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 UMR Clinical Administrative Coordinator - Telecommute in West Virginia - MORGANTOWN, West Virginia, United States

Job information
Posted by: UnitedHealth Group 
Hiring entity type: Insurance 
Work authorization: Not Specified for United States
Position type: Direct Hire, Full-Time 
Compensation: ******
Benefits: See below
Relocation: Not specified 
Position functions: Administrative - Other
Health - Clinical/Medical Assistant
Customer service & support
Management - General
Travel: Unspecified 
Accept candidates: from anywhere 
Languages: English - Fluent
Spanish - Fluent
Minimum education: See below 
Minimum years experience: See below 
Resumes accepted in: English
Cover letter: No cover letter requested
Job code: 800705_1 / Latpro-3656474 
Date posted: Dec-22-2018
State, Zip: West Virginia, 26501


Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Due to our expanding business, UnitedHealth Group is seeking Clinical Administrative Coordinators who share our passion for helping others live healthier lives. As one of the world's leading health care companies, UnitedHealth Group is pursuing innovative new ways to operate our service centers and improve on our ability to deliver high - quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Take this opportunity and begin doing your life's best work.SM
What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
A UMR Clinical Administrative Coordinator (CAC) has a serious responsibility to make every customer contact informative, productive, positive, and memorable. Employees in this position handle provider / member requests for pre - service review, performing initial triage of case types, provide information on available services, and coordinate with nurses and Medical Directors on the prospective review of requested services for UMR members. CACs also manage time - sensitive review requests and have the opportunity to do live outreach to providers.
Primary Responsibilities:
  • Provide excellent Customer Service to both providers and members by responding to and resolving incoming inquiries and requests.
  • Consistently meet established productivity and quality standards while adhering to schedules and maintaining good attendance.
  • Receive Care Coordination notifications for non - clinical assessment / intervention and provide appropriate triage. Approve when able and send to clinical reviewer when unable.
  • Process notifications for outpatient procedures, home health, DME, transition of care, and network gap issues.
  • Depending on product, process out – of – network requests for consideration of in - network level of benefits for physician specialty referrals.
  • Determine benefit coverage based on employer group contracts.
  • Communicate benefit determinations to providers / members within DOL timeframes.
  • Process letters within DOL timeframes.
  • When relevant, ensure potential member needs are identified and forwarded to the appropriate Care Coordinator for risk evaluation - refer to CM and DM as relevant.
  • Verify appropriate ICD - 10 and CPT coding usage.
  • Assist with processing of faxes and emails, including sending provider “fax forms” for certain clinical scenarios as designated. Make outbound calls to contact Providers, requesting clinical from provider as necessary.
  • Take inbound calls to provide status of cases from providers.
  • Ensure case requires PA, is “scrubbed” prior to sending to clinical reviewer, and includes all necessary components.
  • Take inbound calls from providers requesting a Peer – to – Peer discussion, prep requests for Peer – to – Peer discussions with Medical Directors and assign them in Aerial.
  • Confirm urgent versus non - urgent.
  • Prioritize and organize own work to meet deadlines while working with others as part of a team.
  • Cooperate with all members of CCR staff to ensure compliance with standards and regulations.
  • Work with other departments to ensure appropriate handling of customer requests.
  • Use knowledge and judgment to escalate complex problems to supervisor when necessary.
  • Perform other duties as assigned by manager and / or director.

Required Qualifications:
  • High School Diploma / GED or higher
  • 1+ years of professional experience in an office / customer service environment
  • Previous experience working with Microsoft Word (ability to create, edit and save)
  • Previous experience working with Microsoft Excel (ability to create, edit and save)
  • Computer proficiency including, but not limited to, ability to learn new computer system applications
  • Flexibility to work outside standard hours of operation due to changing business needs
  • Must have a quiet designated work space and access to install secure high - speed internet (minimum speed 1.5 download mps and 1 upload mps) via cable / DSL in home (NOTE: wireless / cell phone provider, satellite, microwave, etc. does NOT meet this requirement)
Preferred Qualifications:
  • Bachelor's Degree or higher
  • Professional experience in an Office setting using the telephone and computer as the primary instruments to perform the job duties OR Customer Service experience analyzing and solving customer problems
  • Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD - 10 and CPT codes, Medicare and / or Medicaid Services, call center environment
  • Professional experience in a Clerical or Administrative support related role
  • Previous experience with Microsoft Outlook (ability to create, edit and save) or Lotus Notes (ability to create, edit and save)
  • Bilingual fluency in English and Spanish
Physical Requirements and Work Environment:
  • Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer
Soft Skills:
  • Ability to work in a fast - paced, dynamic, rapidly changing environment.
  • Excellent oral and written communication skills.
  • Strong aptitude for working in a production driven environment.
  • Must be a self - starter and able to work autonomously.
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near - obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM
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.
Keywords: UHG, Clinical, Healthcare, Administrative, UnitedHealthcare


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