Job 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.
Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.
UnitedHealth Group is working to create the Healthcare system of tomorrow and you can help. Already a Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.
Through our family of businesses and a lot of inspired individuals, we're building a high-performance Healthcare system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant and built for speed. Join us and start doing your life's best work.
This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours (8:00am - 5:00pm). It may be necessary, given the business need, to work occasional overtime.
This is high volume, customer service environment. You'll need to be efficient, productive, and thoroughly deal with our members, providers, and clinical team. You also must be able to adapt to change and participate actively in process updates.
If you are located in Ohio, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:

• Adherence with Transition of Care (TOC) contract requirements, including but not limited to, management and oversight of TOC activities and documentation of TOC activities in EMR, including but not limited to:

• Work with hospitals, clinics, facilities, and the clinical team to manage requests for services from members and/or providers following and during a transition period, including but not limited to:

• Member benefit questions
• Durable medical equipment requests
• Out-patient service requests
• Prior Authorizations
• Provide a complete continuum of quality care through close communication with members via phone calls, home visits and inpatient facility visits to other settings where members can be found, including but not limited to:

• Conduct comprehensive non-clinical member assessment that includes bio-psychosocial, functional, and behavioral health needs
• Assist members with Discharge Planning from various health care settings such as hospitals and nursing facilities
• Ensure the members have the services in the community to meet their health needs to prevent re-admissions
• Utilize interviewing techniques and active listening to collect and retain member information and incorporating responses as they are presented to complete assessments
• Identify member service needs related to health concerns
• Identify urgent situations and escalate to next level when necessary
• Identify, develop, and collaborate with members, a Health Action Plan (HAP) related to health concerns
• Work with members to identify barriers to accessing care and achieving person-centered goals with HAP, as well as work to close gaps in care
• Identify member support systems available and incorporate into HAP
• Review plan benefits and identify appropriate programs and services based on heath needs and benefits and refer members to appropriate programs and services
• Help members connect with transportation resources and give appointment reminders in special circumstances. Transporting members is strictly prohibited
• Facilitate member choice of preferred provider
• Work collaboratively with the interdisciplinary care team to ensure an integrated team approach, including but not limited to:

• Completing referrals to internal care team when care needs are identified
• Participate actively in team meetings to discuss/provide input member needs
• Participate actively in interdisciplinary care team calls to discuss/provide input on member needs

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 (or higher)
• 1+ years of Medicaid / Medicare experience OR 1+ years of experience as a Certified Community Health Worker OR 1+ years of experience working in the community / community programs
• 1+ years of telephonic customer service experience
• 1+ years of experience with knowledge of Medical Terminology
• Intermediate level of proficiency with computer and Microsoft Office including Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables), and Microsoft Outlook (email and calendar management)
• Access to reliable transportation that will enable you to travel to person company meetings
• Reside in Ohio

Preferred Qualifications:

• Associate's Degree (or higher)
• LPN
• Completion of Community Health Worker Training program
• Community Health Worker experience with MMP and Medicaid members
• Transition of care between health care settings experience
• Previous employment in a medical office, hospital or clinical or other provider environment
• Bilingual (any language)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
For more information on our Internal Job Posting 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 $20.00 to $35.72 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 #GREEN

Skills Required