Talent.com
Prior Authorization Clinical Review Coordinator - FL and TN Only

Prior Authorization Clinical Review Coordinator - FL and TN Only

UnitedHealth GroupJacksonville, FL, United States
job_description.job_card.variable_hours_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Clinical Review Coordinator is responsible for reviewing prior-authorization requests for post-acute levels of care. The CRC will review clinical documents and complete reviews based on medical necessity and InterQual criteria. Partners with physicians, providers, and other members of the team to determine the most appropriate level of care for the member.

Hours : Monday through Friday 8AM-5PM

If you are located in states of FL and TN, you will have the flexibility to work remotely

  • as you take on some tough challenges.

Primary Responsibilities :

  • Research member benefits and eligibility
  • Request and review member's clinical information from providers
  • Perform prior authorization reviews on post-acute level of care cases using appropriate clinical criteria; assign to Medical Director for review and decision when applicable; provide determinations to provider and member
  • Complete all assigned cases within required timeframes (TAT)
  • Educate providers, members and internal staff on guidelines, member benefits, and alternate levels of care available
  • Meets performance metrics with goal benchmarks
  • Process and document all case activities per SOPs, Job Aides, and DES; follows Model of Care guidelines
  • Acts as a Clinical resource for LPN / LVN and administrative team members
  • Collaborate with other members of the team to transition the member to an appropriate level of care
  • Communicate escalations and concerns to Senior ICM / Manager
  • Identify opportunities for improved communication or processes
  • Participate in team meetings, compliance meetings, education discussions, and related activities; completes assigned learning timely
  • Professionalism :

  • Personal and Professional Accountability :
  • Foster a positive work environment : assume positive intent, adapts to change in a positive manner

  • Ability to hold self-accountable for performance and results
  • Answers for one's own behavior and actions
  • Career Planning :
  • Develops own career path

  • Sets self-development goals and seeks challenging assignments
  • Demonstrates a mind-set in which continuous learning and personal growth are an expectation
  • Ethics : Integrate high ethical standards and UHG core values into everyday work activities
  • Integrity Value : Act Ethically

  • Relationships Value : Act as a Team Player; Communicate Effectively
  • Compassion Value : Focus on Customers
  • Innovation Value : Support Change and Innovation
  • Performance Value : Make Fact-Based Decisions; Deliver Quality Results
  • 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 :

    Active and unrestricted RN license

  • 3+ years total experience including recent clinical experience in an inpatient / acute setting
  • Experience in acute, long-term acute care, acute rehabilitation, or skilled nursing facilities
  • Experience in prior-authorization review
  • Proficient computer skills
  • Demonstrated high level of organizational skills, self- motivation, and ability to manage time independently
  • Proven exceptional verbal and written interpersonal and communication skills
  • Proven ability to prioritize, plan, and handle multiple tasks / demands simultaneously
  • Proven ability to quickly adapt to change and drive innovation within the team and market
  • Proven ability to work across functional areas and businesses to achieve business goals
  • Proven ability to develop and maintain positive customer relationships
  • Dedicated work area established that is separated from other living areas and provides privacy
  • Live in a location that can receive a UnitedHealth Group approved high-speed internet connection
  • Preferred Qualifications :

  • Bachelor's degree
  • 2+ years case management / utilization review
  • Experience with InterQual and Medicare criteria guidelines
  • Experience working with Commercial, Medicare, and Medicaid plans
  • Utilization Review background in managed care
  • All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
  • Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $34.23 to $61.15 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

    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.

    UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

    UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

    serp_jobs.job_alerts.create_a_job

    Clinical Coordinator • Jacksonville, FL, United States

    Job_description.internal_linking.related_jobs
    • serp_jobs.job_card.promoted
    Health Information Specialist I

    Health Information Specialist I

    DatavantJacksonville, FL, US
    serp_jobs.job_card.full_time
    Datavant is a data platform company and the world's leader in health data exchange.Our vision is that every healthcare decision is powered by the right data, at the right time, in the right for...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Medical Biller / coder / AR

    Medical Biller / coder / AR

    Family Medicine And Rehab IncJacksonville, FL, US
    serp_jobs.job_card.full_time
    As a Medical Biller, you will be working closely with clients to answer questions related to billing, processing all forms needed for insurance billing purposes, and collecting necessary documentat...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Patient Coordinator

    Patient Coordinator

    AkuminJacksonville, FL, US
    serp_jobs.job_card.full_time
    The Patient Coordinator is responsible for performing a variety of customer service and patient care tasks to ensure a positive patient experience. Ensures documentation and patient records are prep...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Patient Services Representative

    Patient Services Representative

    Mint CannabisSaint Augustine, FL, US
    serp_jobs.job_card.full_time
    Patient Services Representative.Mint Cannabis is proud to serve Florida's medical cannabis patients with compassion, innovation, and unmatched service. Everything we do is about elevating the experi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Intake Coordinator - Hospice

    Intake Coordinator - Hospice

    BrightSpring Health ServicesOrange Park, FL, United States
    serp_jobs.job_card.full_time
    Our Hospice Intake Coordinators are the heart of our organization who support patients by maintaining a seamless transition of the patient intake process from initial referral contact to admission....serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Phlebotomist I

