Clinical Review Coordinator - Remote

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. About naviHealth 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. Our Values Rooted in respect Guided by purpose Devoted to service Energized by impact 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.*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.Primary Responsibilities: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. 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:Bachelor’s Degree (or higher)Active, unrestricted registered clinical license required – Registered Nurse, Physical Therapist, or Occupational Therapist.3+ years of clinical experienceExperience in oversight and supervision of assistants (CNAs, PTAs, OTAs). Preferred Qualifications:2+ years of Case Management experience Experience in acute care, rehab or skilled nursing facility environment preferred; managed care experience is a plus. Experience performing clinical audits to improve quality standards or performance Experience working with geriatric population ICD-10 and InterQual experience CMS knowledge Soft Skills:Strong critical thinking skills and the ability to review patients’ clinical information holistically. Flexible and willing to work an early or late shift and/or longer than normal hours to accommodate peaks in volume of work. Exceptional verbal and written interpersonal and communication skills. Ability to work effectively in a self-management environment. Experience with physician engagement and crucial conversations. Strong technical/computer skills. Excellent documentation skills required. Self-starter with the ability to prioritize daily workload. Readiness to embrace a fluid, changing, and fast-paced environment. Telecommuting Requirements:Required to have a dedicated work area established that is separated from other living areas and provides information privacyAbility 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 serviceUnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SMColorado, 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 incentivesDiversity 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.Keywords: #RPO, #YELLOWBrand: Optum Care SolutionsJob ID: 2068844Employment Type: Full-timeJob Area: Clinical