LHI Triage Case Care Coordinator- Remote

UnitedHealth Group
June 8, 2021
Atlanta, GA
Job Type


At Optum, the mission is clear: Help people live heathier lives and help make the health system work better for everyone

LHI is one of 4 businesses under OptumServe. OptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well - being of Americans. By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system.

LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on - location services, patient - specific in - clinic appointments, telehealth assessments, or any combination based on customer need. LHI's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

There’s an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing your life’s best work.SM

The role of the Triage Case Coordinator is to support and handle member scenarios within a short amount of time. The Triage Case Coordinator’s responsibility is to provide resolution for all member calls in order to provide evidence based support and services; assess and coordinate care for a very diverse population of members of the World Trade Center (WTC) Health Program throughout the United States; educate and inform members of program coverage and limitations while ensuring that high quality and cost-effective care is provided within contract requirements; use critical thinking and problem solving skills to navigate through the complexities of a member’s health conditions while maintaining coverage within the program guidelines; coordinate health care services for members; prepare and summarize medical history information on members to present to the Medical Director.  Cultivate relationships with members, providers, co-workers, and other team members to ensure program compliance and member satisfaction.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Training will be conducted virtually from your home.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

  • Complete intake calls to welcome members to the program
  • Initiate care plans and enter in all relative information from the issues at hand to interventions
  • Promote adherence to care plan, developed in coordination with the member, primary care provider as well as other treating providers
  • Assess members unmet needs, coordinate services and treatment needs
  • Identify early risk factors and conduct ongoing assessments and document appropriately
  • Function as an advocate
  • Build and maintain relationships with members and other authorized member representatives
  • Educate members on program benefits and preventative care
  • Maintain contract expertise through internal as well as external training and education programs
  • Increase continuity of care by managing relationships with providers involved
  • Assist in gaining availability for future appointments
  • Complete initial assessment interviews
  • Assist in provider selection for annual screening exams, diagnostic evaluations as well as treatment appointments
  • Acknowledge member’s rights on confidentiality issues, maintain patient confidentiality at all times, and follows HIPAA guidelines and regulations
  • Communicates with a variety of internal and external individuals for the purpose of acquiring accurate and up-to-date information concerning WTCHP NPN certifications
  • Manage inbound calls from members to properly direct their call and help coordinate their care and needs
  • Manage inbound calls from providers to prior authorize tests and procedures related to members’ certified health conditions and program coverage
  • Assess member’s unmet needs, coordinate services and treatment needs
  • Review medical records (monitoring, treatment and supportive) to determine WTC relatedness for potential program coverage and communicate results to members
  • Completion of system generated tasks, including documenting all results as required in internal database (MedNet)
  • Work with partners including medical, clinical, financial, behavioral and Rx to resolve issues
  • Initial point of contact for internal departments to answer questions relative to members of their assigned caseload
  • Engage in real time collaboration with clinical partners including, Medical Directo, CM/DM Nurses in resolving member concerns and engaging appropriate clinical programs and resources
  • Understand program coverage guidelines

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:

One of the following:

  • Associate’s degree in clinical or medical health administration (LPN, social work, psychology, or related field)  or,
  • Associate’s degree in Medical Health Administration, or
  • High School Diploma/ GED (or higher) plus 2+ years of equivalent work experience
  • Experience with medical terminology or completion of medical terminology course
  • Intermediate PC and Microsoft Office computer skills including Microsoft Word (create and edit documents), Microsoft Excel (create, sort, and edit data in spreadsheets), and Microsoft Outlook (email and calendar management) while providing customer support on the phone
  • Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (9:00am - 6:00pm CST).
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Telecommuting Requirements: 

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy 
  • Ability to keep all company sensitive documents secure (if applicable) 
  • Must be able to connect directly into internet – via hard wire (either directly to modem or router) 
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service 

Preferred Qualifications:

  • Case Management experience
  • Medical related experience in a corporate/business setting or call center
  • Knowledge of ICD and CPT coding
  • Call center experience
  • National Career Readiness Certificate
  • Military Experience

Soft Skills:

  • Excellent written and verbal communication, telephone etiquette and interpersonal skills
  • Strong organizational, multi-tasking and time management skills
  • Effective interpersonal, communication, and problem-solving skills
  • Ability to work independently as well as on a team
  • Critical thinking and decision-making skills
  • Must have the ability to take initiative and be detail-orientated

UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non - clinical workforce transitioned to a work at home (remote) status.  We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us. 

You can learn more about all we are doing to fight COVID - 19 and support impacted communities at: https://www.unitedhealthgroup.com/newsroom/addressing-covid.html

Careers with LHI. Our focus is simple. We’re innovators in cost - effective health care management. And when you join our team, you’ll be a partner in impacting the lives of our customers, and employees. We’ve joined OptumHealth, part of the UnitedHealth Group family of companies, and our mission is to help the health system work better for everyone. We’re located on the banks of the beautiful Mississippi River in La Crosse, Wis., with a satellite office in Chicago and remote employees throughout the United States. We’re supported by a national network of more than 25,000 medical and dental providers. Simply put, together we work toward a healthier tomorrow for everyone. Our team members are selected for their dedication and mission - driven focus. For you, that means one incredible team and a singular opportunity to do your life’s best work.

Colorado Residents Only: The hourly range for Colorado residents is $17.12 to $30.34. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary,  UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: intake, medical terminology, customer service, program benefits, care plans, medical health administration, clinical field, CPT, ICD coding, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #rpo

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