Cardinal Health Pre-Service Coordinator in Memphis, Tennessee
naviHealth is the result of over a decade of dedicated visionary leaders and innovative organizations challenging the status quo for PAC management solutions. We do healthcare differently and we are changing healthcare one patient at a time. How might you ask? By hiring talented clinicians, engineers, developers, and healthcare leaders to create and utilize cutting edge technology in order to provide the patient with the best level of care for the right amount of time.
Why Is This Role Critical?
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 requested level of care. He/she will coordinate the transition of members from the community or acute setting to the post-acute setting, while following established facility policies and procedures.
What you will be accountable for….
- Performs all prospective requests within established parameters
- Performs review for all direct admits to SNF via physician office, ED or HH
- Performs all Expedited prospective reviews, including the patient oral and/or written notifications
- Performs secondary reviews for approval or referrals to the Medical Director
- Has EMR access to mirror ICC partner access
- Completes review request sent by ICC partner
- Coordinates Medical Director reviews
- Coordinators peer to peer reviews with naviHealth Medical Directors
- Notifies hospital and SNF of review outcome for non-engaged patients
- Partners with Medical Directors for Pre-Service Coordinator training as needed
- Completes denial processes
- Educates facilities on pre-service denial process
- Assists as required with afterhours coverage for QIO processes
- Performs all SNF CCR for patients over OPT
- Negotiates out of network/non-par contracts
- Regularly participates in weekend coverage rotation
- Participates in clinical phone queue to ensure customer SLA’s are met
- Supports new delegated contract start up to ensure experienced staff work with new contract
- Partners with the full care coordinator team as needed, this may include but is not limited to Operations Leadership, Medical Directors, SICCs, IRF/LTAC Coordinators, HRCMs, Engagement Specialists, and Clinical Leadership as needed
What you will need to be successful in this role….
- Registered Clinician is a requirement of the role with preference for RN, PT, or OT credentials
- Current active unrestricted clinical license required
- 3-5 years of clinical experience required
- At least two years’ recent experience in case-management or utilization management role required
- Strong technical/computer skills
- Excellent documentation skills required.
- Self-starter with the ability to prioritize daily work load.
- Strong interpersonal and communication skills (both verbal and written).
- Ability to travel if business needs required and ability to establish a home office work location if needed.
- Bachelor’s degree preferred
- ICD-10 and InterQual experience a plus.
- CMS knowledge preferred.
- Experience working with the geriatric population preferred
- Experience in an acute care, rehab or skilled nursing facility environment preferred. Managed care experience a plus.
NaviHealth is a pioneer in care transitions with a combined unprecedented 16 years of experience that uniquely positions us to manage and share risk with our partners. As a Cardinal Health company, we provide clinical support alongside scaled technology and advisory solutions that empower health systems, health plans, and post acute providers to navigate care episodes across the continuum, with the goal of reducing waste and improving patient outcomes
naviHealth ™ is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce
Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.