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.Responsible for timely and accurate processing of work that supports the administrative requirements of the Medical Management department. Adheres to policies, procedures, and regulations to ensure compliance and patient safety. Participation in Compliance and other important training is a condition of employment.This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 7:00 AM - 6:00 PM MST OR PST. It may be necessary, given the business need, to work possible weekend rotation.We offer 6 weeks of paid training. The hours during training will be any 8-hour shift between 7:00 AM - 6:00 PM MST & PST.All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.Primary Responsibilities:
Oversee the management of building inpatient admissions and post-acute cases, ensuring that the admissions process is efficient and that turnaround time requirements are met.
Handle incoming clinical documentation by reviewing, organizing, and attaching them to the associated inpatient case in a timely manner.
Answering Inbound calls, providing exceptional customer service, and directing inquiries to the appropriate department or individual as needed.
Manage appeals oversight for the Quality Improvement Organization (QIO) and health plan, ensuring all procedures are followed according to regulatory and company standards.
Initiate peer - to - peer reviews with healthcare providers to discuss patient cases and ensure appropriate care is provided.
Prepare and send out initial Notice of Medicare Non - Coverage (NOMNC) packets and process incoming packets, maintaining compliance, and proper documentation.
Maintain oversight of regional emails and faxes, ensuring timely and accurate responses to all communications.
Manage Prior Authorization intake for Skilled Nursing Facilities (SNF), Long - Term Acute Care Hospitals (LTACH), Acute Inpatient Rehab (AIR), and other services as needed.
Perform any additional duties assigned by UM support leadership, which includes administrative tasks, reporting, or participating in special projects.
Attends departmental meetings and provides constructive recommendations for areas of improvement.
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
Must be 18 years of age OR older
1.5+ years of experience of which one (1) year is in a customer service role and six (6) months in a healthcare environment
Ability to work any 8-hour shift between the hours of 7:00 AM - 6:00 PM MST OR PST from Monday - Friday including the flexibility to work possible weekend rotation based on business need
Preferred Qualifications:
Communication, interpersonal, organization, and customer service skills
Knowledge of medical terminology
Self - motivated, computer skills
Attention to detail
Ability to multi - task and work under pressure
Skilled with Microsoft Office software applications
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, Rhode Island, OR Washington, D.C. Residents Only: The hourly range for this is $16.54 - $32.55 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.#RPO