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- RANCHO CUCA, CA
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UM Technician - Rancho Cucamonga, CA
UnitedHealth Group • RANCHO CUCA, CA
Posted 5 days ago
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Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Due to our expanding business, UnitedHealth Group is seeking Utilization Management Technicians who share our passion for helping others live healthier lives. As one of the world's leading health care companies, UnitedHealth Group is pursuing innovative new ways to operate our service centers and improve on our ability to deliver high - quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Take this opportunity and begin doing your life's best work.(sm)
What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
- Manage administrative intake of members or the admission/discharge information post notification
- Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and / or providers
- Manage the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
- Receive care coordination notification cases for non - clinical assessment / intervention and provide appropriate triage
- Review requests for adverse determination, approval notification and processing notification requirements
- Assist the clinical staff with setting up documents / triage cases for Clinical Coverage Review
- Handle resolution / inquiries from members and / or providers
- High School Diploma or GED
- 1+ years of experience working in utilization management
- Knowledge of medical terminology
- Proficiency utilizing Microsoft Word and Excel
- Familiarity of IPA, referral and authorization processes
- Experience working with Healthcare Insurance
- Experience working in a Hospital, Physician's Office, or Medical Clinical setting.
- Experience working with ICD - 9 and CPT codes
- Experience working with Medicare and / or Medicaid Services
- Experience working in a call center environment
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
North American Medical Management, California, Inc. (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.
The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.
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.
Job Keywords: UM, IPA, High volume phone, medical terminology, referral, authorizations, CPT codes, Rancho Cucamonga, CA