Remote Clinical Review Coordinator II – National

Optum

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Requisition Number: 2194337
Job Category: Medical & Clinical Operations
Primary Location: Dallas, TX
(Remote considered)

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

Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere.

As a team member of our naviHealth product, we help change the way health care is delivered from hospital to home supporting patients transitioning across care settings. This life-changing work helps give older adults more days at home.

We’re connecting care to create a seamless health journey for patients across care settings. Join our team, it’s your chance to improve the lives of millions while doing your life’s best work.SM

This position is full-time. Employees are required to work Monday – Friday, 8:00am – 5:00pm Central Standard Time (CST) including the flexibility and willingness to work an early or late shift and/or longer than normal hours to accommodate peaks in volume of work based on business need.

We offer weeks of paid training. The hours of the training will be based on schedule or will be discussed on your first day of employment.

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

Primary Responsibilities:

  • The Clinical Review Coordinator is responsible for reviewing and determining medical appropriateness of pre-authorization requests following evaluation of medical guidelines.
  • The position coordinates the transition of patients from the community or acute setting to the next appropriate level of care.
  • Complete process as it relates to pre-service authorizations.
  • Participate in the clinical phone queue to ensure customer’s Service Level Agreements are met.
  • Provide written and verbal coordination of care communication with a full team which may consist of, but is not limited to, Medical Directors, Skilled Inpatient Care Coordinators, and Clinical and/or Operations leadership.
  • Positions are responsible for providing appropriately focused Medical Management Clinical Review of Medical Policy, Health Plan Policy, Member Benefits, and Standards of Policy/Work Instructions.
  • Uses technical knowledge and related review protocols in the review of clinical information and documents as they relate to company medical policy and benefit document language.
  • Educate facilities on the pre-service authorization process.
  • Perform other duties and responsibilities as required, assigned, or requested within your scope of licensure.

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: 

  • Associate’s Degree (or higher) WITH equivalent experience for RNs OR Bachelor’s Degree (or higher) in Occupational Therapists OR Physical Therapists
  • 3+ years of clinical experience
  • Active, unrestricted registered clinical license- Registered Nurse, Physical Therapist, Occupational Therapist
  • Ability to work any shift between the hours of 8:00am – 5:00pm CST (Central Standard Time) from Monday – Friday including the flexibility and willingness to work occasional overtime (an early or late shift and / or longer than normal hours to accommodate peaks in volume of work) and weekends based on business need.

Preferred Qualifications:

  • Bachelor’s Degree (or higher)
  • 2+ years of Case Management/Utilization Management experience
  • Experience in acute care, acute inpatient rehabilitation hospital, or skilled nursing facility environment
  • Managed Care experience
  • Experience with performing clinical audits to improve quality standards or performance.
  • Experience in working with geriatric population.
  • Knowledge and experience working with ICD-10 codes and InterQual.
  • Knowledge and experience with CMS guidelines

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: 

  • Ability to review patients clinical information holistically including critical thinking skills
  • Exceptional verbal and written interpersonal and communication skills
  • Ability to work efficiently in a self-management environment
  • Strong technical/computer skills
  • Excellent documentation skills
  • Self-starter with the ability to prioritize daily workload
  • Readiness to embrace a fluid, changing, and fast paced environment

Physical and Work Environment:

  • Ability to establish a home office workspace.
  • Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard timeframe.
  • Ability to communicate with clients and team members including use of cellular phone or comparable communication device.

California, Colorado, Connecticut, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Nevada / New York / New Jersey / Washington / Rhode Island residents is $32.60 – $63.99 per hour. 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.