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UnitedHealth Group Per - Diem Care Coordinator - Boulder, CO in Boulder, Colorado

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Care Coordinator is responsible for assisting in the development and implementation of case management in Behavioral Health Services. The position requires the ability to promote the coordination, collaboration and continuity of care from admission through discharge and post-discharge. The position necessitates leadership skills with the ability to direct and evaluate all aspects of patient care, and to assure that care is delivered a timely, effective and efficient manner. The position interacts with payors to determine the appropriate length of stay, care interventions and discharge plan, utilizing the resources available within the patient's care network. The position requires an ongoing knowledge of managed care and how best to deal with payors. Excellent organizational skills, the ability to consistently multitask and communicating well with others are critical aspects of this position. The ability to interact, educate and develop a therapeutic alliance with families of patients is essential.

Primary Responsibilities:

  • Professional Behavior:

  • Conduct all patient-care activities with respect for patient's privacy and right to confidentiality and autonomy

  • Use discretion in relaying administrative concerns, decisions or discussion with other staff

  • Admission Process:

  • Assist in admission and orientation of patients

  • Review initial assessment(s) and assist in completion

  • Conduct patient assessment evaluation and communication to the attending M.D. and treatment team

  • Treatment Planning:

  • Provide leadership in completion of the Master Treatment Plan and ongoing treatment goals

  • Develop, coordinate and complete discharge planning

  • Facilitate patient access to needed resources and aid in the development of alternatives as necessary to meet identified needs

  • Maintain collateral contacts with family or support systems, outside agencies and professionals as necessary

  • Attend and participate in team clinical supervision, team meeting and treatment planning

  • Chart Review:

  • Review patient charts to:

  • Update treatment plans

  • Assure services are consistent with JCAHO, ADAD and 27-10 Regulations

  • Follow BHS Standards and Guidelines

  • Review chart for drug screen results

  • Case Management:

  • Meet with patients during each scheduled treatment day to assess and evaluate status and discuss measurable treatment goals

  • Actively involve the patient, family and support system in planning and implementation of care

  • Maintain communication with patient's referring therapist, psychiatrist and/or primary care physician

  • Discuss Advanced Directives with patient as appropriate

  • Assist in managing the patient milieu

  • Participate in program QA/SQI as assigned by Program Manager

  • Reports all symptoms related by the patient or observed to the patient's psychiatrist

  • Thoroughly, effectively and accurately documents all patient clinical information in the medical record

  • Develops, maintains, and terminates therapeutic relationships with patients/families/significant others while maintaining appropriate boundaries

  • Function as an advocate for the patient and/or family/significant others as appropriate to the role

  • Set effective limits as appropriate with program philosophy and treatment plan

  • Communicates the discharge plan to the patient, the patient's support system and the appropriate outpatient providers

  • Notify outside agencies as mandated by law, i.e., Adult Protection, Child Protection etc.

  • Utilization Management:

  • Performs precertification and concurrent review of patients with payors in a timely manner to ensure adequate reimbursement

  • Provides regular communication to managed care/insurance provider regarding goals, progress in treatment, attendance and discharge plan

  • Initial review completed within 24 hours of admission, or the next available working day. Patients screened for appropriateness of admission and level of care

  • Identification of cases that do not meet criteria for continued hospitalization. Develop an alternative plan with the attending physician to explore discharge planning options and alternatives to hospitalization. Document all findings in the record. Communicate the decisions and plan to all appropriate parties. Communication of the discharge plan to the managed care/insurance companies

  • Communication of the discharge plan to the managed care/insurance company

  • Communicate the authorization number to the admissions office per policy

  • May need to verify and update the insurance benefit listed

  • Refers identified problems to QA, Risk Management or Medical Staff QA

  • Discharge:

  • Facilitate discharge planning immediately by working with the patient's family, significant supporters, outside providers and community resources

  • Evaluate the need for post hospital services and determine the appropriate discharge plan for all cases

  • Educate the patient/family as to the options/choices for the patient upon discharge. Communicate the recommendations of the treatment team

  • Complete preauthorization for post-discharge care when needed

  • Collaborate with all providers regarding the discharge plan, i.e. Turning Point, Recovery Program, Mapleton Counseling Center, outside therapists, outside psychiatrists, Wardenburg Clinic, the PCP, etc.

