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

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.

The Utilization Management Phone Representative works under minimum supervision to perform routine and complex clerical tasks; answers referral status and determination questions from patients, family members, health plans, and other clinic personnel. Also intakes verbal requests for organization determinations from patients or an appointed representative, and enters those requests into the Utilization Management referral system for processing. Ensures good internal and external public relations including coordination of communication between functional units within Utilization Management to improve customer service outcomes.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00 AM - 5:00 PM. It may be necessary, given the business need, to work occasional overtime.

This will be paid on-the-job training and the hours during training will be 8:00 AM - 5:00 PM from Monday - Friday.

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

Primary Responsibilities: 

• Receives and processes incoming telephone calls into the department, and maintains a log of incoming calls by reason for the call. 
• Assists patients with questions regarding their referrals and determinations through application of a thorough knowledge and timely access to referral management systems. 
• Performs auditing functions of patient referrals including verifications of insurances and eligibility. 
• Acquires and files additional clinical documentation pertaining to incoming calls and inquiries to support referral management and organization determination functions. 
• Assists patients with the appeals process with the health plans. 
• Processes and inputs new verbal referral requests from patients or an appointed representative, and enters the request into the referral management system. 
• Make outbound calls to members and providers regarding organization determinations to meet regulatory notification turnaround time requirements. 
• Researches returned mail searching for current addresses, correcting patient information as necessary, and filing signed certification slips in referral system.

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 experience
• Must be 18 years of age OR older
• 1 years of experience in a medical environment, office, OR clinic
• Experience with computers and Windows - based programs including Microsoft Word, Microsoft Excel, and Microsoft Outlook
• Ability to work any shift between the hours of 8:00 AM - 5:00 PM from Monday - Friday including the flexibility to work occasional overtime business need

Preferred Qualifications:

• 2 years of managed care experience in a medical office / clinic
• Bilingual fluency in English and Spanish

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, or Rhode Island Residents Only: The hourly range for this is $16.00 - $28.27 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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