Job Description

Description

 

Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Due to our expanding business, Optum, part of the UnitedHealth Group family of businesses, is seeking Clinical Administrative Coordinators who share our passion for helping others live healthier lives. As one of the world's leading health care companies, Optum is pursuing innovative new ways to operate our service centers and improve on our ability to deliver high-quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Take this opportunity and begin doing your life's best work.(sm)


What makes your clinical career greater with Optum? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.


Primary Responsibilities: 

  • Act as a Subject Matter Expert for other team members
  • Manage the intake of members or the admission/discharge information post notification 
  • Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and/or providers
  • Manage the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
  • Provide appropriate triage and care coordination notification cases for non-clinical assessment/intervention 
  • Process notification requirements 
  • Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review
  • Handle resolution/inquiries from members and/or providers that may include: 

- Benefit and Eligibility information

- Billing and Payment issues

- Customer material requests

- Physician assignments

- Authorization for treatment

- Explanation of Benefits (EOB)

- Verifying appropriate ICD-9 and CPT coding usage

Qualifications

 

Required Qualifications:

  • Active USRN License
  • Experience working within the Healthcare Industry
  • Working knowledge of Medical Terminology to communicate with members and providers
  • Ability to create, edit, save and send documents utilizing Microsoft Word and Excel
  • Ability to navigate a PC to open applications, send emails, and conduct data entry

Preferred Qualifications:

  • Hospital experience in Critical Care Areas
  • Professional experience in a clerical or administrative support related role
  • Experience working with Healthcare Insurance
  • Experience working with ICD-9 and CPT codes
  • Experience working with Medicare and/or Medicaid Services

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)


Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity 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.

Optum is a drug-free workplace. © 2019 Optum Global Solutions (Philippines) Inc. All rights reserved.

Job Keywords: Hiring for US Registered Nurses, USRN, NCLEX, US Registered Nurse, US Nurse, United States Nurse, United States Registered Nurse, Registered Nurse, RN, Healthcare BPO, Medical Terminology, Quezon City, QC, National Capital Region

Job Field

  Nursing

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