Behavioral Health Clinical Administrative Coordinator

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Clinical Administrative Assistant is responsible for validating the eligibility of providers and members for all authorization requests and preparing Behavioral Health and Substance Use Disorder authorizations for various lines of business, including RMHP PRIME Medicaid, RMHP RAE Medicaid, RMHP CHP+, RMHP IFP, and NHP RAE Medicaid. This role involves collaborating with leadership for guidance, referring members to the RMHP Care Coordination Department for aftercare planning, and notifying providers and requestors of authorization determinations. When cases do not meet criteria, the assistant offers peer-to-peer consultations with the RMHP medical director and drafts denial letters with alternative treatment options. They provide prompt assistance to callers, complete required training, and handle incomplete authorization requests by obtaining missing information. The assistant takes detailed meeting notes, provides consultations on various issues, maintains confidentiality, establishes professional relationships, and handles escalated calls. They utilize clinical knowledge to apply evidence-based guidelines, send correspondence regarding authorization status, monitor the Behavioral Health Fax Queue, verify and upload documentation, organize authorization requests, and distribute information to Clinical Coordinators. Additionally, they ensure handbook updates, upload clinical documentation, bookmark cases for audits, correct errors, complete notifications, enter Single Case Agreements, and maintain job aids for team functions.

Schedule: Monday-Friday, 8-hour shift between 6am-6pm MST

If you are located within the United States and able to work Mountain Time Zone, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Verifies eligibility of providers and members for all authorization requests
• Inputs and prepares all Behavioral Health and Substance Use Disorder authorizations submitted by providers for all lines of business including RMHP PRIME Medicaid, RMHP RAE Medicaid, RMHP CHP+, RMHP IFP, and NHP RAE Medicaid and assign to the specified Clinical Coordinator
• Collaborates with leadership when additional guidance is required
• Refers members to the RMHP Care Coordination Department when completing discharge documentation, ensuring needs are addressed to facilitate successful aftercare planning
• Notifies providers and requestors of all authorization determinations when appropriate
• When a case is determined not to meet criteria, correspond with the requesting provider to offer a peer-to-peer consultation with the RMHP medical director, allowing the provider to present additional information before a final decision is made
• When a medical director issues a denial, the Clinical Administrative Assistant drafts a letter informing the member and the requesting provider of the decision, the reasons for the decision, and offers alternative treatment options
• Promptly provides assistance to callers routed to the BH UM department
• Completes required training by the assigned due dates to comply with auditing entities such as NCQA. These training courses include, but are not limited to the following: MCG criteria, ASAM criteria, and InterQual criteria
• If an incomplete authorization request is submitted, the Clinical Administrative Coordinator will attempt to obtain the missing information from the requestor and initiate an extension if needed with the Clinical Coordinator
• Take detailed notes of meetings attended
• Provides consultation to providers and/or consumers on a variety of issues including benefit information, safety issues, confirmation of authorization decisions, procedures for higher levels of care evaluations, and requests for an explanation of the level of care, coverage determination, or best practice guidelines
• Respects confidentiality and maintain confidence as described in the UHG Employee Handbook. The ability to maintain confidentiality is a critical and essential component of this position
• Establishes and maintains professional working relations with referral sources, community resources, and care providers, and be able to identify and communicate network gaps
• Handles escalated calls and resolve complex issues. Ensure issues or changes are communicated and integrated as appropriate
• Sends correspondence to practitioners, providers, and members regarding authorization status/updates needed
• Monitors the Behavioral Health Fax Que daily and uploads documentation to authorizations
• Verifies and uploads valid Release of Information documentations to electronic health records and notifies the Clinical Coordinator of invalid documentation for follow up
• Organizes and manages authorization requests
• Distributes information to Clinical Coordinators that is sent from providers
• Ensures the Utilization Management Team references the most updated member handbooks across all lines of business (coverage/eligibility-denials)
• Uploads concurrent clinical documentation to the electronic health record
• Creates bookmarks in authorizations pulled for audits by various entities
• Corrects errors identified in various reports
• Completes notifications within the electronic health records and provides documentation to the provider as necessary
• Enters Single Case Agreements into the electronic health record and notify appropriate teams of actions that need to take place
• Maintains and updates job aids for team functions as needed 

What are the reasons to consider working for UnitedHealth Group?   Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• 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 directions 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
• 2+ years of experience analyzing and solving customer problems
• Reside in the USA

Preferred Qualifications:

• 2 years of experience working in the healthcare industry
• 2 years of experience working with medical terminology

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

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 $17.98 to $32.12 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

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.

#RPO #GREEN