Requisition Number: 2186109
Job Category: Medical & Clinical Operations
Primary Location: Dallas, TX
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life’s best work.SM
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 8am – 5pm CST. It may be necessary, given the business need, to work occasional overtime.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
- Communicate with Supervisor/Manager r/t member issues/ member referrals
- Ensure that all potential member needs are identified and processed to appropriate Team member and management
- Communicate with other UMR teams including UM, CM, OCC, Plan Advisors, Customer Service Rep, etc. as needed to follow-up on requests by our Team
- Keep lines of communication open with SME (Subject Matter Expert)
- Will need to be able to anticipate member non-clinical needs, for ex: will know who to refer member with Benefit questions to the Plan Advisor or Customer Service Rep
- Will utilize clinical documentation for reporting purposes
- Assist RN/SW with administrative tasks
- Work with hospitals, clinics, facilities, and the clinical team to manage requests for services
- Manage the referral process, processing incoming and outgoing referrals and prior authorizations, including intake, notification, and census roles
- Resolve inquiries from members and/or providers
- Will work directly with other clinicians to assist with member needs
- Clinical assessment of members to include inbound and outbound calls
- Prioritize and assign members to appropriate clinical staff if needed
- Work directly with RN to communicate member clinical needs and troubleshoot solutions
- Work with other departments to solve member needs
- Collaborate with the Clinical Administrative Assistants on the team to serve members daily
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.
- High School Diploma / GED (or higher)
- 2+ years of experience analyzing and solving customer problems
- Experience working with medical terminology
- Experience working in the health care industry
- Nonrestrictive compact LPN license
- Ability to work 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 CST. It may be necessary, given the business need, to work occasional overtime.
- Experience working with health care insurance
- Experience working with MCO (Managed Care Organization)
- Experience in a hospital, physician’s office, or medical clinic setting
- Clerical or administrative support background or experience working in a call center environment
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Ability to keep all company sensitive documents secure (if applicable)
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
California, Colorado, Connecticut, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The salary range for California / Colorado / Connecticut / Nevada / New Jersey / New York / Washington / Rhode Island residents is $18.80 – $36.78.Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.
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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