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.The CAC will be responsible for managing various administrative and coordination tasks to support efficient inpatient admissions, post-acute case management, and ensure compliance with healthcare standards. This role requires a professional with strong communication skills, the ability to manage multiple priorities, and a commitment to delivering high-quality support in a fast-paced healthcare environment.This position is full time. 4 days, 10 hours shifts between the hours of 6:00 am-8:00 pm PST, Thursday - Sunday or Saturday-Tuesday or 5 days, 8 hour shifts between the hours of 8:00 am – 5:00 pm PST Thursday –Monday or Friday – Tuesday. It may be necessary, given the business need, to work occasional overtime.You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:
Oversee the management of building inpatient admissions and post-acute cases, ensuring that the admissions process is efficient and that turnaround times are met.
Handle incoming clinical records by reviewing, organizing, and attaching them to the associated inpatient case in a timely manner.
Respond to incoming calls, providing exceptional customer service, and directing inquiries to the appropriate department or individual as needed.
Manage appeals oversight for the Quality Improvement Organization (QIO) and health plan, ensuring all procedures are followed according to regulatory and company standards.
Initiate peer-to-peer reviews with healthcare providers to discuss patient cases and ensure appropriate care is provided.
Prepare and send out initial Notice of Medicare Non-Coverage (NOMNC) packets and process incoming packets, maintaining compliance and proper documentation.
Maintain oversight of regional emails and faxes, ensuring timely and accurate responses to all communications.
Manage Prior Authorization intake for Skilled Nursing Facilities (SNF), Long-Term Acute Care Hospitals (LTACH), Acute Inpatient Rehab (AIR), and other services as needed.
Perform any additional duties assigned by UM support leadership, which could include administrative tasks, reporting, or participating in special projects.
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 equivalent yrs of experience
Must be 18+ yrs or older
1+ year in a customer service role
6+ months of experience working in a healthcare environment.
Experience with office products (Microsoft Word, Microsoft Excel, Microsoft outlook and Microsoft PowerPoint)
Ability to work any of our schedules, 4 days, 10 hours shifts between the hours of 6:00 am-8:00 pm PST, Thursday - Sunday or Saturday-Tuesday or 5 days, 8 hour shifts between the hours of 8:00 am – 5:00 pm PST Thursday –Monday or Friday – Tuesday. It may be necessary, given the business need, to work occasional overtime.
Preferred Qualifications:
Knowledge of medical terminology
Health Insurance experience
Telecommuting Requirements:
Ability to keep all company sensitive documents secure (if applicable)
Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.
Soft skills
Excellent verbal communication and organizational skills
Self-motivated
Attention to detail.
Ability to multi-task and work under pressure.
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyCalifornia, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, Rhode Island, OR Washington, D.C. Residents Only: The hourly range for this is $16.54 - $32.55 per hour. 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.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 .#RPO