Intake Representative – National Remote

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.

This position is full time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm CST. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule. Will go through 2 weeks of case review/testing and then moving into shadowing for approximately 4 weeks.

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

        

Primary Responsibilities:

• Triage phone, email, online, and fax requests to determine if Prior Authorization is required.
• Follow guidelines related to group specific prior authorization requirements and procedures.
• When prior authorization is required follow appropriate guidelines to determine if intake approval is appropriate or nurse utilization review is required.
• Answer inbound member and provider calls regarding prior authorization requests and questions.    
• Refer requests for precertification to the appropriate place when precertification is not required.
• Obtain demographic and medical information related to authorization requests. Ensure this information is complete and accurate upon entry into the appropriate computer system.
• Process intake notifications per prescribed guidelines.
• When appropriate, transfer calls to UM reviewer who will take the clinical data on the case.
• Maintain 95% accuracy on all audits.
• Adhere to NCQA Standards with special emphasis on confidentiality of information.
• Appropriately triage calls received that should go to other departments or companies.
• Operational interface with Utilization review software, Outlook, PBMs, as well as the Internet and online applications.

               

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 or equivalent work experience
• Must be 18 years of age or older
• 2+ years of experience in health insurance and/or utilization management
• Demonstrated excellent customer service telephone skills
• Basic knowledge of medical and pharmacy terminology
• Organizational skills and detail orientation, as well as problem solving
• Excellent PC, verbal and written communication skills
• Compliance with regulatory and accrediting organizations (e.g., DOL, NCQA) and applicable laws and regulations (e.g., HIPAA, COBRA)
• Adherence to internal quality control guidelines and processes
• Ability to motivate and communicate clearly and concisely, verbally and in writing
• Ability to do multiple tasks, effectively prioritize workload, adapt to change, handle a fast-paced environment, work independently as well as in a group setting.  
• Must be able to work 8:00am-5:00pm Central time

              

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

                 

Physical and Work Environment:

• Must be able to work on a computer for extended period of time
• Must be able to effectively operate all office equipment including computer, copier, printers, fax machine and phone
• Must be able to tolerate a moderate noise level within a cubicle environment

                 

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

               

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C., Maryland Residents Only: The hourly range for this role is $16.54 to $32.55 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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