Clinical Review Coordinator - National Remote
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life’s best work.SM
The Clinical Review 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
This position is full - time (40 hours / week), Monday - Friday. Employees are required to work our normal business hours of 7:00 AM - 7:00 PM OR 10:00 AM - 7:00 PM CST (Central Standard Time zone) 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.
We offer 5 - 6 weeks of training. Training will be conducted virtually from your home.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
- 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
- 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 / IRF / LTAC via physician office, ED, OR HH
- Perform all expedited 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 naviHealth Medical Directors
- Notify hospitals and SNFs, IRFs or LTAC's 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
- Partner with the full care coordinator team as needed, this may include but is not limited to Operations Leadership, Medical Directors, Skilled Inpatient Care Coordinators, IRF / LTAC Coordinators, Engagement Specialists, and Clinical Leadership
- 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.
- Associate’s Degree (or higher)
- 3+ years of clinical experience
- Active, unrestricted registered clinical license - Registered Nurse OR PT OR OT
- Experience in oversight and supervision of assistants (CNAs, PTAs, OTAs)
- 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
- Ability to work any full - time 8-hour shift (40 hours / week) between the hours of 7:00 AM - 7:00 PM OR 10:00 AM - 7:00 PM CST (Central Standard Time zone) from Monday - Friday
- 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
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military
Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet
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.
Colorado, Connecticut, Nevada or New York City Residents Only: The salary range for Colorado residents is $31.78 - $56.88. The salary range for Connecticut / Nevada / New York City residents is $35.00 - $62.45. 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.
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.