You’ll enjoy the flexibility to telecommute from anywhere within the U.S. 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 CAC will be responsible for managing various administrative and coordination tasks to support efficient inpatient admissions, post-acute case management, and ensure compliance with healthcare standards. This role requires a professional with strong communication skills, the ability to manage multiple priorities, and a commitment to delivering high-quality support in a fast-paced healthcare environment.This position is full-time. Employees are required to have flexibility to work 4 days, 10 hour shifts between the hours of 6:00am – 8:00pm PST, Thursday - Sunday OR Saturday - Tuesday. It may be necessary, given the business need, to work occasional overtime.We offer weeks of on-the-job training. The hours during training will be during your regularly scheduled hours.All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.Primary Responsibilities:
Oversee the management of building inpatient admissions and post-acute cases, ensuring that the admissions process is efficient and that turnaround times are met.
Handle incoming clinical records by reviewing, organizing, and attaching them to the associated inpatient case in a timely manner.
Respond to incoming calls, providing exceptional customer service, and directing inquiries to the appropriate department or individual as needed.
Manage appeals oversight for the Quality Improvement Organization (QIO) and health plan, ensuring all procedures are followed according to regulatory and company standards.
Initiate peer-to-peer reviews with healthcare providers to discuss patient cases and ensure appropriate care is provided.
Prepare and send out initial Notice of Medicare Non-Coverage (NOMNC) packets and process incoming packets, maintaining compliance and proper documentation.
Maintain oversight of regional emails and faxes, ensuring timely and accurate responses to all communications.
Manage Prior Authorization intake for Skilled Nursing Facilities (SNF), Long-Term Acute Care Hospitals (LTACH), Acute Inpatient Rehab (AIR), and other services as needed.
Perform any additional duties assigned by UM support leadership, which could include administrative tasks, reporting, or participating in special projects.
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 experience.
1+ years in a customer service role
6+ months in a healthcare environment.
Experience with office products (Microsoft Word, Microsoft Excel, Microsoft outlook and Microsoft PowerPoint)
Must be 18 years of age OR older
Ability to work full-time, 4 days, 10 hour shifts between the hours of 6:00am – 8:00pm PST, Thursday - Sunday OR Saturday - Tuesday including the flexibility to work occasional overtime given the business need
Preferred Qualifications:
Knowledge of medical terminology
Health Insurance experience
Telecommuting Requirements:
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:
Excellent verbal communication and organizational skills
Self-motivated
Attention to detail.
Ability to multi-task and work under pressure.
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Hawaii / Nevada / New York / New Jersey / Washington / Rhode Island residents is $16.54 - $32.55 per hour. 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.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.#RPO
