Pre-Service Coordinator - National Remote

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere.

As a team member of our naviHealth product, we help change the way health care is delivered from hospital to home supporting patients transitioning across care settings. This life-changing work helps give older adults more days at home .

We’re connecting care to create a seamless health journey for patients across care settings. Join our team, it’s your chance to improve the lives of millions while doing your life’s best work. ℠

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 Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 10:00am - 7:00pm 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.

Primary Responsibilities:

• Perform all standard prospective reviews, including patient oral and/or written notifications.
• Perform review for all direct admits to SNF via physician office, ED or HH.
• Coordinator peer to peer reviews with naviHealth Medical Directors.
• Notify hospitals and SNFs of review outcomes for non-engaged patients.
• 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.
• May have EMR access to mirror Inpatient Care Coordinator partner access.
• Partner with Medical Directors for Pre-Service Coordinator training as needed.
• 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.
• Perform all expedited prospective reviews, including patient oral and/or written notifications.
• Educate facilities on the pre-service denial process.
• Complete processes as it relates to pre-service authorizations.

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:

• 3+ years of clinical experience
• Experience with physician engagement and crucial conversations
• Experience in oversight and supervision of assistants (CNAs, PTAs, OTAs)
• Ability to work any of our 8-hour shift schedules during our normal business hours of 10:00am - 7:00pm CST. Willing to work an early or late shift and/or longer than normal hours to accommodate peaks in volume of work
• Bachelors Degree (or higher)
• Active, unrestricted registered clinical license – Registered Nurse, Physical Therapist, or Occupational Therapist
• Ability to review patients’ clinical information holistically including critical thinking skills

Preferred Qualifications:

• CMS knowledge
• Experience performing clinical audits to improve quality standards or performance
• ICD-10 and InterQual experience
• Experience working with geriatric population
• Managed Care experience
• Experience in acute care, rehab or skilled nursing facility environment
• 2+ years of Case Management experience

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
• Ability to keep all company sensitive documents secure (if applicable)

Soft Skills:

• Self-starter with the ability to prioritize daily workload
• Ability to work effectively in a self-management environment
• Strong technical/computer skills
• Exceptional verbal and written interpersonal and communication skills
• Readiness to embrace a fluid, changing, and fast-paced environment
• Excellent documentation skills

Physical and Work Environment:

• 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

Careers with Optum . Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The salary range for California / Colorado / Connecticut / Nevada / New Jersey / New York / Washington / Rhode Island residents is $32.60 - $63.99.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

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.

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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