    Phlebotomist I

    Spectraforce TechnologiesSt. Augustine, FL, United States
    serp_jobs.job_card.full_time
    Saint Augustine, Florida, United States, 32086.Mandatory Saturday rotation 7a-12p.The Patient Services Representative I (PSR I) represents the face of the company to patients who come in, both as p...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Certified Medical Assistant

    Certified Medical Assistant

    All Medical AlliedPonte Vedra Beach, FL, US
    serp_jobs.job_card.full_time
    We are seeking a Certified Medical Assistant to become a part of our team! You will perform routine administrative and clinical assignments to keep the medical facility&nbs...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Dementia Prog Act Coord

    Dementia Prog Act Coord

    BrightSpring Health ServicesOrange Park, FL, United States
    serp_jobs.job_card.full_time
    The Dementia Program Activities Coordinator will work with dementia patients receiving hospice care at home and in facilities to find activities that engage the interest of persons with Alzheimer's...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Remote Medical Scribe

    Remote Medical Scribe

    Scribe-XJacksonville, FL, US
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    Scribe-X offers unparalleled clinical experience and preparation for medical school.Receive extensive paid training that will help you master EMR systems and patient documentation procedures.Develo...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Medical Assistant, In-Office Procedures

    Medical Assistant, In-Office Procedures

    Southeast Orthopedic Specialists, LLCJacksonville, FL, US
    serp_jobs.job_card.full_time
    Medical Assistant, In-Office Procedures.Full-Time | Jacksonville, FL – Riverside.Join the #1 Orthopedic Team in Northeast Florida!. Southeast Orthopedic Specialists.As the largest private orth...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Patient Coordinator

    Patient Coordinator

    Aspen DentalMiddleburg, FL, US
    serp_jobs.job_card.full_time
    Patient Experience Coordinator.At Aspen Dental, we put you first, offering the security and job stability that comes with working with a world-class dental service organization (DSO).Our best-in-cl...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Medical Assistant, In-Office Procedures

    Medical Assistant, In-Office Procedures

    HOPCo | Healthcare Outcomes Performance CompanyJacksonville, FL, US
    serp_jobs.job_card.full_time
    Medical Assistant, In-Office Procedures.Join the #1 Orthopedic Team in Northeast Florida! Since 2001, Southeast Orthopedic Specialists has been the region's trusted leader in orthopedic medicinedel...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Patient Access Representative

    Patient Access Representative

    AscensionMiddleburg, FL, US
    serp_jobs.job_card.full_time
    Communicate with patients, participants, and staff to accurately schedule patients for prescribed procedures.Perform clerical and reception duties associated with patient registration.Gather necess...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Physician / Dermatology / Florida / Permanent / MOHS Surgery with Beautiful New Office on Northern F

    Physician / Dermatology / Florida / Permanent / MOHS Surgery with Beautiful New Office on Northern F

    Enterprise Medical RecruitingJacksonville, FL, US
    serp_jobs.job_card.permanent
    Join a Privately Owned Dermatology Group in Northern Florida on the Atlantic Coast as a MOHS Surgeon in the beautiful new office! If you love what you do and patient care is your top priority, this...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Physician / Dermatology / Florida / Permanent / MOHS Surgery with Beautiful New Office on Northern Florida's Atlantic Coast Job

    Physician / Dermatology / Florida / Permanent / MOHS Surgery with Beautiful New Office on Northern Florida's Atlantic Coast Job

    Enterprise Medical RecruitingJacksonville, Florida, United States
    serp_jobs.job_card.permanent
    Join a Privately Owned Dermatology Group in Northern Florida on the Atlantic Coast as a MOHS Surgeon in the beautiful new office! If you love what you do and patient care is your top priority, this...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Phlebotomist I

    Phlebotomist I

    Careers Integrated Resources IncSt. Augustine, FL, US
    serp_jobs.job_card.full_time
    Duration : 4+ Months (Possibility of Extension and conversion based upon performance).Shift : Mon-Fri 6 : 00 AM - 3 : 00 PM. Mandatory Saturday rotation 7 AM -12 PM.The Phlebotomist I serves as the face o...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Patient Coordinator

    Patient Coordinator

    Cancer Specialists of North FloridaJacksonville, FL, US
    serp_jobs.job_card.full_time
    Cancer Specialists of North Florida is recruiting for an experienced Patient Coordinator for our busy Ascension's Riverside Office. The Patient Coordinator is responsible for scheduling patient appo...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Medical Billing Specialist

    Medical Billing Specialist

    Center ONE Surgery CenterJacksonville, FL, US
    serp_jobs.job_card.full_time
    We are looking to add a Billing Specialist to our Team.Our board-certified physicians are experts in their fields and committed to the highest-level possible patient-focused healthcare.We utilize t...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Medical Scribe

    Medical Scribe

    Family Medicine And Rehab IncJacksonville, FL, US
    serp_jobs.job_card.full_time
    We are seeking a Medical Scribe to join our team.In this role, you will gather and document information about clients for their doctors visits. Responsibilities include printing lab reports, complet...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Patient Access Representative

    Patient Access Representative

    Women's CareFleming Island, FL, US
    serp_jobs.job_card.full_time
    Women's Care, founded in 1998, is a leading women's healthcare group in the United States, dedicated to providing the highest quality of care for women through their reproductive years and beyond.W...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30