Behavioral Health Utilization Management Clinical Coordinator - Remote inColorado preferred

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 :

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 :

Preferred Qualification :

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.