Utilization Management Coordinator – National Remote

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

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 have flexibility to work any of our 8-hour shift schedules 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. 

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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 network and facilities.
• Processes appropriate authorizations for HMO / PPO 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
• Ability to to work any of our 8-hour shift schedules during our normal business hours of 8am-5pm PST.

Preferred Qualifications:

• Certificate in a healthcare related field
• 3+ 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.

Telecommuting Requirements:

• 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:

• Computer literate.
• Proficient in Microsoft Office Suite, knowledge of utilization management platforms and the capacity to navigate varied health plan websites for benefit determinations.
• Ability to type 30 wpm.
• Broad knowledge of managed care principles.
• Knowledge of medical terminology and CPT/ICD-9 coding.
• Excellent communication, organization and customer service skills.
• Proven ability to problem-solve.
• Strong attention to detail.
• Ability to manage time effectively and work independently.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for this is $16.00 – $28.27 per hour. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group 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.

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

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