What are the responsibilities and job description for the Clinical Review Coordinator - Remote position at UnitedHealth Group?
As part of Optum and the UnitedHealth Group family of businesses, combines the talents of our dedicated staff and leading-edge technology to deliver compassionate care to seniors nationwide. With millions of lives touched, we are innovating the way health care is delivered from hospital to home so seniors can lead more fulfilling lives. A career with us means making an impact in the lives of those we serve, including vulnerable populations who benefit from care that is more efficient, more effective and more human. Our environment empowers our team members to elevate our interactions with each other and the experiences we deliver to our patients, giving them more days at home. Join us to start Caring. Connecting. Growing together.
The Home & Community Care Transitions Clinical Review Coordinator (Registered Nurse RN, Physical Therapist PT, Occupational Therapist OT) plays an integral role in optimizing the patient’s recovery journey. The Clinical Review Coordinator is responsible for reviewing pre-authorization requests for Inpatient Rehab Facilities (IRF) and LTAC Facilities 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, Monday to Friday. 10:00am - 7:00pm Central and requires 4 holidays to be worked per year on a rotating basis. It may be necessary, given the business need, to work occasional overtime.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
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 IRF/LTAC Facilities 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 Medical Directors
- 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.
- Bachelor's Degree (or higher)
- Active, unrestricted registered clinical license in your state of residence – Registered Nurse- OT or PT.
- 3 years of clinical experience
- Experience in oversight and supervision of assistants (CNAs, PTAs, OTAs)
- Ability to work full-time, Monday to Friday. 10:00am-7:00pm Central
- Ability to work 4 Holidays per year on a rotating basis
- 2 years of Case Management experience
- Managed care experience
- ICD-10 experience
- InterQual experience
- Experience working with geriatric population
- Experience in acute care, rehab, or skilled nursing facility environment
- Experience performing clinical audits to improve quality standards or performance
- CMS knowledge
- Previous utilization management, utilization review, prior authorization, retrospective, prospective, concurrent review related experience
- 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
- Solid technical/computer skills
- Excellent documentation skills
- Self-starter with the ability to prioritize daily workload
- Ability to work effectively in a self-management environment
- Experience with physician engagement and crucial conversations
- Readiness to embrace a fluid, changing, and fast-paced environment
- Exceptional verbal and written interpersonal and communication skills
- Solid critical thinking skills and the ability to review patients’ clinical information holistically
- 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 time period
- Ability to communicate with clients and team members including use of cellular phone or comparable communication device
Salary : $1,000 - $1,000,000
