Nurse Navigator

Specialty Navigator II Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Reporting to and working under the general direction of the Supervisor(s) and Manager of the department, the Specialty Navigator II processes referrals and authorizations for Atrius Health patients. Receives inbound requests (calls, emails, faxes, etc.) as well as from within the work queues. Maintains patient records and continually provides information to patients and specialists. Schedule: Monday-Friday, 8:30am-5pm EST. Location: 1177 Providence Hwy. Norwood, MA. If you live near Norwood, MA, you will enjoy the flexibility of a hybrid-remote* role as you take on some tough challenges. Hybrid schedule to be determined upon hire. May be required to work onsite at manager's discretion (for possible training, or if there are connectivity issues, etc.) Primary Responsibilities: Manage the referral process, processing incoming and outgoing referrals and prior authorizations, including intake, notification and census roles Handle resolution/inquiries from members and/or providers This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone Answers and replies to a large volume of telephone calls, faxes and internet queries, utilizing and adhering to department scripts and guidelines Reviews patient record. If referral does not already exist, obtain authorization from payer, enter information into EPIC. Forwards authorization to specialist's office Keeps patient and facility informed of status, referrals, updates and process Obtains authorizations from payer websites efficiently and effectively. Keeps log in and credentials Researches questions and concerns from patients; assists in resolving any issues as they relate to the referral process Escalates difficult issues, problems, etc., to higher level coordinators or supervisory staff Works with team to ensure timely process of referrals. Participates in team problem solving activities, focusing on production and quality Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations Written Communications: Ability to summarize and communicate in English moderately complex information in varies written formats to internal and external customers Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members Accesses only the minimum necessary protected health information (PHI) for the performance of job duties. Actively protects the confidentiality and privacy of all protected health information they access in all its forms (written, verbal and electronic, etc) taking reasonable precautions to prohibit unauthorized access. Complies with all Atrius Health and departmental privacy policies, procedures and protocols. Follows HIPAA privacy guidelines without deviation when handling protected health information Performs other duties as assigned 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 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 1+ years of customer service experience or experience in a medical office setting Intermediate level proficiency with Microsoft Word and Excel Intermediate level of proficiency with typing and talking at the same time and navigating through multiple screens Preferred Qualifications: Call center experience highly preferred Experience working within the healthcare industry and with health insurance Experience working in a metric-driven work environment A clerical or administrative support background Knowledge of ICD-9 and CPT codes Soft Skills: Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations *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 $18.00 to $32.00 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. #RPO #YELLOW