Home Health Clinical Review Coordinator (Central Time)

Company: UnitedHealth Group
Location: San Antonio
Posted on: November 26, 2022

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing -your life's best work.(sm) -

The -Home Health Care Coordinator (HHCC) is responsible for the management of authorization requests for home health services in accordance with CMS and nationally recognized standards. As a member of the Home Health team, the HHCC reviews clinical documentation from home health providers and evaluates the medical necessity of requests for services by utilizing InterQual or internally developed clinical criteria. As necessary, the HHCC collaborates with naviHealth Medical Directors and/or health plan care management staff to determine the most appropriate course of action for a member based on clinical factors.

You will enjoy the flexibility to telecommute* as you take on some tough challenges.

Work Hours: 8 am to 5 pm CST

Primary Responsibilities:

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• Document requests for authorization for home health into naviHealth's clinical documentation system
  
• Review OASIS documentation and clinical notes from providers and utilize InterQual criteria to determine medical necessity and appropriate authorization for home health services
  
• Understand and apply CMS Chapter 7 guidelines for home health
  
• Follow up with providers as necessary for clarification of clinical documentation of patients' status
  
• Collaborate with intake team, home health team, appeals/denials teams, and Medical Directors to ensure efficient processing of home health authorization requests in accordance with mandated turnaround times and quality metrics
  
• Notify the health care provider of denials reviewed by the Medical Director --- Participate in the regular review of departmental reports on key quality metrics and identify opportunities for systemic improvement
  
• Maintain active clinical licensure in state of residence and knowledge of nationally recognized utilization management, CMS home health regulations, NCQA and URAC standards of practice
  
• Attend naviHealth meetings as requested
  
• Adhere to organizational, departmental, and regulatory policies and procedures
  
• Promote a positive attitude and work environment
  
• Complete cross-training and maintain knowledge of multiple contracts/clients to support coverage needs across the business.
  
• Perform other duties and responsibilities as required, assigned, or requested
  
  
  What are the reasons to consider working for UnitedHealth Group? - - Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. -Some of our offerings include:
  
  
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  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
    
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
    
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
    
  • 401(k) Savings Plan, Employee Stock Purchase Plan
    
  • Education Reimbursement
    
  • Employee Discounts
    
  • Employee Assistance Program
    
  • Employee Referral Bonus Program
    
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
    
  • More information can be downloaded at: -
    
    
    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:
    
    
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    • Active, unrestricted registered clinical license in state of residence - Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist
      
    • 1+ years of experience in geriatric care management in a home health setting
      
    • Intermediate proficiency -with Microsoft Office applications including Outlook, Word, Excel and PowerPoint -
      
      
      Preferred Qualifications:
      
      
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      • 2+ years of recent experience in utilization management role
        
      • 2+ years of experience in an acute care setting
        
      • 2+ years of Wound care experience
        
      • Knowledgeable of ICD-10 coding
        
      • Knowledgeable with NCQA and URAC standards
        
      • Proficient in medical terminology
        
        
        Soft Skills:
        
        
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        • Proven documentation skills
          
        • Proven ability to use various office equipment, such as e-fax and telephone system
          
        • Independent problem identification/resolution and decision-making skills
          
        • Proven excellent written skills and oral communication skills to complete the role telephonically
          
        • Demonstrated ability to be detail oriented and able to prioritize, plan, and handle multiple tasks/demands simultaneously
          
          
          Work Conditions and Physical Requirements:
          
          
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          • Ability to establish a home office workspace
            
          • 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 period of time
            
          • Ability to communicate with clients and team members including use of cellular phone or comparable communication device
            
          • Ability to remain stationary for extended time periods (1 - 2 hours)
            
            
            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.
            
            
            
            Colorado, Connecticut or Nevada Residents Only: -The salary range for Colorado residents is $31.78 to $56.88. The salary range for Connecticut / Nevada residents is $35.00 -to $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.
            
            
            
            
            
            #RPO, #Green

Keywords: UnitedHealth Group, San Antonio , Home Health Clinical Review Coordinator (Central Time), Healthcare , San Antonio, Texas