Clinical Review Coordinator - National Remote 9-6pm CST

You''ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. naviHealth, part of Optum and the UnitedHealth Group family of businesses, combines the talents of our dedicated staff and leading-edge technology to deliver compassionate care to seniors nationwide. With millions of lives touched, we are innovating the way health care is delivered from hospital to home so seniors can lead more fulfilling lives. A career with us means making an impact in the lives of those we serve, including vulnerable populations who benefit from care that is more efficient, more effective and more human. Our environment empowers our team members to elevate our interactions with each other and the experiences we deliver to our patients, giving them more days at home. Join our team, it''s your chance to improve the lives of millions while doing your life''s best work.SM This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 9:00am - 6:00pm CST. It may be necessary, given the business need, to work occasional overtime. *All Telecommuters will be required to adhere to UnitedHealth Group''s Telecommuter Policy. 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 naviHealth 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: Bachelor''s Degree (or higher) 3+ years of clinical experience Experience in oversight and supervision of assistants (CNAs, PTAs, OTAs). Active, unrestricted registered clinical license required - Registered Nurse, Physical Therapist, or Occupational Therapist. Flexible and willing to work an early or late shift and/or longer than normal hours to accommodate peaks in volume of work. Ability to work full-time, Monday- Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 9:00am - 6:00pm CST Preferred Qualifications: 2+ years of Case Management experience CMS knowledge Managed care experience ICD-10 and InterQual experience Experience working with geriatric population Experience in acute care, rehab, or skilled nursing facility environment Experience performing clinical audits to improve quality standards or performance Telecommuting Requirements: Required to have a dedicated work area established that is separated from other living areas and provides information privacy Ability to keep all company sensitive documents secure (if applicable) Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service Soft Skills: Strong technical/computer skills Excellent documentation skills required. Self-starter with the ability to prioritize daily workload. Ability to work effectively in a self-management environment. Experience with physician engagement and crucial conversations. Readiness to embrace a fluid, changing, and fast-paced environment. Exceptional verbal and written interpersonal and communication skills. Strong critical thinking skills and the ability to review patients'' clinical information holistically. Physical and Work Environment: Ability to manipulate laptop computer (or similar hardware) between office and site settings Ability to communicate with clients and team members including use of cellular phone or comparable Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard time About naviHealth: naviHealth is improving the healthcare experience for seniors to live more fulfilling lives. For nearly a decade, naviHealth has been a trusted partner for the nation''s top health plans, health systems, and at-risk physician groups navigating the shift from volume to value. Powered by a predictive technology and decision support platform that provides clinicians and care teams with evidence-based protocols, naviHealth''s high-touch, proven care model fully supports patients from pre-acute through to the home. With naviHealth, patients can enjoy more days at home, and healthcare providers and health plans can significantly reduce costs specific to unnecessary care and readmissions. For more information about naviHealth, visit Our Purpose: Improving the healthcare experience for seniors to live a more fulfilling life Our Values: Rooted in respect Guided by purpose Devoted to service Energized by impact The above statements are intended to describe the general nature and level of work performed by colleagues assigned to this job. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications. naviHealth reserves the right to amend and change responsibilities to meet business and organizational needs as necessary. UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status. Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. Careers with Optum. Here''s the idea. We built an entire organization around one giant objective; make the health system 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 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. naviHealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other protected status under applicable laws and will not be discriminated against on the basis of disability. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. RPO, YELLOW

Created: 2025-11-15