Specialty Navigator II

Specialty Navigator II at UnitedHealth Group

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Specialty Navigator II

Norwood Massachusetts

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Caring. Connecting. Growing together.

With these values to guide us our people are committed to making a meaningful difference in the lives of those we are honored to serve.

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Specialty Navigator II

Requisition number 2354700

Job category Medical & Clinical Operations

Primary location Norwood MA

Date posted 04292026

Overtime status Non-exempt

Travel No

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HYBRID IN NORWOOD MA

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 Supervisors and Manager of the department reviews complex referral requests and evaluates and assigns appropriate specialists 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 Atrius Health and with external partners.

Schedule

FT 40 hours. Monday - Friday 830am - 5pm

This is a hybrid role hybrid schedule to be determined by manager upon hire.

Location

1177 PROVIDENCE HWY NORWOOD MA 02062

If you are located within a commutable distance to our Norwood MA office you will have the flexibility to work a hybrid schedule 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

Conduct detailed reviews of specialty referral requests for opportunity to convert to internal referral in collaboration with clinical team members ensuring alignment with organizational referral guidelines

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. Manage complex patient interactions related to referral decisions effectively de‑escalating concerns while maintaining adherence to clinical and organizational standards

Promotes the 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 andor outside vendorsproviders

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 questionsconcerns 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 Practices 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 providersvendors. May coordinate second opinion requests

Works with supervisors to ensure patients are receiving timely responses and detailed answers to their complex questions

Research questionsconcerns 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 andor 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

Accesses only the minimum necessary protected health information PHI for the performance of job duties. Actively protects the confidentiality and privacy of all protected health information they access in all its forms written verbal and electronic etc. taking reasonable precautions to prohibit unauthorized access. Complies with all Atrius Health and departmental privacy policies procedures and protocols. Follows HIPAA privacy guidelines without deviation when handling protected health information

Ability to work in a busy office environment with frequent deadlines and interruptions

Performs other duties as assigned

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

401k 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.

Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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