Registered Nurse Pre - service Coordinator Remote - Mon - fri 1pm To 10pm CT - Remote Eligible

Pre-Service Coordinator

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.

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 1pm-10pm Central Time. 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 posted shift weekly Monday-Friday 1pm-10m in Central Time.
• 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.

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $34.23 to $61.15 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.