Registered Nurse Pre-Service Coordinator Remote - Mon-Fri 1pm to 10pm CT

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 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.

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