Medical Review Coordinator (Work in our center of excellence!)

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.

PacifiCare Health Systems is now part of UnitedHealthcare, a UnitedHealth Group company. As one of the nation's leading consumer health organizations, we are recognized by over 3 million health plan members for delivering first-to-market innovations as well as affordable high-quality programs. And, as part of UnitedHealthcare, we can offer you that rare combination of building a rewarding career with a healthy business while improving the lives of others.



Bring us your medical knowledge, and we'll bring your career to new heights in this unique position on our Clinical Advancement team. The Medical Review Coordinator, focused on referrals, would enjoy plenty of growth potential and variety in a fast-paced team environment.



Key responsibilities include:


Examining various inbound referrals, case-by-case, and making related determinations


Receiving referrals for outpatient procedures, home healthcare, physical therapy and other treatments


Reviewing referrals and auditing the clinical information in each using the Milliman system


Giving the appropriate approvals/denials based on your findings


Contacting the sender of the referral to gather additional information when necessary


Relaying escalated cases to a nurse or Medical Director for further review

Job Requirements:

We need a motivated professional with solid experience working in a medical or doctor's office setting. Clinical experience is also needed, as is familiarity with CPT and ICD-9 medical codes and medical terminology. Certification in any of these is preferred. A background in health insurance and prior authorizations is a plus. Medical coursework would be very helpful in this role. Proficiency with MS Windows applications is essential. If you meet these criteria, and you're an outgoing team player with solid communication skills, you may be the ideal addition to our successful Cypress team - apply now.



UnitedHealth Group offers a full range of comprehensive benefits, including medical, dental and vision, as well as a matching 401k and an employee stock purchase plan.



If you are interested in growing professionally within an innovative, highly respected organization, we invite you to explore this excellent growth opportunity!



Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V.