Specialty Navigator II

Specialty Navigator II at UnitedHealth GroupSkip to main contentThe UnitedHealth Group Careers website will be undergoing planned maintenance. There will be downtime on Friday March 27th 500 PM Central - Saturday March 28th 500 PM Central.BlogsJob seeker resources Login Bookmarked jobs 0 Career areasLife hereJoin our talent communitySearch jobsClinical ›Corporate and business operations ›Customer and support services ›Early careers›Sales and account management ›Technology and data›Physicians›Advanced practice clinicians›Pharmacy›Behavioral health›Nursing›Medical coding›Clinical support›U.S. ›Ireland & UK ›India ›Philippines ›Culture of Belonging›Employee Benefits›BlogJob seeker resources Login Bookmarked jobs 0 Career areas Clinical PhysiciansAdvanced practice cliniciansPharmacyBehavioral healthNursingMedical codingClinical support Corporate and business operations Administrative supportConsultingFinance and business analyticsLegal and complianceMarketing and communicationsPeople teamProject management Customer and support services BillingClaimsCustomer ServiceData entryEarly careers Sales and account management Account managementSalesSales management Technology and data Artificial intelligenceArchitectureBusiness systems analysisData analyticsData engineeringData scienceNetwork infrastructureProduct management & developmentSecurity and riskSoftware engineering Life here U.S. Culture of BelongingEmployee BenefitsMilitary Fellowship Program Ireland & UK Culture of BelongingEmployee Benefits India Culture of BelongingEmployee Benefits Philippines Culture of BelongingEmployee BenefitsJoin our talent communityOpen search formKeyword or job numberLocationGoExplore remote jobsPursue your passion and potentialSpecialty Navigator II Norwood Massachusetts Apply Internal apply Bookmark job Jump to Our values Job description Benefits Testimonial Awards & recognitions Related content 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.IntegrityCompassionInclusionRelationshipsInnovationPerformance Specialty Navigator II Requisition number 2353507 Job category Medical & Clinical Operations Primary location Norwood MA Date posted 03312026 Overtime status Non-exempt Travel No Share this jobFacebookXLinkedInEmailHYBRID IN MASSACHUSETTSOptum 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 startCaring. 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.ScheduleMonday - Friday 830am - 5pmLocationThis is a hybrid role will be required to work onsite 1 day per week at 1177 BOSTON PROVIDENCE HWY NORWOOD MA 02062If you reside near NORWOOD MA youll enjoy the flexibility of a hybrid-remote position as you take on some tough challenges.Primary ResponsibilitiesReviews referral information from clinicians for pertinent information regarding tests consultations and procedures. Verifies demographics and insurance information. Work is highly complex 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 payersReview referral information from work queue for pertinent information regarding referral requestsReviews each external referral for opportunity to convert to internal referral and reviews options with patients. Redirects patients with managed care products appropriately ensuring clinical handoffs are safe using expertise of specialty nurses. Ensures adequate information is obtained and relayed when care is movedExplain insurance benefits and options to patients. Explain denials to patients. Keeps patient informed of status of all referrals approved and denied. Notified patients of scheduled appointments and confirms appointment by mail including confirmed location and map of destination. Inform patient of any preparation that must be completed prior to the appointment. Contacts patients if insurance coverage issues arise during the referral process so that patient can work directly with the insurance companyPromotes the Atrius Health System of Care by highlighting internal providers and their expertiseAs needed places orders to start the referral process for the PCP on behalf of patients who have booked appointments and call for the referral. Research the visit notes to determine if a referral was intended as well as processing referrals for follow-up or annual visits that require a referralSchedules patients for tests consultations services and procedures with other departments local private offices andor outside vendorsprovidersAnswers phone calls faxed requests and other inquiries relating to referrals and communicates with the physicians and clinicians to acquiree authorization or to inform them of patient issues or clinical paperwork neededResearch 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 planWorks 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 requestsWorks with supervisors to ensure patients are receiving timely responses and detailed answers to their complex questionsResearch 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 processReceives escalated issues and stat same day calls determine appropriate action andor works with clinical team for decisionEffectively 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 neededSupports roles within the Navigator. Trains and teaches as neededParticipates in problem solving activities focusing on productivity and quality. Works with supervisors to ensure continuous improvement of the departmentIf 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 SolutionsPerforms other duties as assignedAccesses 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 informationWhat 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 includePaid Time Off which you start to accrue with your first pay period plus 8 Paid HolidaysMedical Plan options along with participation in a Health Spending Account or a Health Saving accountDental Vision Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage401k Savings Plan Employee Stock Purchase PlanEducation ReimbursementEmployee DiscountsEmployee Assistance ProgramEmployee Referral Bonus ProgramVoluntary 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 QualificationsHigh School Diploma