At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
If you reside within a compact state, you’ll enjoy the flexibility to work remotely * as you take on some tough challenges.
Primary Responsibilities:
Secure, track and review records via multiple media
Identify program specific documents within member’s records
Submit coverage checks and claims to Allstate on members behalf
Obtain appropriate medical records from various health care providers
Use clinical judgement to prepare records for external review
Use clinical judgement to triage patients for program candidacy
Make appropriate referrals into various programs in a timely manner
Act as a liaison between COE facilities and Care Managers or referring parties
Facilitate patient participation in Case Management with regular medical carrier
Skilled telecommunications in a high-touch member program
Encourage and support members participating in the program with sensitivity and compassion
Educate members regarding program policies and procedures
Evaluate appointments to determine if they fall under the COE guidelines
Assist members with travel questions related to medical necessities
Receive and collects data necessary for program enrollment, review, and reporting
Responsible for providing seamless customer service to include updating member information, vendors portals, and internal documentation
Participate in staff meetings
Notify patients, COE facilities and Care Managers when program benefit end date is approaching
Develop and maintain a positive relationship with external vendors
Develop and maintain a positive enthusiastic working relationship with all staff, in addition to all members, caregivers, donors and providers
Solid ability to identify appropriate resources for research and problem resolution
Ability to triage telephone calls received in a queue
Other duties as assigned by supervisor
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:
Current and unrestricted compact state RN license
1+ years of clinical nursing experience
Ability to work in a fast-paced multi-tasking environment
Basic proficiency with Microsoft Word, Excel, Teams and Outlook
Preferred Qualifications:
Associates or Bachelors of Science in Nursing
3+ years of clinical nursing experience
Case management experience
Soft Skills:
Demonstrated excellent verbal and written communication skills
Effective organizational and prioritization skills
Proven interpersonal skills with ability to function as a positive team member
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, or Washington, D.C. Residents Only: The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with al 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.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.