Clinical Operations Coordinator - Dallas, TX - Optum : Job Details

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.

Positions 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. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 6:00pm, Monday – Friday. It may be necessary, given the business need, to work occasional overtime. Our office is located at 3107 W CAMP WISDOM RDSU.

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

Primary Responsibilities:

• Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit.
• Impact of work is most often at the team level.
• Owns output at task level.
• Work is generally limited to own function.
• Sets priorities for the team to ensure task completion.
• Coordinates work activities with other supervisors.
• Develops plans to meet short-term objectives.
• Identifies and resolves operational problems using defined processes, expertise and judgment.
• Decisions are guided by policies, procedures and business plan.
• Product, service or process decisions are most likely to impact individual employees and/or customers (internal or external).
• 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
• Must be 18 years of age OR Older
• 3+ years of Customer Service experience
• Proficient with Microsoft Office Suite
• 1+ years of leadership experience
• Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 6:00pm, Monday – Friday. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• Managed care experience in a care coordination role
• Call center experience
• Experience supervising employees

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 #RED