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Behavioral Health Utilization Management Clinical Coordinator - Remote in C at UnitedHealth Group Canada

Grand Junction, Colorado, United States - Full Time

Skills Needed
Behavioral Health, Substance Use Disorders, Medical Necessity Criteria, Care Coordination, Clinical Knowledge, Ms Office, Inter Rater Reliability, Confidentiality, Evidence Based Practices, Community Resources, Authorization Requests, Peer To Peer Consultations, Eligibility Verification, Aftercare Planning, Complex Case Management, Escalated Calls

Specialization
Candidates must have current, unrestricted independent licensure in Colorado and at least 4 years of experience serving individuals with behavioral health conditions. Experience with local behavioral health providers and MS Office is also required.

Experience Required
Minimum 5 year(s)

Sr. Data Architect (Part time)- Remote at UnitedHealth Group Canada

Philadelphia, Pennsylvania, United States - Full Time

Skills Needed
Data Architecture, Data Modeling, Data Governance, Metadata Management, Data Quality, Cloud Data Architecture, Snowflake, Sql, Kafka, Etl, Data Integration, Healthcare, Power Bi, Python, Spark, Master Data Management

Specialization
Candidates should have over 8 years of experience in data architecture or engineering, with expertise in tools like Snowflake and Kafka. A deep understanding of data governance and cloud data architecture is also required.

Experience Required
Minimum 10 year(s)

Supervisor of Operational Services Auburn - Primary Care at UnitedHealth Group Canada

Auburn, Massachusetts, United States - Full Time

Skills Needed
Leadership, Supervision, Medical Terminology, Electronic Medical Records, Microsoft Office, Project Management, Organizational Skills, Interpersonal Skills, Team Building, Communication Skills, Problem Solving, Budget Planning, Quality Improvement, Staff Training, Patient Satisfaction, Operational Management

Specialization
Candidates should have at least 3 years of experience in a medical or healthcare setting, with a preference for 2 years in a supervisory role. Proficiency in medical terminology, electronic medical records, and Microsoft Office is required.

Experience Required
Minimum 2 year(s)

General Surgery Medical Coder at UnitedHealth Group Canada

, , United States - Full Time

Skills Needed
Icd 10 Coding, Cpt Coding, Medical Coding, Documentation Standards, Coding Auditing, Emr Systems, Encoder Systems, Windows Environment, Ms Excel, Workload Management, Coding Queries, Health Outcomes, Data Retrieval, Claims Processing, Outpatient Physician Coding, Coding Guidelines

Specialization
A high school diploma or GED is required along with a professional coder certification from AHIMA and/or AAPC. Candidates should have at least 2 years of experience with ICD-10 and CPT coding, as well as proficiency in a Windows environment.

Experience Required
Minimum 2 year(s)

Principal Full Stack Engineer - ServiceNow, AI with DevOps at UnitedHealth Group Canada

, karnataka, India - Full Time

Skills Needed
Servicenow, Ai Tools, Javascript, Jquery, Reactjs, Typescript, Nodejs, Angular Js, Html, Css, Software Design Principles, Problem Solving, Clean Code, Test Automation, Devops, Microservices

Specialization
Candidates must have a Bachelor's or Master's degree in a related field and at least 12 years of IT experience, including 7 years with ServiceNow. Proficiency in various programming languages and a strong understanding of software design principles are essential.

Experience Required
Minimum 10 year(s)

CCAT Mid Level Practitioner - Remote at UnitedHealth Group Canada

Plymouth, England, United Kingdom - Full Time

Skills Needed
Clinical Leadership, Fraud Prevention, Problem Solving, Negotiation, Persuasion, Collaboration, Communication, Clinical Review, Provider Education, Coding, Health Insurance Knowledge, Conflict Management, Team Building, Medical Policy Interpretation, Analytics, Operations Improvement

Specialization
Candidates must have an active Nurse Practitioner or Physician Assistant license and at least 3 years of clinical practice experience. Coding experience and strong communication skills are also required.

Experience Required
Minimum 5 year(s)

Per Diem Patient Access Representative at UnitedHealth Group Canada

, , - Full Time

Skills Needed
Customer Service, Patient Registration, Insurance Verification, Financial Payments, Medical Terminology, Microsoft Office, Communication Skills, Interpersonal Skills, Data Entry, Compassionate Care, Problem Solving, Attention To Detail, Time Management, Basic Mathematics, Clerical Duties, Administrative Support

Specialization
Candidates must have a High School Diploma or GED and at least 1 year of experience in a customer service role. Proficiency in Microsoft Office and the ability to work on-site at the specified location are also required.

