Complex Customer Care Representative

Complex Customer Care Representative

ProHealth Physicians (CT), part of the Optum family of businesses, is seeking a Complex Customer Care Representative to join our team in Farmington, CT. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone.

Join us and discover how rewarding medicine can be while Caring. Connecting. Growing Together.

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 - 4 : 30 pm EST. It may be necessary, given the business need, to work occasional overtime.

We offer 4 - 8 weeks of paid training. The hours during training will be 8am to 4 : 30pm EST, Monday - Friday. Training will be conducted onsite and virtual.

Primary Responsibilities :

• Documents all member interactions in a concise manner that is compliant with documentation requirements for Model of Care, NCQA and Center for Medicare and Medicaid Services (CMS) regulations
• Receives and responds to incoming Care Coordination inquiries from all communication venues
• Coordinates and assists in monitoring of documentation Care Management queues for Disease Management, Transitions of Care, Complex Care, and Social Work referrals
• CTA processes CM requests via all communication venues; as well as administrative preparation for clinical staff
• Conducts in-bound and out-bound calls for program requirements including, but not limited to : member scheduling, surveys / screenings, census management and distribution of materials to appropriate clinical personnel or members
• Performs daily preparation of INPT and Post-Acute Census for use in CM referrals, and informs Care Management Manager of outstanding cases to ensure adherence to NCQA regulations
• Completes timely data entry of in-bound and / or out-bound call member contact information into software applications
• Provides clerical and / or administrative support to clinical staff and managers for special projects and reporting needs
• Provides excellent customer service by serving as a resource to all internal and external customers
• Attends required meetings and participated in ad hoc committees as needed
• Maintains knowledge of all health plan benefits, network, NCQA regulations, health plan policies
• Identifies opportunities for process improvement in all aspects of member care
• Must always maintain strict confidentiality
• Must adhere to all department / organizational policies and procedures
• Performs all other related duties as assigned

Required Qualifications :

Preferred Qualifications :

Telecommuting Requirements :

Soft Skills :

Physical and Work Environment :

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 $17.74 - $31.63 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.