Care Coordinator - Onsite; Hybrid; PT​/OT​/SLP​/RN - Riverside, CA

Improve the lives of others while Caring. Connecting. Growing together.

Job Description
- Care Coordinator
- Onsite (Hybrid) - PT/OT/SLP/RN
- Riverside, CA (2389997)

Optum Home & Community Care , part of the Optum family of businesses, is creating something new in healthcare. By bringing together industry-leading solutions, advanced technology and compassionate teams, we are building a more connected experience that helps address an individual’s physical, mental and social needs. As a team member of our Optum Care Transitions team, you’ll help patients navigate the healthcare system, access the support and services they need, and receive the right care at the right time.

This meaningful work is helping improve health outcomes, expand access to care and create a more seamless health journey for the people we serve. Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

The Care Coordinator, Onsite plays an integral role in optimizing patients’ recovery journeys. The Care Coordinator completes weekly functional assessments and engages the post-acute care (PAC) inter-disciplinary care team to coordinate discharge planning to support the members PAC journey. The position engages patients and families to share information and facilitate informed decisions. By serving as the link between patients and the appropriate health care personnel, the Care Coordinator is responsible for ensuring efficient, smooth, and prompt transitions of care.

• Engage with patients, families, or caregivers either telephonically or on-site weekly and as needed. Collaborate effectively on discharge goals and assist in resolving barriers
• Collaborate effectively with members health care teams with individualized communication and participation in interdisciplinary team meetings
• Review target outcomes and discharge plans with providers and families
• Perform Skilled Nursing Facility (SNF) assessments on patients using clinical skills and utilizing CMS criteria upon admission to SNF and periodically through the patient stays
• Assess and monitor patients’ continued appropriateness for SNF setting (as indicated) according to CMS criteria
• Complete all SNF continued stay reviews, updating authorizations on a timely basis
• When Care Transitions is delegated for utilization management, review referral requests that cannot be approved for continued stay and are forwarded to licensed physicians for review and issuance of the NOMNC when appropriate
• Complete cross-training and maintain knowledge of multiple contracts/clients to support coverage needs across the business
• Manage assigned caseload efficiently and effectively utilizing time management skills
• Enter timely and accurate documentation into Coordinate
• Adhere to organizational and departmental policies and procedures
• Maintain confidentiality of all PHI information in compliance with HIPPA, federal and state regulations, and laws
• Hold patients’ protected health information confidential as required by applicable laws, regulations, or agency/institution procedures
• Keep current on federal and state regulatory policies related to utilization management and care coordination (CMS guidelines, Health Plan policies, and benefits)
• Adhere to all local, state, and federal regulatory policies and procedures
• Attend Care Transitions meetings as requested
• Promote a positive attitude and work environment
• Perform other duties and responsibilities as required, assigned, or requested

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…