Principal UX Architect at UnitedHealth Group Canada

Noida, karnataka, India - Full Time

Skills Needed
Ux Design, Wireframing, Prototyping, User Research, Human Centered Design, Accessibility, Design Pattern Libraries, Figma, Ai/Ml, Computational Design, Communication Skills, Project Management, Enterprise Software, B2b Applications, Emerging Technologies, User Centered Design

Specialization
The role requires 10+ years of UX design experience and a strong understanding of user-centered design practices. A portfolio showcasing relevant projects, including experience with AI/ML, is also necessary.

Experience Required
Minimum 10 year(s)

Product Manager – Pharmacy Software at UnitedHealth Group Canada

Washington, District of Columbia, United States - Full Time

Skills Needed
Product Management, Pharmacy Experience, Data Analysis, Stakeholder Management, Agile Methodologies, Market Research, Financial Analysis, Product Lifecycle Management, Cross Functional Collaboration, Customer Engagement, Strategic Planning, Competitive Analysis, Technical Knowledge, Business Acumen, Operational Outcomes, Growth Opportunities

Specialization
Candidates must have 5+ years of pharmacy experience and 2+ years as a Product Manager or Product Analyst, preferably in healthcare or technology. A proven understanding of product lifecycle management and the ability to analyze data and make data-driven decisions are essential.

Experience Required
Minimum 5 year(s)

Senior Clinical Appeals RN at UnitedHealth Group Canada

Plymouth, England, United States - Full Time

Skills Needed
Clinical Appeals, Ms Drg Auditing, Apr Drg Auditing, Icd 10 Coding, Problem Solving, Written Documentation, Medical Record Review, Collaboration, Coaching, Education, Risk Identification, Regulatory Knowledge, Research, Data Analysis, Telecommuting, Healthcare Claims

Specialization
Candidates must have an associate's degree and an unrestricted RN license, along with 3+ years of MS DRG/APR DRG coding experience. Certification in CCS or CIC is required within 6 months of hire.

Experience Required
Minimum 5 year(s)

Pharmacist PA/Appeals at UnitedHealth Group Canada

Greensboro, North Carolina, United States - Full Time

Skills Needed
Pharmacy, Clinical Documentation, Drug Interactions, Quality Assurance, Record Keeping, Communication Skills, Coverage Determinations, Clinical References, Regulatory Guidelines, Documentation, Research, Formulary Management, Patient Consultation, Medical Literature, Decision Making, Compendia Support

Specialization
A Bachelor’s Degree in Pharmacy or Pharm D is required along with an active, unrestricted Pharmacist license. Candidates should have at least 1 year of experience in pharmacy coverage determinations or member appeals.

Experience Required
Minimum 2 year(s)

Clinical Pharmacist at UnitedHealth Group Canada

Estero, Florida, United States - Full Time

Skills Needed
Clinical Expertise, Medication Orders, Compounding, Dispensing Prescriptions, Medication Related Issues, Evidence Based Protocols, Cost Effective Drug Therapy, Pharmacy Systems, Microsoft Office

Specialization
An ACPE-accredited pharmacy degree is required, with a PharmD preferred. Candidates must have an active state pharmacist license and at least 1 year of recent pharmacist experience, preferably in a hospital setting.

Experience Required
Minimum 2 year(s)

Pharmacy Technician at UnitedHealth Group Canada

Lima, Ohio, United States - Full Time

Skills Needed
Customer Service, Prescription Filling, Inventory Management, Clerical Duties, Communication Skills, Medication Management, Compliance, Team Collaboration

Specialization
Candidates must have an active Pharmacy Technician license in Ohio and at least 6 months of experience in the field. Reliable transportation and a valid US driver's license are also required.

Pharmacist at UnitedHealth Group Canada

Sugar Land, Texas, United States - Full Time

Skills Needed
Pharmacist License, Medication Adherence, Drug Utilization, Telephonic Outreach, Computer Systems Navigation, Prior Authorization, Clinical Information, Benefit Plan Criteria, Call Center Systems, Ms Office, Windows Environment, Safety Communication, Performance Recognition, Health Equity, Diversity And Inclusion, Career Development

Specialization
A current and unrestricted Pharmacist license in the state of residence is required. Beginner proficiency in MS Office and a Windows-based environment is also necessary.

