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.If you are located within a commutable distance of Little Rock, AR, you’ll enjoy the flexibility to work remotely as you take on some tough challenges.Primary Responsibilities:
Secure, track and review records via multiple media
Identify program specific documents within member’s records
Submit coverage checks and claims to Allstate on members behalf
Use clinical judgement to prepare records for external review
Use clinical judgement to triage patients for program candidacy
Make appropriate referrals into various programs in a timely manner
Act as a liaison between COE facilities and Care Managers or referring parties
Facilitate patient participation in Case Management with regular medical carrier
Skilled telecommunications in a high-touch member program
Encourage and support members participating in the program with sensitivity and compassion
Educate members regarding program policies and procedures
Evaluate appointments to determine if they fall under the transplant COE guidelines
Assist members with travel questions related to medical necessities
Receive and collects data necessary for program enrollment, review, and reporting
Compile network exception requests for submission to appeals team
Responsible for providing seamless customer service to include updating member information, vendors portals, and internal documentation
Participate in staff meetings
Monitor deferred patients monthly to ensure progression and continued suitability for transplant benefit
Notify patients, COE facilities and Care Managers when program benefit end date is approaching
Develop and maintain a positive relationship with external vendors
Develop and maintain a positive enthusiastic working relationship with all staff, in addition to all members, caregivers, donors and providers
Strong ability to identify appropriate resources for research and problem resolution
Ability to triage telephone calls received in a queue
Other duties as assigned by supervisor
Ability to report to the office
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:
Current and unrestricted Arkansas RN license
1+ years of clinical nursing experience
Ability to work in a fast-paced multi-tasking environment
Basic proficiency with Microsoft Word, Excel, Teams and Outlook
Preferred Qualifications:
Associates or Bachelors of Science in Nursing
3+ years of clinical nursing experience
Case management experience
Soft Skills:
Demonstrated excellent verbal and written communication skills
Effective organizational and prioritization skills
Proven interpersonal skills with ability to function as a positive team member
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyAt 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.