Clinical Review Coordinator – Remote
You ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Being a pioneer in post-acute management and care transitions with over 19 years of experience, naviHealth is uniquely positioned to manage patients, improve clinical and financial outcomes, and share risk with payors and providers. We provide clinical service support alongside proprietary technology and advisory solutions that empower health systems, health plans and post-acute providers to navigate care episodes across the continuum, with the goal of reducing waste and improving patient outcomes.
Rooted in respect
Guided by purpose
Devoted to service
Energized by impact
The above statements are intended to describe the general nature and level of work performed by colleagues assigned to this job. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications. naviHealth reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
naviHealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other protected status under applicable laws and will not be discriminated against based on disability.
The Pre-Service Coordinator plays an integral role in optimizing the patient s recovery journey. The Pre-Service Coordinator is responsible for reviewing pre-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 (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 9am – 6pm CST. It may be necessary, given the business need, to work occasional overtime.
*All Telecommuters will be required to adhere to UnitedHealth Group s Telecommuter Policy.
- Perform in a hybrid role as either clinical gatherer and authorization document creator or solely as a clinical and authorization reviewer for all prospective, concurrent, and retrospective requests within established parameters.
- Perform review for all direct admits to SNF via physician office, ED or HH.
- Perform all expedited prospective reviews, including patient oral and/or written notifications.
- Perform all standard prospective reviews, including patient oral and/or written notifications.
- May have EMR access to mirror Inpatient Care Coordinator partner access.
- Coordinator peer to peer reviews with naviHealth Medical Directors.
- Notify hospitals and SNFs of review outcomes for non-engaged patients.
- Partner with Medical Directors for Pre-Service Coordinator training as needed.
- Complete processes as it relates to pre-service authorizations.
- Educate facilities on the pre-service denial process.
- Participate in the clinical phone queue to ensure customer SLA s are met.
- Support new delegated contract start-up to ensure experienced staff work with new contracts.
- Partner with the full care coordinator team as needed, this may include but is not limited to Operations Leadership, Medical Directors, Skilled Inpatient Care Coordinators, IRF/LTAC Coordinators, Engagement Specialists, and Clinical Leadership.
- 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.
- High School Diploma / GED (or higher)
- Active, unrestricted registered clinical license Registered Nurse, Physical Therapist, or Occupational Therapist
- 3+ years of clinical experience
- Experience in oversight and supervision of assistants (CNAs, PTAs, OTAs)
- Experience with physician engagement and crucial conversations
- Flexible and willing to work an early or late shift and/or longer than normal hours of 9am to 6pm CST to accommodate peaks in volume of work
- 2+ years of Case Management experience
- Experience in acute care, rehab or skilled nursing facility environment; managed care experience
- Experience performing clinical audits to improve quality standards or performance
- Experience working with geriatric population
- ICD-10 and InterQual experience
- CMS knowledge
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Ability to keep all company sensitive documents secure (if applicable)
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
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Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $31.15 – $55.77. The salary range for Connecticut / Nevada residents is $34.33 – $61.25. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you ll find a far-reaching choice of benefits and incentives
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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