Talent.com
Specialty Navigator
Specialty NavigatorOptum • Auburn, Massachusetts, United States
Specialty Navigator

Specialty Navigator

Optum • Auburn, Massachusetts, United States
job_description.job_card.variable_hours_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

REMOTE IN MASSACHUSETTS

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Reporting to and working under the general direction of the Supervisor(s) and Manager of the department, the Specialty Navigator reviews complex referral requests and evaluates and assigns appropriate specialist for the patient. Works with patients and providers to understand services being requested. Interviews patients as needed to obtain full understanding of what information is being requested. Works closely with Specialty Nurses to ensure clinical handoffs are safe and appropriate. Coordinates care both within Reliant and Atrius Health and with external partners.

Schedule (38.75 hours / week) : Monday - Friday 8 : 30am - 5pm EST or 8 : 00am - 4 : 30pm EST

If you reside within the state of Massachusetts, you will enjoy the flexibility to telecommute

  • as you take on some tough challenges.

Primary Responsibilities :

  • Reviews referral information from clinicians for pertinent information regarding tests, consultations, and procedures
  • Verifies demographics and insurance information
  • Work is highly complex and detail oriented, involving frequent contact with a range of internal and external contacts as well as the need to understand terms and processes of multiple payers
  • Reviews referral information from work queue for pertinent information regarding referral requests
  • Reviews each external referral for opportunity to convert to internal referral and reviews options with patients
  • Redirects patients with managed care products appropriately ensuring clinical handoff is safe using expertise of specialty nurses
  • Ensures adequate information is obtained and relayed when care is moved
  • Explains insurance benefits and options to patients
  • Explains denials to patients. Keeps patient informed of status of all referrals (approved and denied)
  • Notifies patients of scheduled appointments and confirms appointment by mail including confirmed location and map of destination
  • Informs patient of any preparation that must be completed prior to the appointment
  • Contacts patient if insurance coverage issues arise during the referral process so that patient can work directly with the insurance company
  • Promotes the Reliant and Atrius Health System of Care by highlighting internal providers and their expertise
  • As needed, places orders to start the referral process for the PCP on behalf of patients who have booked appointments and call for the referral
  • Researches the visit notes to determine if a referral was intended as well as processing referrals for follow-up or annual visits that require a referral
  • Schedules patients for tests, consultations, services and procedures with other departments, local private offices, and / or outside vendors / providers
  • Answers phone calls, faxed requests and other inquires relating to referrals and communicates with the physicians and clinicians to acquire authorization or to inform them of patient issues or clinical paperwork needed
  • Research questions / concerns from patients regarding bills and determines if issue is related to the referral process
  • Assists in resolving billing and denied referral matters as they relate to the referral process
  • Refers patients to appropriate staff (e.g., patient account representatives) for billing issues related to insurance benefits and services covered under the benefits plan
  • Works in collaboration with the person designated as the Practice's Benefits Coordinator to maintain cost control, ensure that services provided are within benefit plan guidelines, and that necessary policies and procedures are followed when dealing with non-preferred providers / vendors
  • May coordinate second opinion requests
  • Works with supervisors to ensure patients are receiving timely responses and detailed answers to their complex questions
  • Research questions / concerns from patients regarding billing and determines if issue is related to the referral process. Assists in resolving billing and denied referral matters as they relate to the referral process
  • Receives escalated issues and stat same day calls; determine appropriate action and / or works with clinical team for decision
  • Effectively deescalates issues with upset patients and practices. Uses advanced listening techniques to understand the issue and give patients options as they are available. Escalates to supervisors only as needed
  • Supports roles within the Navigator
  • Trains and teaches as needed
  • Participates in problem solving activities, focusing on productivity and quality
  • Works with supervisors to ensure continuous improvement of the department
  • If needed, contacts appropriate parties to obtain referral authorizations and verify coverage (e.g., the Authorization Services Unit (ASU), National Imaging Associates (NIA) or individual insurance companies)
  • Certain departments may also need to contact additional outside agencies for approval (e.g., American Imaging Management or Med Solutions)
  • Customer Service : Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations
  • Decision Making : Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance
  • Problem Solving : Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents
  • Independence of Action : Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and / or unpredictable situations. Work progress is monitored by supervisor / manager
  • Written Communications : Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers
  • Oral Communications : Ability to comprehend and communicate complex verbal information in
  • English to medical center staff, patients, families and external customers
  • Knowledge : Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations
  • Teamwork : Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members
  • Complies with health and safety requirements and with regulatory agencies
  • Complies with established departmental policies, procedures, and objectives
  • Enhances professional growth and development through educational programs, seminars, etc.
  • Attends a variety of meetings, conferences, and seminars as required or directed
  • Regular, reliable and predictable attendance is required
  • Performs other similar and related duties as required or directed
  • What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include :

