Utilization Management Coordinator – Remote in PST

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Responsible for providing non-clinical support to the utilization management team in maintaining and managing the utilization processes for pre-service authorization requests in a timely and accurate manner consistent with policies and procedures as described in the Utilization Management plan.

This position is full time, Monday – Friday. Employees are required to work an 8-hour shift schedule during our normal business hours of 8am-5pm PST. It may be necessary, given the business need, to work occasional overtime.

We offer 4-6 weeks of paid training. The hours during training will be 8am-5pm PST, Monday – Friday. 

If you are located in PST time zone, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Consistently exhibits behavior and communication skills that demonstrate Optum’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
• Performs all functions of the care coordinator.
• Provides non-clinical support to the CDU nurse in the processing of all adverse determinations and notices including provider outreach for denial avoidance, accessibility verification and benefit validation.
• Ensures informational notices for carve outs and benefits are composed in a manner consistent with federal regulations, state regulations, health plan requirements and NCQA standards.
• Converts service description and diagnosis into language that is easily understood based on resources provided and clinical direction.
• Validates the accuracy of all information provided in the carve out and benefit notices including carve out providers and contact information provided relevant to aforementioned notices.
• Contacts members or providers for continuity of care services related to carve out notices.
• Adheres to the standardized documentation requirements for carve out and benefit notices.
• Documents members’ service benefits by contacting the appropriate health plans.
• Directs providers and members to contracted provider, provider network, facilities and agencies.
• Processes appropriate authorizations for HMO / PPO, Medical/CCS clients as specified in the organization’s procedures.
• Acts as a resource to other coordinators, staff and providers by resolving issues and responding to requests in a timely and effective manner.
• Works with patient services regarding member concerns.
• Identifies gaps in training or process impacting the overall compliance of adverse determinations and communicates in writing an effective performance improvement solution.
• Meets or exceeds productivity targets.
• Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Performs additional duties as assigned.

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:

• High school diploma/GED
• Must be 18+ years of age OR older
• Experience working in Utilization Management
• Experience working with benefit eligibility verification
• Experience with Computers and Windows based programs including Microsoft Word, Excel, Outlook
• Knowledge of medical terminology
• Ability to work fulltime, Monday – Friday. Employees are required to work an 8-hour shift schedule during our normal business hours of 8am-5pm PST. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• 2+ years of experience in a health care setting.
• 2+ years referrals management or related experience.
• 1+ year of experience performing non-clinical functions for prospective Utilization Management review
• 1+ year of experience providing supportive or direct functions for adverse determinations.
• CPT/ICD-10 coding.
• Knowledge of utilization management platforms and the capacity to navigate varied health plan websites for benefit determinations

Telecommuting Requirements: 

• Reside within PST Time Zone
• Ability to keep all company sensitive documents secure (if applicable) 
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy. 
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

• Ability to type 30 wpm.
• Broad knowledge of managed care principles.
• Excellent communication, organization and customer service skills.
• Proven ability to problem-solve.
• Strong attention to detail.
• Ability to manage time effectively and work independently.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The hourly range for this role is $16.00 to $28.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

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