Cross-Market Care Coordinator - naviHealth - Michigan

naviHealth, 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 our team, it’s your chance to improve the lives of millions while doing your life’s best work.(sm)

If you are located in Michigan, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Perform SICC and/or TCC responsibilities telephonically as directed by leadership
• Engage and collaborate with in-market leaders as needed based on current assignment or as directed by leadership.  This could include in-market Clinical Team Managers or Provider Relations Managers
• Participate in the collaborative patient care process to assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet patients’ post-acute health needs, using communication and available resources to promote quality, cost-effective outcomes
• Maintain nH Coordinate case documentation per established standards
• Provide telephonic post-discharge support to assist a defined population of patients in meeting short-term needs to prevent readmissions. This may include:
• Collaboration with other care team members such as home health providers to avoid redundant telephonic follow up and coordinate care
• Address end of life issues including hospice and palliative care options
• Practice cultural competency with awareness and respect for diversity
• Facilitate the development of culturally sensitive individualized transitional care plans for services that including clinical, psycho-social, and environmental needs. Monitor and evaluate the effectiveness of plans and make recommendations for changes in the transitional care plan that incorporates transitional needs, as indicated
• Provide individualized evidence-based condition-specific patient education directed at self-care and reduction of exacerbations. Education is delivered at the appropriate health literacy level in a culturally sensitive manner
• Perform all Transitional Care Coordinator (TCC) and/or Skilled Inpatient Care Coordinator (SICC) specific functions as assigned:
• Assist in identifying patients who qualify for the BPCI-A program
• May perform functional assessments on a defined population of patients using clinical skills and proprietary PAC management workflow system and functionally based assessment technology tools. Provide outcome targets to the appropriate audience
• Utilize naviHealth proprietary technology and industry-standard evidence-based tools, such as nH Predict™ and InterQual, for consideration of the appropriate level of care, readmission risk, and needed interventions
• Collaborate effectively with patients’ interdisciplinary health care teams to coordinate the target length of stay and an optimal transition plan to the most appropriate PAC setting and connecting patients to community resources and additional services as appropriate. The health care team includes physicians, health plan UM/CM Nurse, hospital discharge planners, referral coordinators, etc.
• Communicate with hospital case management and physicians on identified patients that do not meet criteria and assist with developing appropriate discharge setting as needed
• Participate in weekly readmission and other type rounds as needed based upon opportunities
• Attend weekly SNF Rounds and other meetings
• Participate in SNF IDT (Interdisciplinary Teams Rounds) weekly providing accurate and up to date information to the naviHealth Management team
• Engage with patients, families, or caregivers either telephonically or on-site weekly and as needed including attending patient/family care conferences
• Manage assigned caseload in an efficient and effective manner utilizing good time management skills
• Keep current on federal and state regulatory policies related to utilization management and care coordination (CMS guidelines, Health Plan policies, and benefits)
• Pursue and maintain multi-state licensure to meet business needs
• Initiate and maintain access to multiple Electronic Medical Record (EMR) platforms
• Adhere to organizational departmental policies and procedures
• 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 
• Proficient with Microsoft Office applications including Word, Excel, and Outlook
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

• 2 years of case management experience 
• Patient education background, rehabilitation, and/or home health nursing experience 
• Experience working with geriatric population 
• Detail-oriented
• Ability to prioritize, plan, and handle multiple tasks/demands simultaneously
• Team player
• Solid problem solving, conflict resolution, and negotiating skills
• Exceptional verbal and written interpersonal and communication skills
• Independent problem identification/resolution and decision-making skills
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

 To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.