LOS Clinical Review Coordinator - Remote

Join to apply for the LOS Clinical Review Coordinator - Remote role at Optum.

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.

Overview

The Clinical Review Coordinator is responsible for concurrent review for post-acute levels of care. Review clinical documents and complete reviews based on medical necessity and InterQual criteria. Focuses on comprehensive discharge planning upon admission and coordination of care throughout the member\'s stay. Partners with physicians, providers, and other team members to determine the most appropriate level of care for the member.

Hours

Hours for this role are Monday through Friday 8AM-5PM within your time zone.

Primary Responsibilities

• Request and review member\'s clinical information from providers
• Perform utilization review of inpatient cases using InterQual Criteria and updating authorizations on a timely basis
• Complete all assigned cases within required timeframes (TAT)
• Meet performance metrics with goal benchmarks
• Participate in rounds providing accurate clinical information to Manager, Medical Director, and other team members
• Identify and evaluate delays in care
• Collaborate with providers for discharge planning and readmission prevention plans upon admission and through continued stay reviews
• Collaborate with other team members (acute long-term care, acute rehabilitation, or skilled nursing facilities) to move the member through the care continuum
• Consult with the Medical Director for complex cases
• Identify opportunities for improved communication or processes
• Evaluate members’ ongoing needs and complete referrals to outpatient programs as appropriate
• Process and document all case activities per SOPs, Job Aides, and DES; follows Model of Care
• Participate in team meetings, education discussions, and related activities; complete assigned learning timely

Professionalism

• Personal and Professional Accountability: Foster a positive work environment; adapt to change in a positive manner; be accountable for performance and results
• Career Planning: Develops own career path; sets self-development goals; continuous learning and growth
• Ethics: Integrate high ethical standards and UnitedHealth Group core values into daily work
• Integrity Value: Act Ethically
• Relationships Value: Act as a Team Player; Communicate Effectively
• Compassion Value: Focus on Customers
• Innovation Value: Support Change and Innovation
• Performance Value: Make Fact-Based Decisions; Deliver Quality Results

Qualifications

• Active and unrestricted RN License
• 3+ years of total experience including recent clinical experience in an inpatient/acute setting
• Experience in acute long-term acute care, acute rehabilitation, or skilled nursing facilities
• Experience in discharge planning and/or chart review
• Proficient computer skills
• Excellent verbal and written interpersonal and communication skills
• Strong organizational skills, self-motivation, and ability to manage time independently
• Ability to prioritize, plan, and handle multiple tasks simultaneously
• Ability to adapt to change and drive innovation
• Ability to work across functions and businesses to achieve goals
• Ability to develop and maintain positive customer relationships
• Dedicated work area that provides privacy
• Live in a location with UnitedHealth Group-approved high-speed internet

Preferred Qualifications

• Bachelor\'s degree
• 2+ years case management/utilization review
• Experience with Interqual criteria guidelines
• Experience with Commercial, Medicare, and Medicaid plans
• Utilization Review background in managed care

Compensation and Benefits

Pay is based on factors including local labor markets, education, experience, and certifications. In addition to salary, benefits include a comprehensive package, incentive programs, equity stock purchase and 401k contribution (subject to eligibility). The hourly pay range for this role is $34.23 to $61.15 per hour based on full-time employment. We comply with all applicable minimum wage laws.

EEO and Workplace Notice

At UnitedHealth Group, we are committed to fostering an inclusive environment and providing equitable care. UnitedHealth Group is an Equal Employment Opportunity employer and a drug-free workplace. Candidates must pass a drug test before employment where required.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Hospitals and Health Care