Compassion is the essential trait that drives superior health care performance. But it's just a start. At OptumCare innovative thinking is just as important. Our unique team of health care providers are an emerging and important part of Optum and the UnitedHealth Group family of businesses. Our approach is designed to help physicians and other providers deliver the right care at the right time in the right setting. That takes smart ideas and incredible teamwork. And that's where you come in. In this role, you'll support a clinical team that's helping patients in new and better ways while giving them a generous helping of compassion and respect.

Responsible for timely and accurate processing of work that supports the administrative requirements of the Care Management department, including Utilization, Case and Disease Management. Adheres to policies, procedures, and regulations to ensure compliance and patient safety. Participation in Compliance and other important training is a condition of employment

Primary Responsibilities:

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• Provide direct customer service for care management department including responding to incoming calls to department. Finds solution or refers caller to appropriate team member for assistance.
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• Complete outreach calls to patients identified as eligible for Case Management and Disease Management programs.
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• Provides verbal confirmations and written documentation of determinations regarding benefit eligibility, authorizations for inpatient admissions and outpatient precertification and/or prior authorization requests.
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• Performs electronic eligibility and benefits verification,
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• Reviews and routes electronic documentation to clinical staff as needed
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• Coordinates medical appointments with provider clinics
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• Assists with reporting, writing/reviewing workflows, and other projects
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• Maintains up to date knowledge of insurance requirements including in network and out of network, and management of prior authorization process.
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• Attends departmental meetings and provides constructive recommendations for areas of improvement.
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• Performs other duties as assigned
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Youll 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:

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• High School Diploma or GED
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• 1.5 years of experience of which one (1) year is in a customer service role and six (6) months in a healthcare environment
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• Knowledge of medical terminology
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• Skilled with MS Office software applications
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• You will be asked to perform this role in an office setting or other company location.
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• Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
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Preferred Qualifications:

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• Health insurance experience
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• Excellent communication, interpersonal, organization and customer service skills
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• Attention to detail
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• Ability to multi-task and work under pressure
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• Self-motivated, strong computer skills
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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: 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.