Clinical Review Coordinator - National Remote

Company: UnitedHealth Group
Location: Lithia
Posted on: May 19, 2023

Job Description:

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.This position is full - time, Saturday - Tuesday. Employees are required to work any 8-hour shift schedule between the hours of 7:00 AM - 6:00 PM CST (Central Standard Time zone) including the flexibility and willingness to work an early OR late shift and / OR longer than normal hours to accommodate peaks in volume of work based on business need.We offer 3 - 4 weeks of training. Training will be conducted virtually from your home.*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.Primary Responsibilities:

• Perform in a hybrid role as either clinical "gatherer and authorization document creator" or solely as a clinical and authorization "reviewer" for all prospective, concurrent, and retrospective requests within established parametersPerform review for all direct admits to SNF via physician office, ED or HH--Perform all expedited prospective reviews, including patient oral and / or written notificationsPerform all standard prospective reviews, including patient oral and / or written notificationsMay have EMR access to mirror Inpatient Care Coordinator partner accessCoordinator peer to peer reviews with naviHealth Medical DirectorsNotify hospitals and SNFs of review outcomes for non - engaged patientsPartner with Medical Directors for Pre - Service Coordinator training as neededComplete processes as it relates to pre - service authorizationsEducate facilities on the pre - service denial processParticipate in the clinical phone queue to ensure customer SLAs are metSupport new delegated contract start-up to ensure experienced staff work with new contractsYou'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:
  • Bachelor's Degree (or higher)3+ years of clinical experienceExperience in oversight and supervision of assistants (CNAs, PTAs, OTAs)Active, unrestricted, registered clinical license - RN, Occupational Therapist OR Physical Therapist --Ability to work any full - time, 8-hour shift schedule between the hours of 7:00 AM - 6:00 PM CST (Central Standard Time zone) from Saturday - TuesdayFlexibility and willingness to work an early OR late shift and / OR longer than normal hours to accommodate peaks in volume of work based on business needTelecommuting Requirements:
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • --Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet serviceOptum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental, and social needs - helping patients access and navigate care anytime and anywhere.-- As a team member of our naviHealth product, we help change the way health care is delivered from hospital to home supporting patients transitioning across care settings. This life-changing work helps give older adults more days at home. We're connecting care to create a seamless health journey for patients across care settings. Join our team, it's your chance to improve the lives of millions while doing your life's best work.SMCalifornia, Colorado, Connecticut, Nevada, Washington, or New York, Rhode Island Residents Only: The salary range for California / Colorado / Connecticut / Nevada / Washington / New York / Rhode Island residents is $32.60 - $63.99. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.#RPO #YELLOW

Keywords: UnitedHealth Group, Lakeland , Clinical Review Coordinator - National Remote, Healthcare , Lithia, Florida