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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.

WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient’s health. WellMed ’s proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.

Under the supervision of the Network Operations Supervisor, this position is responsible for the daily coordination of Network Operations processes in the Intake Call Center. This position serves as the initial intake of pre - service requests, claim reviews and inpatient hospital coordination and diabetic supplies. Coordinates Network Operations processes with Medical Directors, Network Operations Nurses, hospitals, physicians and other various departments. Provides clerical support to clinical staff in their medical necessity review process. The Clinical Administrative Coordinator is expected to maintain production and quality standards.

This position is full time (40 hours / week), Sunday - Saturday. Employees are required to have flexibility to work any varying 8-hour shifts during our normal business hours of 9:00 AM - 7:00 PM CST to support our 24 hours a day / 7 days per week operations. It may be necessary, given the business need, to work any shift in a 24-hour period, all days of the week, including occasional / mandatory overtime (2 hours per day during peak season), weekends, evening, and / or overnight shifts. The work hours will be in Central Standard Time.

We offer 6 - 8 weeks of paid training. The hours during training will be 8:00 AM - 4:30 PM CST from Monday - Friday. All employees will be required to be on camera every day of training, including when training module assessments are completed. Training will be conducted virtually from home.

If you are located within the Mountain OR Central Time Zone, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Managing authorizations / notifications and other service requests received via incoming phone calls, faxes and portal submission

• Providing excellent customer service, including the ability to handle escalated callers

• Determining authorization or notification requirements

• Preparing authorization cases for Medical Directors, Network Operations Nurses, and Case Managers

• Providing administrative approvals (depends on the line of business)

• Handling expedited authorizations, authorization updates and status checks

• Confirming member eligibility

• Outreaches to providers and / or Patient to complete authorization requests and prescriptions

• Maintaining knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies

• Utilizing experience and judgement to plan, accomplish goals and effectively resolve each assigned task

• Non - Clinical staff is not responsible for conducting any Network Operations activity that requires interpretation of clinical information

• Performs all other related duties as assigned

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+ years of combined OR related experience in a healthcare, call center, and / OR customer service setting using the telephone and computer as the primary instrument to perform job duties

• Proficiency with Microsoft Office: Microsoft Word (create and maintain documents), Microsoft Excel (create and maintain spreadsheets), and Microsoft Outlook (email and calendaring)

• Ability to work any varying 8-hour shifts between the hours of 9:00 AM - 7:00 PM CST from Sunday - Saturday to support our 24 hours a day / 7 days per week operations. It may be necessary, given the business need, to work any shift in a 24-hour period, all days of the week, including occasional / mandatory overtime (2 hours per day during peak season), weekends, evening, and / or overnight shifts.

Preferred Qualifications:

• Medical terminology

• ICD - 10 and CPT knowledge

Telecommuting Requirements:

• Reside within the Mountain OR Central Time Zone

• 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

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Colorado 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.

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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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