4 days old

Senior Clinical Administrative Coordinator - Remote - 934247

Dallas, TX 75201 Work Remotely
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  • Job Code
    934247

Energize your career with one of Healthcares fastest growing companies.

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You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, its a dream that definitely can come true. Already one of the worlds leading Healthcare companies,UnitedHealthGroupis restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

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This opportunity is with one of our most exciting business areas:Optum- a growing part of our family of companies that makeUnitedHealthGroupa Fortune 10leader.

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Optumhelps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

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What makes your clinical career greater withUnitedHealthGroup? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.

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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 9:00am - 6:00pm CST. It may be necessary, given the business need, to work occasional overtime.

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Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Training will be conducted virtually from your home.

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

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Primary Responsibilities:

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  • Manage call volume (inbound, Manual outbound, and auto-dialer)
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  • Receives Care Coordination notification cases for non - clinical assessment / intervention and provides appropriate triage
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  • Processes out of network requests for consideration of in network level of benefits for physician specialty referrals for appropriate products
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  • Determines benefit coverage issues based on employer group contracts
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  • Sets up / documents / triages cases for (CCR) Clinical Coverage Review
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  • Ensures all potential member needs are identified and forwarded to the appropriate Care Coordinator for risk validation when applicable
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  • Processes letters within DOL time frames
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  • Communicates to providers and members benefit determinations within DOL time frames
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  • Other duties as assigned by manager and / or director
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  • Provide excellent Customer Service to both providers and members by responding to and resolving incoming inquiries and requests.
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  • Consistently meet established productivity and quality standards while adhering to schedules and maintaining good attendance.
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  • Process notifications for outpatient procedures, home health, DME, transition of care, and network gap issues.
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  • Depending on product, process out-of-network requests for consideration of in-network level of benefits for physician specialty referrals.
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  • Determine benefit coverage based on employer group contracts.
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  • Communicate benefit determinations to providers/members within DOL timeframes.
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  • Process letters within DOL timeframes.
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  • When relevant, ensure potential member needs are identified and forwarded to the appropriate Care Coordinator for risk evaluation - refer to CM and DM as relevant.
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  • Assist with processing of faxes and emails, including sending provider fax forms for certain clinical scenarios as designated.
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  • Confirm urgent versus non-urgent.
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  • Prioritize and organize own work to meet deadlines while working with others as part of a team.
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  • Cooperate with all members of CCR staff to ensure compliance with standards and regulations.
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  • Use knowledge and judgment to escalate complex problems to supervisor when necessary.
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  • Perform other duties as assigned by manager and/or director.
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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.

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Required Qualifications:

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  • High School Diploma / GED (or higher)
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  • 2+ years of Customer Service Experience
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  • 2+ years of experience working within the healthcare industry
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  • Experience working with Microsoft Word (creating, editing, saving documents) and Microsoft Excel (creating, editing, saving spreadsheets)
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  • Experience working with a PC and windows applications, with the ability to learn other sometimes complex systems
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  • Working knowledge of medical terminology
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  • Ability to work any of our 8 hour shift schedules during our normal business hours of 9:00am - 6:00pm CST
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  • If you need to enter a work site for any reason, you will be 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. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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TelecommutingRequirements:

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

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  • Professional experience in a clerical or administrative support related role
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  • Experience working in a hospital, physicians office or medical clinic setting
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  • Experience working in a call center Working knowledge of benefit design and interpretation
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UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non - clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.

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You can learn more about all we are doing to fight COVID-19 and support impacted communities at:https://www.unitedhealthgroup.com/newsroom/addressing-covid.html

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Careers with Optum.Here's the idea. We built an entire organization around one giant objective; make the health system 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 doyour life's best work.SM

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Colorado Residents Only: Thehourly range for Colorado residents is $17.12to $30.34. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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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.

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UnitedHealth Groupis a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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Keywords: customer service, healthcare, telephonic, patient interaction, field based, advocacy, medical terminology, codes, coding, work from home, WAH, WFH, remote, telecommute, hiring immediately, #RPO

Posted: 2021-06-08 Expires: 2021-07-08

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Senior Clinical Administrative Coordinator - Remote - 934247

UnitedHealth Group
Dallas, TX 75201

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