What’re the thoughts on the future of these positions? Are these positions at risk for being cut?
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It’s telling UGH shut down HH and believe they know home based medical is no longer the cash cow it was in years past.
Using clinical judgement is not supported when Navi was eventually acquired. Predict predict NOMNC NOMNC. At least, that’s how I feel. Nowadays, SNF will rarely issue facility initiated NOMNC.
I met an Optum RN Case Manager once while doing onsite IDT. He would come in every other week or when he had quite a few patients. I remember he would just approve auths one week at a time; he asks similar, pertinent questions such as medical status, living situation, DC planning, etc. but no predict report to share with an ELOS, CG burden, etc.
In fact, one time he told the facility case manager to issue the NOMNC once the family has completed family training. To me, it seems like they are basing off their decisions on clinical judgment. I also don’t believe that they had to submit the cases to a physician for a review.
He did not visit patients regularly. He would go to IDT, talk to CM and leave.
Curious to know how the original UHC/Optum Coordinators approached continued stay before Navi SICCs came to the picture. Did they do onsite visits too or was it all telephonic?
Yeah Navi was really one of the only companies to hire therapists for this role. You rarely see PT/OT and especially SLP meet the criteria for other similar jobs. All roles state RN licensure.
There’s more openings for nurses. Not really a new thing. Check out the board and you’ll see.
Does this mean that Optum isn’t hiring therapists for certain roles, or is it just that the job boards are currently showing more openings for RNs rather than therapists?
Optum has reviewers for all LOC. Therapists included. If you look at the job boards, generally positions are looking for RNs and not therapists.
I hear you on this—there’s definitely reason to be wary about where things are headed. Optum might lean more toward RNs for the future, especially since they’re more flexible when it comes to handling clinical reviews. They’re already using RNs for most of the reviews, and if they want to streamline things, it would make sense to keep that same approach across the board.
As for Navi, even if they keep a handful of SICC folks around, I wouldn’t be shocked if they start putting more value on RNs than on PTs, OTs, and SLPs. The whole trend seems to be leaning toward cutting those specialized roles in favor of something more general. And honestly, I can’t shake the feeling that PT, OT, and SLP might get left behind in the shuffle. It’s hard not to feel like their days might be numbered, especially with the cost-cutting focus. It’s a bit of a tough pill to swallow, especially if you’ve seen the work those roles do, but things are changing fast, and it’s hard to say where it’ll all land.
I know UHG has their own clinical reviewers but considering Navi has managed much of UHGs contracts for quite some time, there can’t be that many of them over there? Or are there?
But even if they cut and keep some Navi SICC around, I wonder if the RNs will be seen as more valuable vs PT, OT, SLP. Since it sounds like UHG/Optum reviewers are RN…. Idk just going off of gut but I have a bad feeling about this.
You’re absolutely right—NH Predict never really seemed grounded in solid, real-world science, at least not in the way one would expect from a tool handling such crucial decisions. It always felt more like an algorithm designed to churn out quick predictions with the main goal of shortening patient stays and cutting costs. The idea of predicting patient outcomes is appealing on the surface, but the reality is, it was more of a black-box system that didn’t have the transparency or clinical validation needed to inspire real trust among healthcare professionals.
The algorithm likely focused on metrics like length of stay and predicted outcomes, but without considering the full complexity of a patient’s situation, it could have oversimplified things to meet budget-driven goals. Instead of relying on a clinician’s nuanced judgment, it pushed for decisions that were more about efficiency than individual patient needs. That’s probably why it didn’t hold up well when it came under legal scrutiny. If it was based on questionable assumptions or too rigid a model, the result was an overly deterministic approach to care that ignored the unpredictability and complexity of real-life healthcare.
And as you pointed out, this is likely why UHG might be moving away from it now. When you’ve got tools like Interqual and MCG, which have solid clinical backing and long-standing use in the industry, there’s no reason to keep relying on something that was essentially designed to push patients out the door faster, without having the kind of science-based validation that supports safe, quality care.
Honestly, much of the work we currently do could be effectively automated with AI. With systems like Coordinate, documentation can be uploaded and processed seamlessly, allowing the program to capture all relevant data, generate predicted timelines, and simply require a clinician to verify the results. This would drastically reduce the need for a large workforce, as the majority of the tasks could be handled by automated processes. Given the direction this company is moving, it seems inevitable that automation will play an increasingly central role in our operations. It’s just a matter of time before it becomes the new norm.
Exactly my thoughts!!! From being so proud of Predict, now they are keen to abolish and erase Navi and any Navi related process from the equation.
This is what’s going through my mind right now - when UHG acquired NaviHealth, it was because of their proprietary “NH Predict”. UHG sees it as an effective way of cost-containment in the PAC setting, ergo more profit.
It’s all good and dandy until the class-action lawsuits came to light, where the NH Predict was singled-out as the cause of the morbidity and mortality of the former patients who complained. Of course damage control has to be done and legal processes are costly.
So maybe, just maybe, the NH Predict is now seen as a nuisance more than a useful tool, which has cost UHG a lot of money. See, UHG and Optum have their own UM reviewers, mostly RNs, who don’t use a special tool apart from Interqual and MCG, which are both widely used in the world of UM.
I think that Navi Legacy will soon be “NOMNCed”. Pun intended.
https://www.thelayoff.com/t/1jjjdpv4e
Many threads on this. Here’s a recent one.
Do you think so because of loss of contracts or are there UHG reviewers that would be doing the work? I just feel like there is so much work out there and we seem ”valuable” so who would take over the work if these positions get cut?
Yes!