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Clinical Administrative Coordinator - Miami, FL

UnitedHealth Group

Miami, FL
Job Code:
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Job Details

Clinical Administrative Coordinator - Miami, FL(Job Number:713992)

Position Description:

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.

Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Due to our expanding business, UnitedHealth Group is seeking Clinical Administrative Coordinators who share our passion for helping others live healthier lives. As one of the world's leading health care companies, UnitedHealth Group is pursuing innovative new ways to operate our service centers and improve on our ability to deliver high-quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Take this opportunity and begin doing your life's best work. (sm) 

What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.

Primary Responsibilities:

  • Under the general direction of the Clinical Director or designee, provide Authorizations for Hospital Admissions, Skilled Nursing facilities, Rehabilitation facilities, Specialist Providers, Outpatient services and Ancillary services such as Home Health Care, Durable Medical equipment, Orthotics/ Prosthetic devices, Colostomy supplies and Infusion services, and others as directed.
  • Assist in the coordination of Discharge Planning activities on all Plan participants. The Plan is dependent upon participants' Discharge needs.
  • Communicate with a variety of Clinical disciplines to clarify and enforce Plan policies and procedures.
  • Collect and review of service requests for completeness and referral to Clinical Director or Medical Director.
  • Answer the telephone ACD line, as scheduled.
  • Verify benefits in Diamond System.
  • Referral filling and distribution to the designee coordinator.
  • Referral processing for Outpatient services, including but not limited to Outpatient Surgeries, Rehabilitation Therapies, Radiation Therapy, Chemotherapy, Provider’s evaluations and Follow-up, Ancillary services, such as DME’s, HHC and Orthotics/Prosthetic devices.
  • Collection of data for Clinical oversight.
  • Pre-Authorization entering for Requests of services such as Clinical Evaluations/Follow-up visits, Outpatient procedures, Inpatient services such as: Elective Admissions, Emergency Room Admissions, Skilled Nursing facilities, Rehabilitation facilities, Outpatient services, Ancillary services, such as DME’s, HHC and Orthotics/ Prosthetic Devices in Diamond System, when applicable.
  • Daily notification to PCP’S of Admissions Authorizations to Acute facilities. Authorization entering for Plan Members under the care of Dialysis and Hospice services.
  • Process Denial Authorizations for non-coverage services for Medicare and Medicaid plan participant’s adherence to timeliness for determinations.                                            
  • Maintain and update daily reports as required, including but not limited to: Daily Hospital Admission Census, Skilled Nursing Facility Census, Rehabilitation Census, Part B Census, and Home Health Care Census.
  • Maintain monthly reports for Dialysis, Hospice, Healthy Start, Medicaid Sterilization, Abortion and Hysterectomy, Re-admission to Acute facilities, Admissions to Acute facility and Telephone ACD Reports.
  • Assist Case Managers and PCPs in the coordination of Discharge planning from Acute Facilities to Sub-Acute placements and from Skilled Nursing facilities and Rehabilitation facilities to Home and to Community services.
  • Maintain record of Discharge planning implemented and coordinated services.
  • Send Discharge Notification form with all discharge planning arrangements to PCPs upon discharge from facilities.
  • Follow up with patient to assure accuracy that the coordination of services such as HHC and DMEs has been completed.
  • Consult with various Clinical disciplines regarding specifics patient and their follow-up needs.
  • Identify Risk Management issues thru Health Plan guidelines and requirements and submit Incident Reports to Director.   
  • Participate in monthly staff meetings.
  • Participate in scheduled In-service for different disciplines.
  • Perform Health Risk Assessment program.
  • Ensure compliance with Risk Management policies and incident reporting.
  • Assist with Health Risk Assessment data verification.

Job Clinical Admin & Processing
Primary Location US-FL-Miami
Other Location 
Organization Clin Support & Notifications
Schedule Full-time
Number of Openings 4
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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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