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Job Details

UnitedHealth Group

Clinical Admin Coordinator Southwest




Full Time


Colorado Springs, Colorado, United States

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

Positions in this family include those reposnsible for functions in areas such as health services, clinical services and delivery of clinical care.

Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing theadmission/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. This function includes intake, notification and census roles. *Employees in jobs labeled with 'SCA' must support a government Service Contract Act (SCA) agreement.

General Job Profile:

  • Limited work experience
  • Works on simple tasks using established procedures
  • Depends on others for guidance
  • Work is typically reviewed by others

Primary Responsibilities:

  • Applies knowledge/skills to basic, repeated activities
  • Demonstrates minimum depth of knowledge and skills in own function
  • Responds to standard requests
  • Requires assistance in responding to nonstandard requests
  • Solves routine problems by following established procedures
  • Others prioritize and set deadlines for employee
  • Works with others as part of a team

Functional Competencies:

Receive Medical/Behavioral/Clinical Services or Benefits Requests:

  • Serve as primary point of contact for providers or members regarding medical/behavioral/clinical services or benefits
  • Extract and review fax requests for medical or clinical services
  • Receive calls requesting medical/behavioral/clinical services or benefits information (e.g., from providers or members)
  • Receive electronic referral form requests for medical/behavioral/clinical services
  • Utilize phone system to respond to and transfer calls to appropriate individuals
  • Ask callers standard questions to understand requests, gather necessary information, and assess urgency
  • Access electronic member files using policy or id number
  • Determine member eligibility
  • Follow protocols to task requests appropriately
  • Check procedure codes against notification requirements and benefit coverage to determine next steps
  • Reference automated job aid tools via the computer to identify appropriate procedures when needed

Research Information to Respond to Medical/Behavioral/Clinical Services or Benefits:

  • Access claims information
  • Review and interpret call history documentation (e.g., case notes)
  • Navigate between computer screens and platforms to research information (e.g., medical, clinical, or benefits information)
  • Take calls and questions from members and/or providers regarding case status
  • Determine whether authorizations are required for requested medical services
  • Reference automated job aid tools via computer to research relevant rules, regulations, or procedures
  • Learn computer system and process changes and updates and incorporate into daily work
  • Contact internal resources if necessary to clarify information
  • Identify appropriate resource (e.g., doctor, resource, contracted provider) to respond to medical requests

Process Medical/Behavioral/Clinical Services or Benefits Requests:

  • Provide/explain benefit information to members/providers
  • Provide/explain authorization information to members/providers
  • Communicate with clinical team to ensure provider receives a response when necessary
  • Document call history information into relevant computer system
  • Enter medical request data into relevant computer system
  • Follow standard procedures to complete requests
  • Request medical review via relevant computer system as needed
  • Review and advise member/provider of status of a request (e.g., notification, authorization)
  • Schedule appointments for members based on request
  • Provide information regarding appointments and medical services to facilities staff to assist members

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 or equivalent
  • 1+ years of experience in working in a fast-paced environment handling multiple phone calls
  • Basic PC skills including EMR, and Outlook
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • Basic knowledge of medical terminology
  • Customer service
  • Good organizational skills
  • Ability to problem solve

Values Based Competencies:

  • Integrity Value: Act Ethically
    • Comply with Applicable Laws, Regulations and Policies
    • Demonstrate Integrity
  • Compassion Value: Focus on Customers
    • Identify and Exceed Customer Expectations
    • Improve the Customer Experience
  • Relationships Value: Act as a Team Player
    • Collaborate with Others
    • Demonstrate Diversity Awareness
    • Learn and Develop
  • Relationships Value: Communicate Effectively
    • Influence Others
    • Listen Actively
    • Speak and Write Clearly
  • Innovation Value: Support Change and Innovation
    • Contribute Innovative Ideas
    • Work Effectively in a Changing Environment
  • Performance Value: Make Fact Based Decisions
    • Apply Business Knowledge
    • Use Sound Judgement
  • Performance Value: Deliver Quality Results
    • Drive for Results
    • Manage Time Effectively
    • Produce High Quality Work

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID19 vaccination regulations as well as all client COVID19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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 $16.00 to $26.88. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far reaching choice of benefits and incentives.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drugfree workplace. Candidates are required to pass a drug test before beginning employment