Utilization Management Phone Representative - Remote in Redlands, CA

If you are located within a commutable distance of 1615 Orange Tree Ln, Redlands, CA, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

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.

The Utilization Management Phone Representative works under minimum supervision to perform routine and complex clerical tasks; answers referral status and determination questions from patients, family members, health plans, and other clinic personnel. Also intakes verbal requests for organization determinations from patients or an appointed representative, and enters those requests into the Utilization Management referral system for processing. Ensures good internal and external public relations including coordination of communication between functional units within Utilization Management to improve customer service outcomes. Reports directly to the Utilization Management Specialist Supervisor and has regular interaction with patients and other areas within Utilization Management.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00 AM - 5:00 PM PST. Our office is located at 1615 Orange Tree Ln, Redlands, CA. Must attend a monthly meeting onsite once a month in Redlands, CA.

We offer weeks of paid on-the-job training. The hours of the training will be aligned with your schedule or will be discussed on your first day of employment.

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

Primary Responsibilities:

• Receives and processes incoming telephone calls into the department, and maintains a log of incoming calls by reason for the call.
• Assists patients with questions regarding their referrals and detenninations through application of a thorough knowledge and timely access to referral management systems.
• Performs auditing functions of patient referrals including verifications of insurances and eligibility
• Acquires and files additional clinical documentation pertaining to incoming calls and inquiries to support referral management and organization determination functions.
• Assists patients with the appeals process with the health plans.
• Processes and inputs new verbal referral requests from patients or an appointed representative, and enters the request into the referral management system.
• Make outbound calls to members and providers regarding organization determinations to meet regulatory notification turnaround time requirements.
• Researches returned mail searching for current addresses, correcting patient information as necessary, and filing signed certification slips in referral system.
• May be assigned special project or other assignments and work tasks that are generally within the scope and level of the position, and relative to the need for flexible Company operations.

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 equivalent years of work experience
• Must be 18 years of age OR older
• 1+ years of front office experience in a medical office / clinic
• Ability to work any shift between the hours of 8:00 AM - 5:00 PM PST from Monday - Friday

Preferred Qualifications:

• 2+ years of managed care experience in a medical office / clinic
• Customer Service Training

Telecommuting Requirements:

• Reside within a commutable distance of 1615 Orange Tree Ln, Redlands, CA
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

• Appropriate English usage, spelling, grammar, punctuation; knowledge of basic arithmetic concepts; ability to operate standard office machines; basic application of CPT's.
• Excellent telephone skills.
• Ability to complete tasks in a timely and accurate manner; and compliance with department and organization policies and procedures.
• Strong verbal / written communication and customer service skills.
• Ability to successfully uphold the established customer service standards and Company Mission Statement.
• Bilingual fluency in English and any other language.

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

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for 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.

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