  • 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.)
  • More information can be downloaded at : http : / / uhg.hr / uhgbenefits
  • 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 :

  • High School Diploma / GED (or higher)
  • 1+ years of receptionist, admin support, or healthcare-related experience
  • Intermediate level of proficiency with MS Office tools
  • Preferred Qualifications :

  • 1+ years of experience working in a medical front office position performing duties such as scheduling appointments, checking patients in / out, insurance verification, collecting co-pays and maintaining medical records
  • Proficiency in Microsoft Office (Word, Excel and Outlook)
  • Knowledge of Epic EMR software
  • Ability to learn new software (EPIC / EMR) and flexibility to attend new hire training
  • Soft Skills :

  • Ability to work independently and maintain good judgment and accountability
  • Ability to prioritize tasks to meet all deadlines
  • Ability to work well under pressure in a fast-paced environment
  • Demonstrated ability to work well with health care providers
  • Strong organizational and time management skills
  • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others
  • All Telecommuters 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 $17.74 to $31.63 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, #RED

    serp_jobs.job_alerts.create_a_job

    Navigator • Auburn, Massachusetts, United States

    Job_description.internal_linking.related_jobs
    Travel Nurse RN - Telemetry - $1,872 per week in Gardner, MA

    Travel Nurse RN - Telemetry - $1,872 per week in Gardner, MA

    TravelNurseSource • Gardner, MA, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with GQR Healthcare to find a qualified Telemetry RN in Gardner, Massachusetts, 01440!.GQR Healthcare is representing a well-known health system that is seeking Medica...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel X-Ray Technician - $2029.51 / Week

    Travel X-Ray Technician - $2029.51 / Week

    Atlas MedStaff • Southbridge, MA, US
    serp_jobs.job_card.full_time
    Atlas MedStaff is seeking an experienced X-Ray Technician for an exciting Travel Allied job in Southbridge, MA.Shift : 5x8 hr nights Start Date : 12 / 22 / 2025 Duration : 13 weeks Pay : $2029.Atlas Medsta...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Anesthesiology

    Anesthesiology

    VISTA Staffing Solutions • Putnam, US
    serp_jobs.job_card.full_time
    We are looking for a CRNA for our clients site in Connecticut.Great time of year to visit the northeast ‐ are you available?. Schedule : 7am‐cases are finished.Job Setting / Type of Cases : H...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Radiology Technologist - $2,225 per week

    Travel Radiology Technologist - $2,225 per week

    First Connect Health • Southbridge, MA, United States
    serp_jobs.job_card.full_time
    First Connect Health is seeking a travel Radiology Technologist for a travel job in Southbridge, Massachusetts.Job Description & Requirements. Looking for an end of Dec Start Date.Position : Day Shif...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Customs and Border Protection Officer

    Customs and Border Protection Officer

    U.S. Customs and Border Protection • Baldwinville, Massachusetts, US
    serp_jobs.job_card.full_time +1
    Customs and Border Protection Officer (CBPO).A high number of candidates may make applications for this position, so make sure to send your CV and application through as soon as possible.Customs an...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Entry Level Driver Flexible Schedule

    Entry Level Driver Flexible Schedule

    Beacon Mobility - Butler's Bus Service • Temple, NH, United States
    serp_jobs.job_card.full_time +1
    School Bus Driver Paid CDL Training + $3,000$5,000 Sign-On Bonus.Part-time weekdays Split shift (AM / PM) No nights, weekends, or holidays. Drive With Purpose and Enjoy Great Pay & Flexibility.Looking...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Delivery Driver - Earn Extra Cash

    Delivery Driver - Earn Extra Cash

    DoorDash • Auburn, MA, US
    serp_jobs.job_card.full_time +1
    DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day. As a Dasher, you’ll stay busy with a var...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
    Lead - Transporter

    Lead - Transporter

    Tenet Massachusetts • Cherry Valley, MA, US
    serp_jobs.job_card.full_time
    Tenet Massachusetts is seeking a Transporter Lead for a job in Cherry Valley, Massachusetts.Job Description & Requirements. Provides direction, coordination and monitoring of transport staff.Mon...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Telemetry - $1,664 per week in Gardner, MA

