Registered Nurse Pre-Service Coordinator, Thurs-Sun - Remote

Davita Inc.; Eden Prairie (MN); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare organization is seeking a Registered Nurse Pre-Service Coordinator to optimize patient transitions and improve health outcomes. The role is remote and full-time from Thursday to Sunday, focusing on pre-authorization for skilled nursing and rehabilitative services. Successful candidates will hold an active nursing license with significant clinical experience and possess excellent communication skills.

Benefits

Comprehensive benefits package

401k contribution

Incentive and recognition programs

Qualifications

• 3+ years of clinical experience required.
• Ability to work Thursday-Sunday 7am-6pm CST.
• Flexibility to accommodate work volume peaks.

Responsibilities

• Review pre-authorization requests for skilled nursing services.
• Coordinate patient transitions to appropriate care levels.
• Educate facilities on the pre-service denial process.

Skills

Clinical experience

Physician engagement

Critical conversations

Education

Active, unrestricted Registered Nurse license

Job description

Registered Nurse Pre-Service Coordinator, Thurs-Sun - Remote

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. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Registered Nurse Pre-Service Coordinator plays an integral role in optimizing the patient's recovery journey. The Registered Nurse 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) Thursday-Sunday 7am-6pm Central Time.

Employees are required to have flexibility to work any of our 8-hour or 10-hour shift schedules during our business hours of Monday through Sunday. 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 Registered Nurse license in state of residence
• 3+ years of clinical experience
• Experience with physician engagement and crucial conversations
• Ability to work the weekly assigned shift: Thursday-Sunday 7am-6pm CST
• Ability to work any shift including 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
• Managed Care experience
• Experience with performing clinical audits to improve quality standards or performance
• Experience in working with geriatric population
• ICD - 10 and InterQual experience
• CMS knowledge

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The hourly range for this role is $34.42 to $67.60 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and 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, rules, or regulations.

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

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