UMR Clinical Administrative Coordinator – Remote

UnitedHealth Group
October 10, 2021
Atlanta, GA
Job Type


You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Energize your career with one of Healthcare’s fastest growing companies.  

You dream of a great career with a great company – where you can make an impact and help people.  We dream of giving you the opportunity to do just this.  And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.  We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 10 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

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 Clinical Administrative Coordinators 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.

A UMR Clinical Administrative Coordinator (CAC) has a serious responsibility to make every customer contact informative, productive, positive, and memorable. Employees in this position handle provider / member requests for pre - service review, performing initial triage of case types, provide information on available services, and coordinate with nurses and Medical Directors on the prospective review of requested services for UMR members. CACs also manage time - sensitive review requests and have the opportunity to do live outreach to providers.

Training will be conducted virtually from your home. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends. 

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

  • Provide excellent Customer Service to both providers and members by responding to and resolving incoming inquiries and requests.
  • Consistently meet established productivity and quality standards while adhering to schedules and maintaining good attendance.
  • Receive Care Coordination notifications for non - clinical assessment / intervention and provide appropriate triage. Approve when able and send to clinical reviewer when unable.
  • Process notifications for outpatient procedures, home health, DME, transition of care, and network gap issues.
  • Depending on product, process out – of – network requests for consideration of in - network level of benefits for physician specialty referrals.
  • Determine benefit coverage based on employer group contracts.
  • Communicate benefit determinations to providers / members within DOL timeframes.
  • Process letters within DOL timeframes.
  • When relevant, ensure potential member needs are identified and forwarded to the appropriate Care Coordinator for risk evaluation - refer to CM and DM as relevant.
  • Verify appropriate ICD - 10 and CPT coding usage.
  • Assist with processing of faxes and emails, including sending provider “fax forms” for certain clinical scenarios as designated. Make outbound calls to contact Providers, requesting clinical from provider as necessary.
  • Take inbound calls to provide status of cases from providers.
  • Ensure case requires PA, is “scrubbed” prior to sending to clinical reviewer, and includes all necessary components.
  • Take inbound calls from providers requesting a Peer – to – Peer discussion, prep requests for Peer – to – Peer discussions with Medical Directors and assign them in Aerial.
  • Confirm urgent versus non - urgent.
  • Prioritize and organize own work to meet deadlines while working with others as part of a team.
  • Cooperate with all members of CCR staff to ensure compliance with standards and regulations.
  • Work with other departments to ensure appropriate handling of customer requests.
  • Use knowledge and judgment to escalate complex problems to supervisor when necessary.
  • Perform other duties as assigned by manager and / or director.

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 professional experience in an office / customer service environment
  • Previous experience working with Microsoft Word (ability to create, edit and save documents)
  • Previous experience working with Microsoft Excel (ability to create, edit and save spreadsheets)
  • Computer proficiency including, but not limited to, ability to learn new computer system applications
  • Flexibility to work outside standard hours of operation due to changing business needs

Telecommuting Requirements:

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:

  • Bachelor's Degree (or higher)
  • Professional experience in an Office setting using the telephone and computer as the primary instruments to perform the job duties OR Customer Service experience analyzing and solving customer problems
  • Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD - 10 and CPT codes, Medicare and / or Medicaid Services, call center environment
  • Professional experience in a Clerical or Administrative support related role
  • Previous experience with Microsoft Outlook (ability to create, edit and save) or Lotus Notes (ability to create, edit and save)
  • Bilingual fluency in English and Spanish

Physical and Work Environment:

  • Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer

Soft Skills:

  • Ability to work in a fast - paced, dynamic, rapidly changing environment.
  • Excellent oral and written communication skills.
  • Strong aptitude for working in a production driven environment.
  • Must be a self - starter and able to work autonomously.

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible.

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

Colorado Residents Only: The hourly range for Colorado residents is $15.00 to $25.19. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary,  UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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.

Keywords: work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #RPO

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