Senior Referral Navigator

Jobtome; Spring Valley (NV); On-site; USD 28,000 - 50,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan options

Dental, Vision, Life & AD&D Insurance

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Equity stock purchase

Job summary

UnitedHealth Group is hiring a Senior Referral Navigator for Southwest Medical Referral Office, part of Optum. The role focuses on patient outreach, education about program benefits, and managing member cases in a high-volume, fast-paced environment.

The position offers a Monday–Friday schedule (8:00 am–5:00 pm), with a focus on accuracy, empathy, and efficient coordination of care across clinics and services.

Qualifications

• High School Diploma or GED and 5+ years of medical customer service experience.
• 3+ years of experience in a medical setting.
• Intermediate computer proficiency with multiple applications including Outlook, Excel, and Word.

Responsibilities

• Respond to patient questions in person or over the phone.
• Schedule patient office and infusion appointments.
• Process outbound referral orders and obtain prior authorization.

Skills

Medical customer service

Call center

Microsoft Outlook

Excel

Word

Education

High School Diploma/GED

Tools

Outlook

Excel

Word

Job description

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's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)Like you, UnitedHealth Group is strong on innovation. And like you, we'll go the distance 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 a chance to make an impact.

Southwest Medical Referral Office, part of Optum has an immediate opening for a friendly, patient focused and detailed oriented Senior Referral Navigator to join our team. The hours are Monday through Friday are 8:00 am to 5:00pm. No nights or Weekends.

Primary Responsibilities

• Respond to patient questions in person or over the phone
• Scheduling patient office/infusion appointments
• Processing all outbound referral orders
• Obtaining prior authorization for all outbound referrals
• Reschedule patient appointments due to cancellation
• Back up call center for inbound phone calls
• Ask patients for and/or assist patients with completing required paperwork (e.G., health history, insurance documentation, etc.)
• Accurately schedules and coordinates patient appointments for assigned clinics
• The ability to work in a high call volume environment while meeting productivity and quality standards
• Make patient follow up calls (e.G., after procedures, admissions, or ER visits) to identify/close gaps in care
• Connect patients with outside resources (e.G., community resources, social services) to promote self-care
• Coordinate services/case management for non-episodic and non-catastrophic cases
• Manage/respond constructively to challenging patient interactions (e.G., address lack of understanding, socioeconomic challenges, frustrated patients, language barriers)
• Document patient interactions in appropriate systems/logs (e.G., medication changes)
• Explain and ensure understanding of details related to patient care (e.G.,, home health care transition procedures)
• Input/update patient demographic data into computer system
• Update/upload patient care data (e.G., care plan data, inpatient data, patient program flags) in computer systems
• Document patient interactions in appropriate systems/logs (e.G., medication changes)
• Enter/process patient referral data (e.G., medical services, radiology, durable medical equipment)
• Generate reports on patient data through relevant computer systems/applications
• Performs other duties as assigned

This is a self-motivated, results driven Provider Management position. This position will require you to be able to self-manage day to day activities to include but not limited to, scheduling weekly and monthly meetings via Teams with providers to go over compliance issues regarding late or missed homecare visits with our members and be capable of using time and resources efficiently. You will need to have a strong phone presence, provide support and manage conflicts while holding the provider accountable in a professional, helpful and friendly manner. You will also be accountable for ensuring all documentation is in place for every step of the process.

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

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 equivalent 5+ years of medical customer service experience
• 3+ years of experience in a medical setting
• Intermediate of computer proficiency (multi-task through multiple applications including Microsoft Outlook, Excel, and Word)

Preferred Qualifications

• Experience working within the health care Industry and with health care insurance
• Experience working in a hospital, physician's office or medical clinic setting
• A clerical or administrative support background
• Knowledge of ICD-10 and CPT codes
• Experience working in a call center

Soft Skills

• Very fast paced environment with 40+ people, team player, goal focused, must be self - motivated, take initiative and willing to learn in a fast environment
• Solid typing, strong oral and written communication skills
• Demonstrated effective organizational skills and scheduling skills as observed in day-to-day work
• Excellent customer service skills
• Excellent interpersonal and problem-solving skills
• Attention to detail, as observed in day-to-day work
• Excellent time management and prioritization skills.
• Must demonstrate flexibility, ability to follow through on all tasks in a timely fashion, good attention to detail and a willingness to learn
• Strong team player and team building skills
• Able to handle sensitive issues with members and providers in a confidential manner
• Demonstrates initiative in achieving individual, team, and organizational goals and objectives
• Creative problem-solving skills with the ability to use community and network resources to meet members' needs.
• Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment

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 $20.00 to $36.00 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.