Director of Pharmacy at UnitedHealth Group Canada

, , - Full Time

Skills Needed
Pharmacy Operations, Leadership, Collaboration, Regulatory Compliance, Clinical Expertise, Teaching, Professional Publications, Pharmacy Management

Specialization
Candidates must have an ACPE-accredited pharmacy degree and an active state Pharmacist license. Additionally, 3+ years of experience in an acute care hospital setting and 2+ years of pharmacy management experience are required.

Experience Required
Minimum 5 year(s)

Medical Assistant I/II/III - Internal Medicine Kelsey - Seybold Clinic - Me at UnitedHealth Group Canada

Houston, Texas, United States - Full Time

Skills Needed
Patient Care, Medical Terminology, Computer Proficiency, Bls Certification, Injectables Administration, Clinical Procedures, Ambulatory Care, Epic Systems

Specialization
Candidates must have a High School Diploma or GED and be a graduate of an accredited Medical Assistant program or have 1+ years of related experience. BLS certification and basic medical terminology experience are also required.

Per Diem Associate Patient Care Coordinator at UnitedHealth Group Canada

Oconomowoc, Wisconsin, United States - Full Time

Skills Needed
Customer Service, Communication, Organizational Skills, Time Management, Multi Tasking, Prioritization, Independence, Judgment, Accountability, Teamwork, Verbal Communication, Written Communication, Medical Terminology, Electronic Medical Records, Lean Processes, Wayfinding

Specialization
Candidates must have a High School Diploma or GED and at least 1 year of customer service experience. Proficiency in Microsoft Office and the ability to work flexible shifts are also required.

Medical Assistant - WellMed at Frisco at UnitedHealth Group Canada

Frisco, Texas, United States - Full Time

Skills Needed
Medical Assistant Certification, Bls Certification, Medical Terminology, Customer Service, Communication Skills, Infection Control, Specimen Collection, Patient Care, Diagnostic Equipment Operation, Wound Care, Ekg, Basic Computer Literacy, Excel Skills, Emergency Response, Confidentiality, Team Coordination

Specialization
Candidates must have a high school diploma or GED and a current Medical Assistant certification or the ability to obtain it within 180 days. They should also have BLS certification and knowledge of medical terminology.

Associate Patient Care Coordinator at UnitedHealth Group Canada

Anacortes, Washington, United States - Full Time

Skills Needed
Customer Service, Healthcare Experience, Computer Proficiency, Insurance Verification, Appointment Scheduling, Medical Records Maintenance, Organizational Skills, Time Management, Communication Skills, Empathy, Teamwork, Adaptability, Attention To Detail, Problem Solving, Multi Tasking, Ppe Compliance

Specialization
A High School Diploma or GED is required, along with at least one year of customer service or healthcare-related experience. Intermediate computer skills and the ability to travel for coverage are also necessary.

Patient Access Team Lead at UnitedHealth Group Canada

, , - Full Time

Skills Needed
Customer Service, Leadership, Problem Solving, Adaptability, Collaboration, Multi Tasking, Critical Thinking, Communication, Training, Monitoring, Coaching, Analysis, Instruction, Efficiency Improvement, Active Listening, Change Management

Specialization
Candidates must have a High School Diploma or GED and at least 2 years of healthcare and scheduling experience in a medical setting. Previous leadership experience is preferred.

Experience Required
Minimum 2 year(s)

Behavioral Health Utilization Management Clinical Coordinator - Remote in C at UnitedHealth Group Canada

Grand Junction, Colorado, United States -

Full Time

Start Date

Immediate

Expiry Date

17 Jan, 26

Salary

50.48

Posted On

19 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Behavioral Health, Substance Use Disorders, Medical Necessity Criteria, Care Coordination, Clinical Knowledge, MS Office, Inter-Rater Reliability, Confidentiality, Evidence-Based Practices, Community Resources, Authorization Requests, Peer-To-Peer Consultations, Eligibility Verification, Aftercare Planning, Complex Case Management, Escalated Calls

