Authorization & Care Coordination Specialist

UnitedHealth Group; Pearland (TX); On-site; USD 25,000 - 44,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Job summary

Kelsey-Seybold Clinic, part of the Optum family, seeks an Utilization Management Representative to support Utilization Management and Population Health initiatives across Houston’s network. You will handle authorizations, maintain records, coordinate care, and serve as a liaison between patients, providers, payers, and care teams.

Join UnitedHealth Group and contribute to higher quality, higher patient satisfaction, and lower total costs while growing your career in a nationally recognized

Qualifications

• High School Diploma or GED required.
• 2+ years of managed care experience in a physician office, hospital, health plan, ACO, or similar healthcare environment.
• Knowledge of medical terminology – HMO, PPO, and referral processes.
• Alpha-numeric data entry and basic PC literacy.
• Proven excellent time management skills.
• Valid Texas Driver's License.
• Preferred: Experience using Epic and knowledge of CPT/ICD-10 coding methodologies.

Responsibilities

• Process incoming authorization and pre-certification requests.
• Enter and maintain utilization management, admission, discharge, and clinical information in designated systems.
• Support bed day reporting, tracking, and data collection activities.
• Provide clerical and administrative support, including filing, faxing, correspondence management, and report generation.
• Coordinate care and discharge planning activities with patients, providers, payers, and internal stakeholders.
• Schedule appointments and assist with service coordination as needed.
• Obtain authorizations for referrals and covered services.
• Verify and document benefit information and payer communications.
• Serve as a resource for physicians, clinic staff, patients, and health plans regarding authorization and pre-certification processes.
• Respond to referral status requests and assist with obtaining clinical updates from facilities.
• Maintain accurate documentation and ensure compliance with organizational policies and procedures.
• Perform other duties as assigned.

Skills

Time management

Alpha-numeric data entry

Medical terminology

Education

High School Diploma or GED

Tools

Epic

Job description

Kelsey-Seybold Clinic, part of the Optum family, seeks an Utilization Management Representative to support Utilization Management and Population Health initiatives across Houston’s network. You will handle authorizations, maintain records, coordinate care, and serve as a liaison between patients, providers, payers, and care teams.

Join UnitedHealth Group and contribute to higher quality, higher patient satisfaction, and lower total costs while growing your career in a nationally recognized