Specialty Utilization Management Technician - Ontario, CA

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)
 
The Specialty Technician will be responsible for managing all specialty requests. Requests for injectable / infusion medications, Durable Medical Equipment and Home Health Care requested by physicians / vendors will be entered and / or processed based on Timeliness of UM Decisions Policy and Procedures. This position will work with closely with Medical Management staff within the network.
 
Primary Responsibilities:

Managing incoming specialty requests
Performs duties as outlined in Policy and Procedures for specialty referrals
Reviews initial clinical information to determine if additional information is necessary prior to forwarding to reviewer and ensures consistent and timely flow of authorization process
Follows Pend and denial process per guidelines and documents system same day
Provides eligibility,  benefits, authorization history information,  prescription / order, clinical information, and health plan criteria to reviewer for decision making
Maintains lists of contacts and  stays current on health plan guidelines and updates
Corrects errors as identified on daily / weekly Error Reports
Assists with Grievance and Appeals Department by providing necessary documentation for upholding decision

Required Qualifications:


High school graduate or G.E.D
1+ year data entry experience
2+ years of experience in the healthcare industry
Knowledgeable in Microsoft Office applications-Word
Preferred Qualifications:

Knowledge of medical terminology
Knowledge of general PMG / IPA operations
Managed care experience
Previous utilization management experience
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 managers 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 healthcare 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: Data entry, medical terminology, managed care, IPA / PMG Operations, injectable / infusion medications, Home health care, durable medical equipment