Clinical review coordinator - remote - united states, hartford

you’ll enjoy the flexibility to telecommute* from anywhere within the u.s. as you take on some tough challenges.

energize your career with one of healthcare’s fastest growing companies.  

you dream of a great career with a great company – where you can make an impact and help people.  we dream of giving you the opportunity to do just this.  and with the incredible growth of our business, it’s a dream that definitely can come true. already one of the world’s leading healthcare companies, unitedhealth group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.  we live for the opportunity to make a difference and right now, we are living it up.

this opportunity is with one of our most exciting business areas: optum – a growing part of our family of companies that make unitedhealth group a fortune 10 leader.

optum helps nearly 60 million americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. no other business touches so many lives in such a positive way. and we do it all with every action focused on our shared values of integrity, compassion, relationships, innovation & performance.

this position is full-time (40 hours / week). employees are required to work our normal business hours of 8:00 am - 5:00 pm. it may be necessary, given the business need, to work occasional / mandatory overtime or weekends.

we offer 1 - 2 weeks of training. training will be conducted virtually from your home.

*all telecommuters will be required to adhere to unitedhealth group’s telecommuter policy.

primary responsibilities: 

perform initial and concurrent review of inpatient cases applying mcg criteria for approval and sending to medical directors if review is necessary for determining an adverse determination. discuss cases with facility healthcare professionals to obtain plans-of-care collaborate with unitedhealthcare medical directors on performing utilization management participation in discussions with the clinical services team to improve the progression of care to the most appropriate level. consult with the medical director as needed for complex cases and make appropriate referrals to sister segments. apply clinical expertise when discussing case with internal and external case managers and physicians identify delays in care or services and manage with md follow all standard operating procedures in end to end management of cases obtain clinical information to assess and expedite alternate levels of care facilitate timely and appropriate care and effective discharge planning participate in team meetings, education discussions and related activities maintain compliance with federal, state and accreditation organizations identify opportunities for improved communication or processes participate in telephonic and in-person staff meetings plan for interqual certification

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 higher) physical therapist license / certificate computer skills: microsoft word (ability to create, edit, save, and send documents) and microsoft excel (ability to create, edit, save, and send spreadsheets) ability to work any 8-hour shift between the hours of 8:00 am - 5:00 pm including the flexibility to work occasional / mandatory overtime and weekends based on business need

preferred qualifications:

3+ years of experience in case management or utilization management experience in acute long - term care, acute rehabilitation, or skilled nursing facilities case management certification and / or experience experience in discharge planning and / or chart review background that involves utilization review for an insurance company or in a managed care facility

telecommuting requirements:

required to have a dedicated work area established that is separated from other living areas and provides information privacy ability to keep all company sensitive documents secure (if applicable) must live in a location that can receive a unitedhealth group approved high-speed internet connection or leverage an existing high-speed internet service

unitedhealth group requires all new hires and employees to report their covid-19 vaccination status.

military & veterans find your next mission: we know your background and experience is different and we like that. unitedhealth group values the skills, experience and dedication that serving in the military demands. in fact, many of the values defined in the service mirror what the unitedhealth group culture holds true: integrity, compassion, relationships, innovation and performance. whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. learn more at [link available when viewing the job]

learn how teresa, a senior quality analyst, works with military veterans and ensures they receive the best benefits and experience possible. [link available when viewing the job]

careers with optum. here's the idea. we built an entire organization around one giant objective; make the health system 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, connecticut or nevada residents only: the salary range for colorado residents is $31.15 to $55.77. the salary range for connecticut / nevada residents is $34.33 to $61.25. 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: 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.

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