Industry

Hospitals and Health Care

Description

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 Coordinator is responsible for processing all Behavioral Health and Substance Use Disorder authorizations within designated turnaround times for various lines of business, including RMHP DSNP, RMHP Medicare, RMHP PRIME Medicaid, RMHP RAE Medicaid, RMHP CHP+, RMHP IFP, and NHP RAE Medicaid. This role involves applying approved medical necessity criteria, escalating cases to secondary medical director review when necessary, and collaborating with leadership and medical directors on complex cases. The Clinical Coordinator proactively manages and identifies potential barriers for members, ensuring they receive necessary care and support. They refer members to the RMHP Care Coordination Department for specific needs, notify providers and requestors of authorization determinations, and offer peer-to-peer consultations when cases do not meet criteria. Additionally, the Clinical Coordinators draft denial letters, validate eligibility, input authorization requests into electronic health records, and provide assistance to callers. They complete required trainings, participate in annual Inter-Rater Reliability testing, and facilitate care coordination meetings. The role also involves engaging members in the RMHP Contingency Management Program, collaborating with facility staff, providing consultations, maintaining confidentiality, supporting evidence-based practices, establishing and maintaining professional relationships, identifying the need for higher-level reviews, formulating case overviews, administering benefits, handling escalated calls, and applying clinical knowledge to determine medical appropriateness. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Remote in Colorado preferred. Primary Responsibilities: Process all Behavioral Health and Substance Use Disorder authorizations submitted by providers within the designated turnaround times specified in the Prior Authorization List for all lines of business, including RMHP DSNP, RMHP Medicare, RMHP PRIME Medicaid, RMHP RAE Medicaid, RMHP CHP+, RMHP IFP, and NHP RAE Medicaid When processing authorization requests, the Clinical Coordinator applies approved medical necessity criteria and appropriately escalates cases to secondary medical director review when necessary Collaborates with leadership to discuss authorization requests when additional guidance is required Proactively manages and identifies potential barriers for members, activating appropriate entities and departments to ensure members receive the necessary care and support to stabilize Collaborates with the medical director on complex cases to ensure members receive appropriate treatment Refers members to the RMHP Care Coordination Department when specific needs are identified, ensuring they are addressed to facilitate successful aftercare planning Notifies providers and requestors of all authorization determinations When a case is determined not to meet criteria, corresponds 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 Coordinator drafts a letter informing the member and the requesting provider of the decision, the reasons for the decision, and offers alternative treatment options Verifies eligibility of providers and members for all authorization requests Inputs authorization requests into an electronic health record Promptly provides assistance to callers routed to the BH UM department Completes required trainings by the assigned due dates to comply with auditing entities such as NCQA. These trainings include, but are not limited to the following: MCG criteria, ASAM criteria, and InterQual criteria Participates in annual Inter-Rater Reliability testing and pass with a score of 90%25 or higher If an incomplete authorization request is submitted, the Clinical Coordinator attempts to obtain the missing information from the requestor and initiates an extension if needed Schedules and facilitates care coordination meetings with members who are receiving substance use disorder residential treatment. The Clinical Coordinator identifies and assists members with unmet needs, resources, and aftercare planning Engages members in the RMHP Contingency Management Program by submitting referrals to Care Management staff, and tracks member milestones met Collaborates with facility staff, attends meetings, and addresses provider concerns 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 maintains confidence as described in the UHG Employee Handbook. The ability to maintain confidentiality is a critical and essential component of this position Supports outcome-focused, evidence-based best practices and guidelines with providers Establishes and maintains professional working relationships with referral sources, community resources, and care providers Identifies and communicates network gaps in care to Leadership Appropriately identifies the need for secondary reviews or case consultations with the Medical Director Documents concise case reviews Manages member benefits, reviews treatment plans, and coordinates transitions between various levels of care Collaborates with providers and members to address gaps in care within the community, assisting members in transitioning along the continuum of care as needed Addresses escalated calls to resolve complex issues Ensures issues or changes are communicated and implemented as appropriate Applies clinical knowledge and critical thinking to evidence-based guidelines pertaining to clinical presentations. Determines medical appropriateness and appropriate levels of care Sends correspondence to practitioners, providers, and members regarding authorization status/updates needed Maintains job aids for team operations current and updated as needed 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: Current, unrestricted independent licensure as a LAC, LPC, LMFT, LCSW in Colorado 4+ years directly serving individuals with behavioral health conditions (mental health/substance use disorders) 1+ years of experience with local behavioral health providers and community support organizations addressing SDoH (e.g., food banks, non-emergent transportation, utility assistance, housing / rapid re-housing assistance, etc. 1+ years of experience with MS Office, including Word, Excel, and Outlook Substance use treatment experience and/or behavioral health treatment experience Ability to work Monday - Friday, 930am-6pm Mountain Standard Time Preferred Qualification: Utilization Management experience *All employees working remotely 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 $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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.

