Medical Review Coordinator (Grow in our center of excellence!)

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.



PacifiCare Health Systems is now part of UnitedHealthcare, a UnitedHealth Group company. As one of the nation’s leading consumer health organizations, we are recognized by over 3 million health plan members for delivering first-to-market innovations as well as affordable high-quality programs. And, as part of UnitedHealthcare, we can offer you that rare combination of building a rewarding career with a healthy business while improving the lives of others.


 


Show us your medical knowledge, and we’ll show you a promising path of advancement in this unique position on our Clinical Advancement team in Cypress. The Medical Review Coordinator, focused on referrals, would enjoy plenty of job variety and many opportunities to learn and develop new skills in a fast-paced team environment.


 


Key responsibilities include:



Examining various inbound referrals, case-by-case, and making related determinations


Receiving referrals for outpatient procedures, home healthcare, physical therapy and other treatments


Reviewing referrals and auditing the clinical information in each using the Milliman system


Giving the appropriate approvals/denials based on your findings


Contacting the sender of the referral to gather additional information when necessary


Relaying escalated cases to a nurse or Medical Director for further review



We need a motivated professional with solid experience working in a medical or doctor’s office setting. Additional criteria for this position are as follows:



Clinical experience is needed


Familiarity with CPT and ICD-9 medical codes and medical terminology is required, and related certification is preferred


A background in health insurance and prior authorizations is a plus


Medical coursework would be very helpful in this role


Proficiency with MS Windows applications is essential


UnitedHealth Group offers a full range of comprehensive benefits, including medical, dental and vision, as well as a matching 401k and an employee stock purchase plan.


 


If you are interested in growing professionally within an innovative, highly respected organization, we invite you to explore this excellent growth opportunity!


 


Diversity creates a healthier atmosphere:  equal opportunity employer M/F/D/V.