Optum
Utilization Management Representative - Kelsey Seybold Clinic
Optum, Pearland, Texas, us, 77588
Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind
Caring. Connecting. Growing together.
Primary Responsibilities
Provides office support for all units within the Utilization Management and/or Population Health Department. (Utilization Review, Concurrent Review, Population Health and Case Management.)
Assist with incoming authorization requests; data entry of clinical information, pre-certification requests
Direct communication with KSC Clinic Representatives as needed
Responsible for clerical support relative to the Bed Day process
Under the supervision of the Transfer Nurses, the Utilization Management Representative is primarily responsible for the collection, reporting, clarification and entry of bed day data and pre and post-acute certification requests for specific services
Under the supervision of the Health Service Supervisor, the Utilization Management Representative is primarily responsible for collection of non-clinical data, report generation, health plan coordination for non-clinical issues, and other administrative duties that are required to provide comprehensive coordination of services
Additional duties can include handling and appropriately directing referral status requests received via phone and assisting with requesting clinical updates via phone and fax from facilities
Other duties as assigned
Required Qualifications
High School diploma or GED from an accredited program
2+ years of managed care experience either in a physician office or hospital setting health plan, ACO, or other managed care setting
Proven knowledge of medical terminology, HMO, PPO and referral processes
Proven excellent communication skills
Demonstrated alpha/numeric data entry and basic PC literacy
Valid Texas driver's license
Preferred Qualifications
Knowledge of CPT & ICD 10 Coding methodologies
Epic System usage
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 $16.15 to $28.80 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.
OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive
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Caring. Connecting. Growing together.
Primary Responsibilities
Provides office support for all units within the Utilization Management and/or Population Health Department. (Utilization Review, Concurrent Review, Population Health and Case Management.)
Assist with incoming authorization requests; data entry of clinical information, pre-certification requests
Direct communication with KSC Clinic Representatives as needed
Responsible for clerical support relative to the Bed Day process
Under the supervision of the Transfer Nurses, the Utilization Management Representative is primarily responsible for the collection, reporting, clarification and entry of bed day data and pre and post-acute certification requests for specific services
Under the supervision of the Health Service Supervisor, the Utilization Management Representative is primarily responsible for collection of non-clinical data, report generation, health plan coordination for non-clinical issues, and other administrative duties that are required to provide comprehensive coordination of services
Additional duties can include handling and appropriately directing referral status requests received via phone and assisting with requesting clinical updates via phone and fax from facilities
Other duties as assigned
Required Qualifications
High School diploma or GED from an accredited program
2+ years of managed care experience either in a physician office or hospital setting health plan, ACO, or other managed care setting
Proven knowledge of medical terminology, HMO, PPO and referral processes
Proven excellent communication skills
Demonstrated alpha/numeric data entry and basic PC literacy
Valid Texas driver's license
Preferred Qualifications
Knowledge of CPT & ICD 10 Coding methodologies
Epic System usage
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 $16.15 to $28.80 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.
OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive
#J-18808-Ljbffr