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Optum ’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California, to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

Position in this function includes those 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.

This position is full time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 AM - 5:00 PM PST. It may be necessary, given the business need, to work occasional overtime.

This will be paid on-the-job training and the hours during training will be 8:00 AM - 5:00 PM PST from Monday - Friday.

If you are located within the state of California, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• 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 next steps

• Reference automated job aid tools via the computer to identify appropriate procedures when needed

• 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 system and process changes and updates and incorporate into daily work

• Contact internal resources if necessary to clarify information

• Identify appropriate resource (e.g., doctor, resource, contracted provider) to respond to medical 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

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

• Must be 18 years of age OR older

• 1+ years of experience in customer service in an office setting OR healthcare experience

• Experience with using computers including Windows based programs

• Experience with Microsoft Word and Microsoft Outlook

• Ability to work any of our shift schedules during our normal business hours of 8:00 AM - 5:00 PM PST from Monday - Friday.

Preferred Qualifications:

• 2+ years of office experience in the healthcare industry

• Medical assistant

Telecommuting Requirements:

• Reside within the state of California

• 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

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The hourly range for this role is $16.00 to $28.85 per hour based on full-time employment. 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 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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