Senior Clinical Administration Coordinator

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Senior Clinical Administrative Coordinator is responsible for initial triage of members, administrative intake of members or managing the admission/discharge information post-notification, working with hospitals and the clinical team. Includes managing incoming calls, managing requests for services from providers/members, providing information on available network services and transferring members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior authorizations. This function includes intake, notification and census roles. *Employees in jobs labeled with 'SCA' must support a government Service Contract Act (SCA) agreement.

This position is full-time. Employees are required to work during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime. Our office is located at 5820 S Eastern Ave, Las Vegas, NV.

Primary Responsibilities:

• Receive Medical/Behavioral/Clinical Services or Benefits Requests
• Serve as primary point of contact for providers or members regarding medical/behavioral/clinical services or benefits
• Extract and review fax requests for medical or clinical services
• Receive calls requesting medical/behavioral/clinical services or benefits information (e.g., from providers or members)
• Receive electronic referral form requests for medical/behavioral/clinical services
• Utilize phone system to respond to and transfer calls to appropriate individuals
• Ask callers standard questions to understand requests, gather necessary information, and assess urgency
• Access electronic member files using policy or id number
• Determine member eligibility
• Follow protocols to task requests appropriately
• Check procedure codes against notification requirements and benefit coverage to determine the next steps
• Reference automated job aid tools via the computer to identify appropriate procedures when needed
• Research Information to Respond to Medical/Behavioral/Clinical Services or Benefits
• Access claims information
• Review and interpret call history documentation (e.g., case notes)
• Navigate between computer screens and platforms to research information (e.g., medical, clinical, or benefits information)
• Take calls and questions from members and/or providers regarding case status
• Determine whether authorizations are required for requested medical services
• Reference automated job aid tools via computer to research relevant rules, regulations, or procedures
• Learn computer systems and process changes and updates and incorporate into daily work
• Contact internal resources if necessary to clarify information
• Identify appropriate resources (e.g., doctor, resource, contracted provider) to respond to medical requests
• Process Medical/Behavioral/Clinical Services or Benefits Requests
• Provide/explain benefit information to members/providers
• Provide/explain authorization information to members/providers
• Communicate with clinical team to ensure provider receives a response when necessary
• Document call history information into relevant computer system
• Enter medical request data into relevant computer system
• Follow standard procedures to complete requests
• Request medical review via relevant computer system as needed
• Review and advise member/provider of status of a request (e.g., notification, authorization)
• Schedule appointments for members based on request
• Provide information regarding appointments and medical services to facilities staff to assist members

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

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)
• 1+ years of customer service experience
• 1+ years of experience in patient care
• Ability to work during our normal business hours of 8:00am - 5:00pm, including the flexibility to work occasional overtime, based on business needs
• Must be 18 years of age OR older

Preferred Qualifications:

• Bilingual fluency in English and Spanish

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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