  • Whenever possible obtain specific appointments with all providers following up with the patient after discharge

  • Hospital Required:

  • Employees are expected to comply with all regulatory requirements, including Joint Commission Standards

  • Familiar with organization, department and job specific, fire, safety and disaster policies

  • Must adhere to Standard Precautions which include:

  • The use of protective barriers as appropriate:

  • gloves

  • masks

  • gowns

  • pocket masks

  • safety glasses

  • Handling and disposing of infectious waste appropriately

  • Hand washing as appropriate

  • Performs other duties as assigned

  • Maintain other licenses as necessary

  • Participate in Quality Improvement as assigned by Program Manager

When applicable, employees must be able to adjust the essential functions they perform appropriately to the age of their patient/customer. Employees must demonstrate knowledge of the principles of growth and development and the knowledge and skills necessary to provide for the primary population of patients served in the department. Employees demonstrate the ability to alter care and patient/family education based on the age or developmental level of the patient.

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:

  • Licensed or eligible forlicensure

  • Colorado LPC or LCSW Licensure

  • Master's Degree in Social Work,Family Therapy, Counseling, Psychology or Psychiatric Nursing or relatedfield for non-licensed Therapists

  • 2-3 years of experience in apsychiatric setting inpatient and/or outpatient

  • Knowledge of family systems theoryand its application in the short-term setting

  • Knowledge of current state andfederal laws relating to mental health (27-10, JCAHO and ADAD)

  • Knowledge of Medicaid/Medicareregulations

  • Knowledge of and ability toimplement the PASSR process

  • Knowledge of community andstatewide resources and the ability to develop a discharge plan usingthose available resources

  • Knowledge of DSM-IV andimplementing that information into the treatment plan in a diagnosisdirected manner

  • Knowledge of the QA-SQI process

  • Computer literacy and abilityto use word processing, Meditech systems for coordination of care,clinical reports, and billing

  • Ability to perform thoroughsocial, psychological, family and chemical dependency assessments to 1)pre-certify treatment and 2) incorporate the information gathered into thetreatment plan

PreferredQualifications:

  • Colorado RegisteredPsychotherapist, LPC Candidate or Licensed Addictions Counselor requiredwithin 3 months of hire for non-licensed Care Coordinators

  • Knowledge of reimbursementsystems and network systems used in the process of Utilization Review

  • CAC II or III; experience in aChemical Dependency Treatment setting

  • Recovery experience

  • Ability to assess and evaluatea wide range of psychosocial impairments within a patient population 18through the continuum of life

  • Demonstrated ability to dealtactfully with all clients, third-party payors, attorneys, all hospitalstaff and physicians, families and hospital staff

  • Ability to seek and maintaincurrent knowledge of reimbursement practices, including knowledge ofcapitated and roll-in contracts, preferred providers and incorporate intotreatment planning

  • Ability to maintain currentknowledge of Child and Adult Protection laws

  • Ability to maintain currentknowledge of Advanced Directives

  • Ability to maintain internalcontacts with physicians and employees, ability to act as resource andmotivate these individuals

  • Ability to coordinate serviceswith medical staff, treatment programs and third-party payors

Working environment/PhysicalActivities:

  • Functional physical demandsinclude manual dexterity and fine motor skills. The following senses willbe needed for essential duties of the job: speech, vision, hearing, smelland touch

  • Accomplish tasks while working underpressure of consistent deadlines

  • Work in artificial light andsits for substantial periods of time

  • Ability to work in high-stressnoisy environment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)

Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

Optum is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. © 2020 Optum. All rights reserved.

Job Keywords: Care Coordinator, LPC, LCSW, Registered Psychotherapist, Mental Health, 27-10, JCAHO, ADAD, PASSR, BCH, Boulder Community Health, Boulder, CO, Colorado

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