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 Charleston, SC.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.If you are located in Charleston or Mount Pleasant, SC, you will have the flexibility to work from home and the office in this hybrid role as you take on some tough challenges.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 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. 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 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
Support new delegated contract start-up to ensure experienced staff work with new contracts
Manage assigned caseload in an 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, 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
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
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
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:
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 Charleston, South Carolina
Dedicated, distraction-free space in home for home office
Access to high-speed internet from home (Broadband Cable, DSL, Fiber)
Preferred Qualifications:
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
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.
