Utilization Management Representative

Explore opportunities at Southern California Physicians Managed Care Services, part of the Optum family of businesses. We're committed to delivering innovative leadership in health care management, continuously improving services for our clients and communities. You can be part of a dedicated team of professionals who provide administrative and financial solutions to support physicians in delivering quality care to patients. Join us and discover the meaning behind Caring. Connecting. Growing together.

As a Utilization Management Representative you will be responsible for initial triage of members, administrative intake of members or managing the admission/discharge information post-notification, working with hospitals and the clinical team. Includes managing incoming calls, managing requests for services from providers/members, providing information on available network services and transferring members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior authorizations.

Location: 6760 Top Gun Street, Suite 201, San Diego, CA

Schedule: This position is full time, Monday - Thursday. Employees are required to have flexibility to work any of our 10-hour shift schedules during our normal business hours of 6:30 - 5:00 PM PST. It may be necessary, given the business need, to work occasional overtime

We offer 3 - 4 months of paid on-the-job training. The hours of training will be aligned with your schedule. Training will be conducted onsite and then will have the option of going remote.

Primary Responsibilities:

• 75% - Performs data entry of prior authorization requests accurately on a daily basis to meet turnaround time standards
• 15% - Contacts Health Plans for medical policies or benefit interpretations
• 5% - Contacts physician offices as directed by Case Manager to obtain additional clinical information
• 5% - Sorts and distributes faxed images into designated folders on a rotating shared sorting schedule
• Other duties as assigned

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)
• 1+ years of experience working in a healthcare environment, physician's office, insurance company
• 1+ years of experience working in medical terminology, ICD and CPT coding
• Intermediate level of proficiency working with computers and Windows based programs including Microsoft Word and Microsoft Outlook
• Ability to work any of our 10-hour shift schedules during our normal business hours of 6:30 - 5:00 PM PST. It may be necessary, given the business need, to work occasional overtime
• Must be 18 years of age or older

Preferred Qualifications:

• Experience in working with prior authorizations

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 $16.00 to $27.69 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.

#RPO #RED