficiently and effectively utilizing time management skills

　　Enter timely and accurate documentation into the CM Tool application

　　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 HIPPA, federal and state regulations, and laws

　　Perform other duties and responsibilities as required, assigned, or requested

　　You’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:

　　Associate’s Degree

　　3+ years of clinical experience

　　Active, unrestricted, registered, clinical license - Registered Nurse, Physical Therapist, Speech Therapist, OR Occupational Therapist

　　Ability to work any of our full-time, 8-hour shift schedules during our normal business hours of 8:00 AM - 5:00 PM CST from Monday - Friday

　　Must be 18 years of age OR older

　　Preferred Qualifications:

　　2+ years of Case Management experience

　　CMS knowledge

　　Managed care experience

　　ICD - 10 and InterQual experience

　　Experience in working with geriatric population

　　Experience in acute care, rehab, OR skilled nursing facility environment

　　Experience with performing clinical audits to improve quality standards OR performance

　　Flexibility and willingness to work an early or late shift and / OR longer than normal hours to accommodate peaks in volume of work

　　Telecommuting Requirements:

　　Reside within a 30-mile commutable distance of 711 Lukas Drive, Athens, TX, 75751, including the ability to attend on - site for 1 - 2 days a week

　　Ability to keep all company sensitive documents secure (if applicable)

　　Required to have a dedicated work area established that is separated from other living areas and provides information privacy

　　Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

　　Soft Skills:

　　Strong technical / computer skills

　　Excellent documentation skills required

　　Self - starter with the ability to prioritize daily workload

　　Ability to work effectively in a self - management environment

　　Experience with physician engagement and crucial conversations

　　Readiness to embrace a fluid, changing, and fast - paced environment

　　Exceptional verbal and written interpersonal and communication skills

　　Strong critical thinking skills and the ability to review patients’ clinical information holistically

　　Physical and Work Environment:

　　Ability to manipulate laptop computer (or similar hardware) between office and site settings

　　Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard time period

　　Ability to communicate with clients and team members including use of cellular phone or comparable communication device

　　At 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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