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Responsibilities

The Clinical Coordinator processes all Behavioral Health and Substance Use Disorder authorizations, ensuring compliance with designated turnaround times. They collaborate with leadership and medical directors on complex cases while proactively managing member needs and barriers to care.

Behavioral Health Utilization Management Clinical Coordinator - Remote in C at UnitedHealth Group Canada

Grand Junction, Colorado, United States - Full Time

Experience Required
Minimum 5 year(s)

Sr. Data Architect (Part time)- Remote at UnitedHealth Group Canada

Philadelphia, Pennsylvania, United States - Full Time

Experience Required
Minimum 10 year(s)

Supervisor of Operational Services Auburn - Primary Care at UnitedHealth Group Canada

Auburn, Massachusetts, United States - Full Time

Experience Required
Minimum 2 year(s)

General Surgery Medical Coder at UnitedHealth Group Canada

, , United States - Full Time

Experience Required
Minimum 2 year(s)

Principal Full Stack Engineer - ServiceNow, AI with DevOps at UnitedHealth Group Canada

, karnataka, India - Full Time

Experience Required
Minimum 10 year(s)

CCAT Mid Level Practitioner - Remote at UnitedHealth Group Canada

Plymouth, England, United Kingdom - Full Time

Experience Required
Minimum 5 year(s)

Per Diem Patient Access Representative at UnitedHealth Group Canada

, , - Full Time

Principal UX Architect at UnitedHealth Group Canada

Noida, karnataka, India - Full Time

Experience Required
Minimum 10 year(s)

Product Manager – Pharmacy Software at UnitedHealth Group Canada

Washington, District of Columbia, United States - Full Time

Experience Required
Minimum 5 year(s)

Senior Clinical Appeals RN at UnitedHealth Group Canada

Plymouth, England, United States - Full Time

Experience Required
Minimum 5 year(s)

Pharmacist PA/Appeals at UnitedHealth Group Canada

Greensboro, North Carolina, United States - Full Time

Experience Required
Minimum 2 year(s)

Clinical Pharmacist at UnitedHealth Group Canada

Estero, Florida, United States - Full Time

Experience Required
Minimum 2 year(s)

Pharmacy Technician at UnitedHealth Group Canada

Lima, Ohio, United States - Full Time

Skills Needed
Customer Service, Prescription Filling, Inventory Management, Clerical Duties, Communication Skills, Medication Management, Compliance, Team Collaboration

Pharmacist at UnitedHealth Group Canada

Sugar Land, Texas, United States - Full Time

Specialization
A current and unrestricted Pharmacist license in the state of residence is required. Beginner proficiency in MS Office and a Windows-based environment is also necessary.

Director of Pharmacy at UnitedHealth Group Canada

, , - Full Time

Skills Needed
Pharmacy Operations, Leadership, Collaboration, Regulatory Compliance, Clinical Expertise, Teaching, Professional Publications, Pharmacy Management

Experience Required
Minimum 5 year(s)

Medical Assistant I/II/III - Internal Medicine Kelsey - Seybold Clinic - Me at UnitedHealth Group Canada

Houston, Texas, United States - Full Time

Skills Needed
Patient Care, Medical Terminology, Computer Proficiency, Bls Certification, Injectables Administration, Clinical Procedures, Ambulatory Care, Epic Systems

Per Diem Associate Patient Care Coordinator at UnitedHealth Group Canada

Oconomowoc, Wisconsin, United States - Full Time

Medical Assistant - WellMed at Frisco at UnitedHealth Group Canada

Frisco, Texas, United States - Full Time

Associate Patient Care Coordinator at UnitedHealth Group Canada

Anacortes, Washington, United States - Full Time

Patient Access Team Lead at UnitedHealth Group Canada

, , - Full Time

Specialization
Candidates must have a High School Diploma or GED and at least 2 years of healthcare and scheduling experience in a medical setting. Previous leadership experience is preferred.

Experience Required
Minimum 2 year(s)