Behavioral Health Clinical Administrative Coordinator

UnitedHealth Group • Grand Junction, CO

3h • $18 - $32 • Remote

About The Position

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 Administrative Assistant is responsible for validating the eligibility of providers and members for all authorization requests and preparing Behavioral Health and Substance Use Disorder authorizations for various lines of business, including RMHP PRIME Medicaid, RMHP RAE Medicaid, RMHP CHP+, RMHP IFP, and NHP RAE Medicaid. This role involves collaborating with leadership guidance, referring members to the RMHP Care Coordination Department for aftercare planning, and notifying providers and requestors of authorization determinations. When cases do not meet criteria, the assistant offers peer-to-peer consultations with the RMHP medical director and drafts denial letters with alternative treatment options. They provide prompt assistance to callers, complete required trainings, and handle incomplete authorization requests by obtaining missing information. The assistant takes detailed meeting notes, provides consultations on various issues, maintains confidentiality, establishes professional relationships, and handles escalated calls. They utilize clinical knowledge to apply evidence-based guidelines, send correspondence regarding authorization status, monitor the Behavioral Health Fax Queue, verify and upload documentation, organize authorization requests, and distribute information to Clinical Coordinators. Additionally, they ensure handbook updates, upload clinical documentation, bookmark cases for audits, correct errors, complete notifications, enter Single Case Agreements, and maintain job aids for team functions.

Requirements

• High School Diploma/GED
• 2+ years of experience analyzing and solving customer problems
• Reside in the USA

Nice To Haves

• 2 years of experience working in the healthcare industry
• 2 years of experience working with medical terminology

Responsibilities

• Verifies eligibility of providers and members for all authorization requests
• Inputs and prepares all Behavioral Health and Substance Use Disorder authorizations submitted by providers for all lines of business including RMHP PRIME Medicaid, RMHP RAE Medicaid, RMHP CHP+, RMHP IFP, and NHP RAE Medicaid and assign to the specified Clinical Coordinator
• Collaborates with leadership when additional guidance is required
• Refers members to the RMHP Care Coordination Department when completing discharge documentation, ensuring needs are addressed to facilitate successful aftercare planning
• Notifies providers and requestors of all authorization determinations when appropriate
• When a case is determined not to meet criteria, correspond 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 Administrative Assistant drafts a letter informing the member and the requesting provider of the decision, the reasons for the decision, and offers alternative treatment options
• Promptly provides assistance to callers routed to the BH UM department
• Completes required training by the assigned due dates to comply with auditing entities such as NCQA. These training courses include, but are not limited to the following: MCG criteria, ASAM criteria, and InterQual criteria
• If an incomplete authorization request is submitted, the Clinical Administrative Coordinator will attempt to obtain the missing information from the requestor and initiate an extension if needed with the Clinical Coordinator
• Take detailed notes of meetings attended
• 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 maintain confidence as described in the UHG Employee Handbook. The ability to maintain confidentiality is a critical and essential component of this position
• Establishes and maintains professional working relations with referral sources, community resources, and care providers, and be able to identify and communicate network gaps
• Handles escalated calls and resolve complex issues. Ensure issues or changes are communicated and integrated as appropriate
• Sends correspondence to practitioners, providers, and members regarding authorization status/updates needed
• Monitors the Behavioral Health Fax Que daily and uploads documentation to authorizations
• Verifies and uploads valid Release of Information documentations to electronic health records and notifies the Clinical Coordinator of invalid documentation for follow up
• Organizes and manages authorization requests
• Distributes information to Clinical Coordinators that is sent from providers
• Ensures the Utilization Management Team references the most updated member handbooks across all lines of business (coverage/eligibility-denials)
• Uploads concurrent clinical documentation to the electronic health record
• Creates bookmarks in authorizations pulled for audits by various entities
• Corrects errors identified in various reports
• Completes notifications within the electronic health records and provides documentation to the provider as necessary
• Enters Single Case Agreements into the electronic health record and notifies appropriate teams of actions that need to take place
• Maintains and updates job aids for team functions as needed

Benefits

• 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.)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED