Clinical Review Coordinator – Hybrid RN, PT, OT, ST – Cumming, GA

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. 

 

The Care Coordinator- Onsite plays an integral role in optimizing patients’ recovery journeys. The Care Coordinator- Onsite completes 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 Clinical Review Coordinator- Onsite is responsible for ensuring efficient, smooth, and prompt transitions of care. 

 

Candidate must live within 30 minutes of the following facilities: 

Chestnut Ridge Nursing and Rehabilitation Center: 125 SAMARITAN DR, CUMMING, GA 30040-2354 

Cumming Health And Rehab: 2775 CASTLEBERRY RD, CUMMING, GA 30040-5803

PruittHealth Lanier: 2451 PEACHTREE INDUSTRIAL BLVD, BUFORD, GA 30518-2418
 

 

Primary Responsibilities: 

• By serving as the link between patients and the appropriate health care personnel, the Care Coordinator- Onsite 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 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 H&C Transitions 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 H&C Transitions 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 H&C Transitions 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 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 H&C Transitions 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 required in state of hire – Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Language Pathologist 
• 5+ years of clinical experience 
• Candidate hired will support specific location(s) for on-site facility needs within 30-mile maximum radius of home location based on manager discretion
  • Reside within or near the country listed on the job description
• Driver’s License and access to a reliable transportation

 

Preferred Qualifications:

• Experience working with the geriatric population 
• Patient education background, rehabilitation, and/or home health nursing experience 
• Familiarity with care management, utilization/resource management processes and disease management programs. 
• Proficient with Microsoft Office applications including Outlook, Excel and PowerPoint 
• Demonstrated ability to prioritize, plan, and handle multiple tasks/demands simultaneously 
• Proven detail-oriented 
• Proven team player 
• Proven 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 

  

Work Conditions and Physical Requirements:

• Ability to establish a home office workspace 
• 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 period of time 
• Ability to communicate with clients and team members including use of cellular phone or comparable communication device 
• Ability to remain stationary for extended time periods (1 – 2 hours) 
• Ability to mobilize to and within sites within an assigned local or regional market/area, including car transport, up to 85% of the time 

  

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $34.23 to $61.15 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.    

 

 

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.     

 

OptumCare is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.