About the position
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. The Skilled Inpatient Care Coordinator (SICC) plays an integral role in optimizing patients' recovery journeys. The SICC travels to the skilled nursing facility to complete weekly functional assessments and engages the post-acute care (PAC) inter-disciplinary care team to coordinate discharge planning to support the members PAC journey. 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. This role will be traveling to facilities throughout Maryville and Louisville, TN.
Responsibilities
- Serve as the link between patients and the appropriate health care personnel to ensure efficient, smooth, and prompt transitions of care.
- 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' health care teams to establish an optimal discharge, including physicians, referral coordinators, discharge planners, social workers, and physical therapists.
- 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 according to CMS criteria.
- 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.
- Support new delegated contract start-up to ensure experienced staff work with new contracts.
- Manage assigned caseload 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 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.
Requirements
- Active, unrestricted registered clinical license - Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist.
- 3+ years of clinical experience as a Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist.
- Proficient with Outlook, Excel and Word.
- Access to reliable transportation to travel to facilities throughout Maryville and Louisville, TN.
- Dedicated, distraction-free space in home for home office.
- Access to high-speed internet from home (Broadband Cable, DSL, Fiber).
Nice-to-haves
- Understanding/knowledge of CMS, Medicare, and Medicaid guidelines/regulations.
- Case Management experience.
- Experience working with geriatric population.
- Patient education background, rehabilitation, and/or home health nursing experience.
- Proven ability to be detail-oriented and goal driven.
- Proven ability to be a team player.
- Demonstrated exceptional verbal and written interpersonal and communication skills.
- Proven solid problem solving, conflict resolution, and negotiating skills.
- Proven independent problem identification/resolution and decision-making skills.
- Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously and independently.
Benefits
- Competitive salary and performance-based bonuses.
- Comprehensive health insurance plans including medical, dental, and vision coverage.
- 401(k) retirement savings plan with company match.
- Paid time off and holidays.
- Opportunities for professional development and career advancement.
