Primary Responsibilities:

• 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 Qualification:

• 1+ years of experience in customer service or healthcare experience

Preferred Qualifications:

• 2+ years of office experience in healthcare industry
• Intermediate level of experience with Microsoft Office

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

California Residents Only: The hourly range for this role is $16.00 to $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.