    Travel Nurse RN - Telemetry - $1,664 per week in Gardner, MA

    TravelNurseSource • Gardner, MA, US
    serp_jobs.job_card.full_time
    TravelNurseSource is working with GQR Healthcare to find a qualified Telemetry RN in Gardner, Massachusetts, 01440!.GQR Healthcare is representing a well-known health system seeking experienced Med...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Physical Therapist (PT) - $2,465 per week in Rochdale, MA

    Travel Physical Therapist (PT) - $2,465 per week in Rochdale, MA

    AlliedTravelCareers • Rochdale, MA, US
    serp_jobs.job_card.full_time
    AlliedTravelCareers is working with Cross Country Allied to find a qualified Physical Therapist (PT) in Rochdale, Massachusetts, 01542!. As an inpatient physical therapist, you'll provide PT service...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Nurse RN - Behavioral Health - $1,944 per week

    Travel Nurse RN - Behavioral Health - $1,944 per week

    HonorVet Technologies • Gardner, MA, United States
    serp_jobs.job_card.full_time
    HonorVet Technologies is seeking a travel nurse RN Behavioral Health for a travel nursing job in Gardner, Massachusetts.Job Description & Requirements. REQUIRED SKILLS / CERTS / EXP : .Minimum Years o...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Cardiopulmonary Respiratory Therapist - $1,802 per week

    Travel Cardiopulmonary Respiratory Therapist - $1,802 per week

    Aequor Allied • Gardner, MA, United States
    serp_jobs.job_card.full_time
    Aequor Allied is seeking a travel Respiratory Therapist for a travel job in Gardner, Massachusetts.Job Description & Requirements. Pay package is based on 12 hour shifts and 36 hours per week (subje...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Cardiopulmonary Respiratory Therapist

    Travel Cardiopulmonary Respiratory Therapist

    GHR Healthcare - PH Division • Gardner, MA, US
    serp_jobs.job_card.full_time
    GHR Healthcare - PH Division is seeking a travel Respiratory Therapist for a travel job in Gardner, Massachusetts.Job Description & Requirements. Planet Healthcare Job ID #73026504.Pay package i...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Driver gig - Earn at least $1785 by driving 115 trips with Uber

    Driver gig - Earn at least $1785 by driving 115 trips with Uber

    Uber • Fitzwilliam, New Hampshire, US
    serp_jobs.job_card.full_time +2
    Earn at least $1785 driving with Uber when you complete your first 115 trips in 30 days.Read all the information about this opportunity carefully, then use the application button below to send your...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Physical Therapist (PT) - $2,117 per week in Auburn, MA

    Travel Physical Therapist (PT) - $2,117 per week in Auburn, MA

    AlliedTravelCareers • Auburn, MA, US
    serp_jobs.job_card.full_time
    AlliedTravelCareers is working with Centra Healthcare Solutions to find a qualified Physical Therapist (PT) in Auburn, Massachusetts, 01501!. A great Outpatient Clinic is looking for an experienced ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Nuclear Medicine Technologist - $36-59 per hour

    Nuclear Medicine Technologist - $36-59 per hour

    Tenet Massachusetts • Cherry Valley, MA, United States
    serp_jobs.job_card.full_time
    Tenet Massachusetts is seeking a Nuclear Medicine Technologist for a job in Cherry Valley, Massachusetts.Job Description & Requirements. Up to $20,000 Sign-on Bonus Based on Eligibility.By combining...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Travel Physical Therapist - $2,466 per week

    Travel Physical Therapist - $2,466 per week

    Medical Solutions Allied • Rochdale, MA, United States
    serp_jobs.job_card.full_time
    Medical Solutions Allied is seeking a travel Physical Therapist for a travel job in Rochdale, Massachusetts.Job Description & Requirements. We’re seeking talented healthcare professionals whose adve...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Drive with Uber - Earn at least $1785 in your first 115 trips with Uber.

    Drive with Uber - Earn at least $1785 in your first 115 trips with Uber.

    Uber • New Ipswich, New Hampshire, US
    serp_jobs.job_card.full_time +2
    Earn at least $1785 driving with Uber when you complete your first 115 trips in 30 days.Read all the information about this opportunity carefully, then use the application button below to send your...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted