naviHealth, Inc. Remote Pre-Service Coordinator- RN, OT, PT in Portland, Oregon
The Pre-Service Coordinator plays an integral role in optimizing the patient’s recovery journey. The 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.
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 hospital and SNF of review outcome 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 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.
Partner with the full care coordinator team as needed, this may include but is not limited to Operations Leadership, Medical Directors, Skilled Inpatient Care Coordinators, IRF/LTAC Coordinators, Engagement Specialists, and Clinical Leadership.
Perform other duties and responsibilities as required, assigned, or requested.
Active, unrestricted registered clinical license required – Registered Nurse, Physical Therapist, or Occupational Therapist
3 - 5 years of clinical experience required
At least 2 years of Case Management experience preferred
Experience in an acute care, rehab or skilled nursing facility environment preferred; managed care experience is a plus
Experience performing clinical audits to improve quality standards or performance preferred
Experience working with geriatric population preferred
Strong critical thinking skills and the ability to review patients’ clinical information holistically
Flexible and willing to work an early or late shift and/or longer than normal hours to accommodate peaks in volume of work
Exceptional verbal and written interpersonal and communication skills
Experience in oversight and supervision of assistants (CNAs, PTAs, OTAs)
Ability to work effectively in a self-management environment
Experience with physician engagement and crucial conversations
ICD-10 and InterQual experience a plus
CMS knowledge preferred
Strong technical/computer skills
Excellent documentation skills required
Self-starter with the ability to prioritize daily work load
Readiness to embrace a fluid, changing, and fast-paced environment
Work Conditions and Physical Requirements
Ability to establish a home office workspace
Ability to manipulate laptop computer (or similar hardware) between office and site settings
Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard time period
Ability to communicate with clients and team members including use of cellular phone or comparable communication device
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 www.navihealth.com.
Improving the healthcare experience for seniors to live a more fulfilling life
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.
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.
External Job Posting Title: Remote Pre-Service Coordinator- RN, OT, PT
Requisition ID: 2021-7174
Location Type: Field / Office / Virtual: Virtual (Home Office)