Behavioral Health Clinical Administrative Coordinator - Remote Nationwide

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Clinical Administrative Assistant validates eligibility for authorization requests and prepares Behavioral Health and Substance Use Disorder authorizations across various lines of business. They collaborate with leadership, refer members for aftercare planning, and notify providers of authorization determinations. They offer peer-to-peer consultations for cases not meeting criteria, drafts denial letters, and assists callers promptly. They handle incomplete requests, take meeting notes, maintain confidentiality, and manage escalated calls. Additionally, they apply clinical knowledge to guidelines, monitor the fax queue, verify documentation, and maintain job aids.

If you are located within the United States and able to work Mountain Time Zone you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Verifies eligibility of providers and members for all authorization requests
• Inputs and prepares all Behavioral Health and Substance Use Disorder authorizations submitted by providers for all lines of business, including RMHP DSNP, RMHP Medicare, RMHP PRIME Medicaid, RMHP RAE Medicaid, RMHP CHP+, RMHP IFP, and NHP RAE Medicaid and assign to the specified Clinical Coordinator
• Refers members to the RMHP Care Coordination Department when completing discharge documentation, ensuring needs are addressed to facilitate successful aftercare planning
• Notifies providers and requestors of all authorization determinations when appropriate
• When a case is determined not to meet criteria, correspond with the requesting provider to offer a peer-to-peer consultation with the RMHP medical director, allowing the provider to present additional information before a final decision is made
• When a medical director issues a denial, the Clinical Administrative Assistant drafts a letter informing the member and the requesting provider of the decision, the reasons for the decision, and offers alternative treatment options
• Promptly provides assistance to callers routed to the BH UM department
• Completes required trainings by the assigned due dates to comply with auditing entities such as NCQA. These trainings include, but are not limited to the following: MCG criteria, ASAM criteria, and InterQual criteria
• If an incomplete authorization request is submitted, the Clinical Administrative Coordinator will attempt to obtain the missing information from the requestor and initiate an extension if needed with the Clinical Coordinator
• Take detailed notes of meetings attended and share with attendees
• Provides consultation to providers and/or consumers on a variety of issues including benefit information, safety issues, confirmation of authorization decisions, procedures for higher levels of care evaluations, and requests for an explanation of the level of care, coverage determination, or best practice guidelines
• Respects confidentiality and maintain confidences as described in the UHG Employee Handbook. The ability to maintain confidentiality is a critical and essential component of this position
• Establishes and maintains professional working relations with referral sources, community resources, and care providers, and be able to identify and communicate network gaps
• Handles escalated calls and resolve complex issues. Ensure issues or changes are communicated and integrated as appropriate
• Sends correspondence to practitioners, providers, and members regarding authorization status/updates needed
• Verifies and uploads valid Release of Information documentations to electronic health records and notifies the Clinical Coordinator of invalid documentation for follow up
• Organizes and manages authorization requests
• Ensures the Utilization Management Team references the most updated member handbooks across all lines of business (coverage/eligibility-denials)
• Creates bookmarks in authorizations pulled for audits by various entities
• Corrects errors identified in various reports
• Enters Single Case Agreements into the electronic health record and notifies appropriate teams of actions that need to take place
• Maintains and updates job aids for team functions as needed
• Complete all duties in accordance with company safety policies and practices
• Other functions may be assigned, and management retains the right to add or change the duties at any time

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at: http://uhg.hr/uhgbenefits

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 higher)
• 2+ years of experience analyzing and solving customer problems
• 2+ years of experience working in the healthcare industry
• 2+ years of experience working with medical or behavioral health terminology
• Intermediate level of computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications
• Ability to work Mountain Time Zone schedule
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
• Reside in the United States
• Reside in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:

• Previous experience working in the Colorado healthcare industry
• 6+ months of experience with EMR (electronic medical records) systems
• Previous data entry experience
• Previous experience working remotely

Physical & Mental Requirements:

• Ability to execute regular, reliable, and predictable performance of the essential functions of this job through a consistent ability to be physically and mentally present at the assigned work location, at the prescribed time, with the prescribed tools and with the availability necessary to successfully complete the essential duties described herein
• Ability to handle and manage stress associated with the performance of job duties
• Ability to appropriately interact with, and get along with others including supervisors, coworkers, customers and other stakeholders
• Ability to work collaboratively with others as set forth in the job description
• Ability to accurately and timely follow directions of supervisors
• Ability to perform the essential functions of this job at the assigned primary work location for this job, which is in the person's home
• Ability to perform the essential functions of the job at the assigned primary work location for this job, which is in the employee's home. All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
• Ability to effectively speak, understand and be understood, and communicate in English
• Ability to hear adequately on the phone, in person and in group settings
• Ability to work a flexible schedule including before and after core business hours and occasional evenings and weekends
• Ability to work in front of a computer screen and keyboard, sitting and/or standing up to 8-10 hours per day (possibly longer if required)
• Ability to see computer screen and work papers
• Ability to access, research and interpret information from a variety of media (e.g., computer screen, projected images, printed material) and individuals
• Ability to work in normal office environment conditions and with various office equipment (e.g., computer, keyboard, mouse, calculator, copier, printer, fax, scanner, telephone)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

The salary range for this role is $19.86 to $38.85 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.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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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