Care Coordinator, Onsite - Chesterton, IN

Optum; La Porte (IN); Hybrid; USD 46,838 - 84,033; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock purchase

401(k) contribution

Incentive programs

Job summary

Optum Home & Community Care, part of UnitedHealth Group, seeks a Care Coordinator–Onsite to support older adults transitioning from hospital to home. This hybrid role requires four in‑office days per week and focuses on coordinating SNF assessments, discharge planning, and collaboration with the care team to keep patients in the community.

You will work with physicians, nurses, social workers, and other providers, reviewing CMS criteria, ensuring timely authorizations, and guiding families

Qualifications

• Active, unrestricted clinical license in the state of hire (RN, PT, OT, or SLP).
• At least 5 years of clinical experience.
• Ability to support on-site facility needs within a 30‑mile radius of home location.

Responsibilities

• Serve as the link between patients, families and health-care personnel to ensure smooth transitions of care.
• Perform SNF assessments using CMS criteria upon admission and during stay.
• Review discharge plans with providers and families and update authorizations promptly.
• Collaborate with the care team to establish an optimal discharge plan.
• Ensure progress toward discharge goals and resolve barriers.
• Participate in SNF rounds and communicate with leadership.
• Maintain HIPAA privacy and compliance.

Skills

Clinical license

Experience

Driver's license

On-site/local travel

Job description

About the Role

Optum Home & Community Care, part of UnitedHealth Group, is creating a new integrated care model that addresses patients’ physical, mental, and social needs. As a member of the naviHealth product, the Care Coordinator‑Onsite supports patients as they transition from hospital to home, helping older adults stay in the community longer. This hybrid position requires four in‑office days per week.

Primary Responsibilities

• Serve as the link between patients, families, and appropriate health‑care personnel to ensure smooth, efficient, and timely transitions of care.
• Perform Skilled Nursing Facility (SNF) assessments on patients using clinical skills and CMS criteria upon admission and periodically throughout the stay.
• Review target outcomes, and discharge plans with providers and families.
• Complete all SNF concurrent reviews, updating authorizations promptly.
• Collaborate with the patient’s health‑care team (physicians, referral coordinators, discharge planners, social workers, PT/OT, etc.) to establish an optimal discharge plan.
• Assure patients’ progress toward discharge goals and assist in resolving barriers.
• Participate weekly in SNF rounds, providing accurate information to the H&C Transitions Senior Manager or Medical Director.
• Ensure appropriate referrals are made to the Health Plan, High‑Risk Case Manager, and/or community‑based services.
• Engage with patients, families, or caregivers either telephonically or on‑site weekly and as needed.
• Attend patient/family care conferences.
• Assess and monitor patients’ continued appropriateness for SNF settings according to CMS criteria.
• When delegated for utilization management, review referral requests that cannot be approved for continued stay and forward them to licensed physicians for review, issuing NOMNC when appropriate.
• Coordinate peer‑to‑peer reviews with H&C Transitions Medical Directors.
• Support new delegated contract start‑ups, ensuring experienced staff cover new contracts.
• Manage assigned caseload efficiently, using time‑management skills.
• Enter timely and accurate documentation.
• Review daily census, identify barriers, and support workload management.
• Review monthly dashboards, readmission reports, quarterly reports, etc. with the Clinical Team Manager to identify improvement opportunities.
• Adhere to organizational and departmental policies and procedures.
• Maintain confidentiality of all PHI in compliance with HIPAA, federal, and state regulations.
• Complete cross‑training and maintain knowledge of multiple contracts/clients for coverage support.
• Stay current on federal and state regulatory policies related to utilization management and care coordination (CMS guidelines, Health Plan policies).
• Promote a positive attitude and work environment.
• Attend H&C Transitions meetings as requested.
• Keep PHI confidential per applicable laws and institutional policies.
• Perform other duties as required, assigned, or requested.

Required Qualifications

• Active, unrestricted registered clinical license in the state of hire (Registered Nurse, Physical Therapist, Occupational Therapist, or Speech‑Language Pathologist).
• At least 5 years of clinical experience.
• Ability to support specific location(s) for on‑site facility needs within a 30‑mile radius of home location, based on manager discretion.
• Residence within the county listed in the job description.
• Driver’s license and reliable transportation.

Preferred Qualifications

• Experience working with the geriatric population.
• Familiarity with care management, utilization/resource management processes, and disease‑management programs.
• Background in patient education, rehabilitation, and/or home health nursing.
• Proficiency with Microsoft Office (Outlook, Excel, PowerPoint).
• Detail‑oriented, with proven ability to prioritize, plan, and handle multiple tasks simultaneously.
• Team player with exceptional verbal and written communication skills.
• Strong problem‑solving, conflict‑resolution, and negotiation skills.
• Independent problem identification and decision‑making skills.

Work Conditions and Physical Requirements

• Ability to establish a home office workspace.
• Ability to manipulate a laptop computer between office and site settings.
• Ability to view screen and enter data into a laptop within a standard period of time.
• Ability to communicate with clients and team members using a cellular phone or comparable device.
• Ability to remain stationary for extended periods (1‑2 hours).
• Ability to mobilize to and within sites in an assigned local or regional market (up to 85% of the time).

Compensation and Benefits

The hourly pay for this role ranges from $34.23 to $61.15, based on full‑time employment, local labor markets, education, work experience, and certifications. In addition to salary, the position offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401(k) contribution, and other benefits subject to eligibility requirements.

Equal Employment Opportunity

UnitedHealth Group is an Equal Employment Opportunity employer. Qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws.

UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before commencing employment.