Optum
Care Coordinator, Onsite, San Francisco, CA (Hybrid /RN/PT/OT/ST)
Optum, San Francisco, California, United States, 94199
Overview
Care Coordinator, Onsite, San Francisco, CA (Hybrid / RN / PT / OT / ST) at Optum. Optum Home & Community Care, part of the UnitedHealth Group family, is creating an integrated care model to holistically address physical, mental and social needs, helping patients access and navigate care anytime and anywhere. The Care Coordinator- Onsite plays an integral role in optimizing patients\' recovery journeys by coordinating discharge planning and engaging patients and families to support the PAC journey. The position acts as the link between patients and the appropriate health care personnel to ensure efficient, smooth, and prompt transitions of care. This is a hybrid role with three in-office days per week. Join a team focused on connecting care to create a seamless health journey for patients across care settings. This role belongs to the naviHealth product family and supports care transitions from hospital to home, with a focus on helping older adults remain at home where possible. Primary Responsibilities
Serve as the link between patients and the appropriate health care personnel to ensure efficient, smooth, and prompt transitions of care. Perform Skilled Nursing Facility (SNF) assessments using clinical skills and CMS criteria upon admission to SNF and periodically through patient stays. Review target outcomes and discharge plans with providers and families; complete all SNF concurrent reviews and update authorizations promptly. Collaborate with patients\' health care teams (physicians, referral coordinators, discharge planners, social workers, physical therapists, etc.) to establish an optimal discharge plan. Monitor progress toward discharge goals and help resolve barriers; participate weekly in SNF rounds with accurate information for the Transitions team. Refer appropriately to Health Plan, High-Risk Case Manager, and/or community-based services; engage with patients, families, or caregivers weekly or as needed (telephonically or on-site). Attend patient/family care conferences; assess and monitor continued suitability for SNF per CMS criteria; review referral requests when delegated for utilization management and forward to licensed physicians for review as needed. Coordinate peer-to-peer reviews with Transitions Medical Directors; support new delegated contract startup to ensure experienced staff work with new contracts. Manage assigned caseload efficiently; document timely and accurately; review monthly dashboards and reports to identify opportunities for improvement. Adhere to organizational and departmental policies; maintain PHI confidentiality in compliance with HIPAA and related regulations; cross-train to support multiple contracts/clients and stay current on regulatory policies. Promote a positive work environment; attend H&C Transitions meetings as requested; perform other duties as required. Required Qualifications
Active, unrestricted clinical license in state of hire — RN, Physical Therapist, Occupational Therapist, or Speech-Language Pathologist. 5+ years of clinical experience. Reside within the 30-mile radius of the specified location or as directed by the manager; on-site facility needs in San Francisco area. Driver\'s license and reliable transportation. Preferred Qualifications
Experience with geriatric populations; familiarity with care management, utilization/resource management, and disease management programs. Proficiency with Microsoft Office (Outlook, Excel, PowerPoint); patient education, rehabilitation, and/or home health nursing experience. Detail-oriented with strong prioritization, planning, and multitasking abilities; team player with excellent verbal and written communication skills; problem solving, conflict resolution, and independent decision-making skills. Ability to identify and resolve issues independently. Work Conditions And Physical Requirements
Ability to establish a home office workspace; operate a laptop and communicate with clients and team members via cellular devices. Ability to view screens and enter data; sit for extended periods; travel locally up to 85% of the time as required. Salary and benefits vary by location and are based on factors including local labor markets, education, experience, and certifications. The role may include a comprehensive benefits package, incentive programs, and 401k contribution, subject to eligibility. UnitedHealth Group is an Equal Employment Opportunity employer and participates in drug testing where required.
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Care Coordinator, Onsite, San Francisco, CA (Hybrid / RN / PT / OT / ST) at Optum. Optum Home & Community Care, part of the UnitedHealth Group family, is creating an integrated care model to holistically address physical, mental and social needs, helping patients access and navigate care anytime and anywhere. The Care Coordinator- Onsite plays an integral role in optimizing patients\' recovery journeys by coordinating discharge planning and engaging patients and families to support the PAC journey. The position acts as the link between patients and the appropriate health care personnel to ensure efficient, smooth, and prompt transitions of care. This is a hybrid role with three in-office days per week. Join a team focused on connecting care to create a seamless health journey for patients across care settings. This role belongs to the naviHealth product family and supports care transitions from hospital to home, with a focus on helping older adults remain at home where possible. Primary Responsibilities
Serve as the link between patients and the appropriate health care personnel to ensure efficient, smooth, and prompt transitions of care. Perform Skilled Nursing Facility (SNF) assessments using clinical skills and CMS criteria upon admission to SNF and periodically through patient stays. Review target outcomes and discharge plans with providers and families; complete all SNF concurrent reviews and update authorizations promptly. Collaborate with patients\' health care teams (physicians, referral coordinators, discharge planners, social workers, physical therapists, etc.) to establish an optimal discharge plan. Monitor progress toward discharge goals and help resolve barriers; participate weekly in SNF rounds with accurate information for the Transitions team. Refer appropriately to Health Plan, High-Risk Case Manager, and/or community-based services; engage with patients, families, or caregivers weekly or as needed (telephonically or on-site). Attend patient/family care conferences; assess and monitor continued suitability for SNF per CMS criteria; review referral requests when delegated for utilization management and forward to licensed physicians for review as needed. Coordinate peer-to-peer reviews with Transitions Medical Directors; support new delegated contract startup to ensure experienced staff work with new contracts. Manage assigned caseload efficiently; document timely and accurately; review monthly dashboards and reports to identify opportunities for improvement. Adhere to organizational and departmental policies; maintain PHI confidentiality in compliance with HIPAA and related regulations; cross-train to support multiple contracts/clients and stay current on regulatory policies. Promote a positive work environment; attend H&C Transitions meetings as requested; perform other duties as required. Required Qualifications
Active, unrestricted clinical license in state of hire — RN, Physical Therapist, Occupational Therapist, or Speech-Language Pathologist. 5+ years of clinical experience. Reside within the 30-mile radius of the specified location or as directed by the manager; on-site facility needs in San Francisco area. Driver\'s license and reliable transportation. Preferred Qualifications
Experience with geriatric populations; familiarity with care management, utilization/resource management, and disease management programs. Proficiency with Microsoft Office (Outlook, Excel, PowerPoint); patient education, rehabilitation, and/or home health nursing experience. Detail-oriented with strong prioritization, planning, and multitasking abilities; team player with excellent verbal and written communication skills; problem solving, conflict resolution, and independent decision-making skills. Ability to identify and resolve issues independently. Work Conditions And Physical Requirements
Ability to establish a home office workspace; operate a laptop and communicate with clients and team members via cellular devices. Ability to view screens and enter data; sit for extended periods; travel locally up to 85% of the time as required. Salary and benefits vary by location and are based on factors including local labor markets, education, experience, and certifications. The role may include a comprehensive benefits package, incentive programs, and 401k contribution, subject to eligibility. UnitedHealth Group is an Equal Employment Opportunity employer and participates in drug testing where required.
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