Pre-Service Coordinator Remote

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 us to start Caring. Connecting. Growing together.

Why naviHealth?

At naviHealth, our mission is to work with extraordinarily talented people who are committed to making a positive and powerful impact on society by transforming health care. naviHealth is the result of almost two decades of dedicated visionary leaders and innovative organizations challenging the status quo for care transition solutions. We do health care differently and we are changing health care one patient at a time. Moreover, have a genuine passion and energy to grow within an aggressive and fun environment, using the latest technologies in alignment with the company’s technical vision and strategy.

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 (40 hours/week) Monday–Friday, Saturday-Tuesday or Thursday-Sunday. Employees are required to have flexibility to work any of our 8-hour or 10-hour shift schedules during our business hours of Monday through Sunday.  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 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 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:

• Active, unrestricted RN license in state of residence
• 3+ years of clinical experience
• Experience in oversight and supervision of assistants (CNAs, PTAs, OTAs) 
• Experience with physician engagement and crucial conversations 
• Ability to work any shift including the flexibility and willingness to work an early or late shift and / or longer than normal hours to accommodate peaks in volume of work based on business need

Preferred Qualifications: 

• 2+ years of Case Management experience
• Experience in acute care, rehab, OR skilled nursing facility environment
• Experience with performing clinical audits to improve quality standards or performance
• Experience in working with geriatric population
• Managed Care experience
• ICD – 10 and InterQual experience
• CMS knowledge
• Ability to work the aligned shifts (select any that are possible)
  • • 1-10 CST M-F
    • 7-6p CST Th-Sun

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 

The hourly range for this role is $34.42 to $67.60 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

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.