Shire Jobs

If you are located within Commerce, CA, you will have the flexibility to telecommute* (work from home) 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.

Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California, to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

Responsible for providing administrative and clerical support within area of responsibility that may include telephone support, filing, typing, coordinating schedules, distributing correspondence, materials management, data entry, simple data analyses, and rudimentary reporting. All within established legal guidelines and maintaining confidentiality at all times.

This position is full time, Monday - Friday. Employees are required to have flexibility to work our normal business hours of 8:00am - 5:00pm (Rotate weekends every other weekend). It may be necessary, given the business need, to work occasional overtime. Our office is located at 5701 South Eastern Avenue, Commerce, CA.

We offer 4 weeks of paid training. The hours during training will be 8am to 5pm, Monday - Friday.

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

Primary Responsibilities:

• Consistently exhibits behavior and communication skills that demonstrate our company's commitment to superior customer service, including quality, care and concern with each and every internal and external customer.

• Performs effective prospective and concurrent review of requested services according to established guidelines and timeframes.

• Documents members’ service benefits by contacting the appropriate health plans as needed.

• Directs providers/members to contracted provider network and facilities.

• Processes appropriate authorizations for HMO/PPO clients as specified in the Optum procedures.

• Prints and mails authorizations to providers, patients, HMOs and facilities as needed.

• Assists and monitors in the processing of referrals.Enters, updates and closes referrals daily while assuring that appropriate internal/external referral providers are utilized, members are eligible and have benefits coverage, correct CPT/ICD-9 codes have been entered, accurate records of all dates and other required fields are entered, supporting clinical data for the referrals is entered, and all urgent referrals are processed within the designated timeframe.

• Processes referrals for durable medical equipment and coordinates home health services according to established policies, procedures and guidelines.

• Processes elective surgical requests including the coordination of surgery dates and notification of inpatient team, Hospitalist or Care Manager when appropriate.

• Coordinates, identifies and routes referrals that require review to licensed Care Management staff who arranges outside physician medical review as appropriate.

• Acts as a resource to other coordinators, staff and providers by resolving issues and responding to requests in a timely and effective manner.

• Works with Patient Services regarding member concerns.

• Processes referrals for inter-facility transfers using pre-established guidelines.

• Processes after-hours emergency/urgent care logs/lists as needed.

• Collects and prepares medical records for review when appropriate or as requested.

• Assists with answering telephones and maintaining files, logs or other reports.

• Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

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 front office, back office, coordinator, insurance or medical group

• Ability to work our normal business hours of 8:00am - 5:00pm (Rotate weekends every other weekend). It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• 2+ years of office experience in healthcare industry at the corporate level

• 1+ years of experience insurance eligibility

• Intermediate level of experience with Microsoft Suite

Telecommuting Requirements:

• Reside within commutable distance to Commerce, CA

• 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 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.

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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