Pre-Service Coordinator - Remote

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 9:00am - 6:00pm CST or 10:00am - 7:00pm CST. It may be necessary, given the business need, to work occasional overtime.

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

Primary Responsibilities:

Positions are responsible for providing clinical and medical management services, including case management, health assessments, interventions, and discharge planning.

• Assesses and interprets customer needs and requirements.
• Identifies solutions to non-standard requests and problems.
• Solves moderately complex problems and/or conducts moderately complex analyses.
• Works with minimal guidance; seeks guidance on only the most complex tasks.
• Translates concepts into practice.
• Provides explanations and information to others on difficult issues.
• Coaches, provides feedback, and guides others.
• Acts as a resource for others with less experience

Positions in this function require various professional clinical education, certification and clinical licensure in ancillary clinical roles such as therapist or technician i.e., other than that of physician (MD or DO) or nursing (RN or LPN), based on the specific job posting, job code and grade level. Current, unrestricted licensure in applicable state is required, depending on role and grade level, for therapists (e.g., physical or speech therapists), prosthetists/orthotists, or medical specialty technicians (e.g., sleep lab technicians). Therapists may work under the supervision of an RN or a physician, and technicians work under the supervision of a physician.

Positions are responsible for providing appropriately focused Medical Mgmt Clinical Review of the activities listed below, in support of physician activities, and in accordance with specific review protocols, based on individual member plan documents, national and proprietary coverage review guidelines, and established clinical review guidelines.

• Preservice and Retrospective coverage determinations, and/or
• Appeals for services that have been denied.

Uses technical knowledge and related review protocols in the review of clinical information and documents as they relate to company medical policy and benefit document language. Under the direct oversight of physicians or RNs, may recommend clinical appropriateness of designated services.

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 higher)
• 3+ years of clinical experience
• Active, unrestricted registered clinical license - Registered Nurse, Physical Therapist, Occupational Therapist
• Experience with physician engagement & crucial conversations
• Flexible and willing to work a later shift and/or longer than normal hours to accommodate peaks in volume of work
• Ability to work any of our 8-hour shift, Monday - Friday between the hours of 9:00am - 6:00pm CST or 10:00am - 7:00pm CST

Preferred Qualifications:

• 2+ years of Case Management experience
• Experience in acute care, rehab, or skilled nursing facility environment
• Managed Care experience
• Experience working with geriatric population
• ICD-10, InterQual and Milliman Experience
• CMS knowledge

Soft Skills:

• Exceptional verbal & written interpersonal & communication skills
• Ability to work effectively in a self-managed environment
• Solid technical/computer skills
• Readiness to embrace a fluid, changing and fast-paced environment
• Solid critical thinking skills & the ability to review patients clinical information holistically

Telecommuting 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 service

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at {apply below}

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. {apply below}

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $31.78 - $56.88. The salary range for Connecticut / Nevada residents is $35.00 - $62.45. 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.

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: #RPO, #YELLOW

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