Referral Navigator Representative - - Kelsey Seybold

UnitedHealth Group•Pearland, TX

16h•$18 - $32•Remote

About The Position

The Referral Navigator Representative serves as a centralized care navigation and coordination resource within the Medical Management Department. The role supports referral completion, home health services, durable medical equipment (DME) requests, call center operations, and continuity-of-care activities across Kelsey-Seybold Clinic and external providers. It performs initial review, triage, and validation of clinical and administrative documentation to ensure requests meet foundational criteria for authorization, physician review, and regulatory processing. The representative coordinates with physicians, clinics, facilities, home health agencies, providers, members, nurses, medical reviewers, and internal departments to facilitate timely progression of patient care requests and complete communication across the continuum of care. The role also supports the Closed the Loop program by monitoring and coordinating activities to ensure members receive requested services and stakeholders are informed of outcomes and next steps. The position may be performed remotely from anywhere in the United States, subject to UnitedHealth Group’s Telecommuter Policy.

Requirements

High school diploma or GED from an accredited program.
At least 2 years of experience in a managed care, utilization management, referral management, care coordination, home health, DME, case management, medical office, hospital, health plan, accountable care organization (ACO), or healthcare operations environment.
Experience interacting with providers, physicians, clinical staff, healthcare facilities, members, and external vendors regarding healthcare services, authorizations, referrals, or care coordination activities.
Experience using electronic medical records (EMR), authorization systems, payer portals, or healthcare information systems.
Knowledge of medical terminology, healthcare delivery systems, referral management, authorization processes, and care coordination principles.
Knowledge of medical terminology, CPT and ICD-10 coding, and prior authorization processes.

Nice To Haves

Graduate of an accredited medical assistant program.
At least 5 years of managed care experience in a physician office, hospital, health plan, ACO, or other managed care setting.
Experience creating authorization requests or billing Medicare or private insurance companies.

Responsibilities

Support referral completion, home health services, durable medical equipment (DME) requests, call center operations, and continuity-of-care activities.
Perform initial review, triage, and validation of clinical and administrative documentation for authorization, physician review, and regulatory processing.
Coordinate with physicians, clinics, facilities, home health agencies, providers, members, nurses, medical reviewers, and internal departments to facilitate timely patient care requests.
Ensure complete communication throughout the continuum of care.
Support the Closed the Loop program by monitoring and coordinating activities to ensure members receive requested services and stakeholders are informed of outcomes and next steps.