Specialty Navigator II at UnitedHealth Group
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Specialty Navigator II
Norwood Massachusetts
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Specialty Navigator II
Requisition number 2354701
Job category Medical & Clinical Operations
Primary location Norwood MA
Date posted 04302026
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 vendors/providers
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 questions/concerns 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 providers/vendors. May coordinate second opinion requests
Works with supervisors to ensure patients are receiving timely responses and detailed answers to their complex questions
Research questions/concerns 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 and/or 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/GED
3 years of experience in a clinical or healthcare setting
Intermediate level proficiency in Microsoft scheduling software and electronic medical records systems Epic or equivalent
Preferred Qualifications
Strong problem solving and complex patient management skills
Relevant experience in the managed care environment
High level of understanding of health insurance products and limitations in order to match patient to available providers
Bilingual
Soft Skills
Customer Service
Ability to provide a high level of customer service to patients visitors staff and external customers in a professional service-oriented respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations
Decision Making
Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance
Problem Solving
Ability to address problems that are varied requiring analysis or interpretation of the situation using direct observation knowledge and skills based on general precedents
Independence of Action
Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager
Written Communications
Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers
Oral Communications
Ability to comprehend and communicate complex verbal information in English to medical center staff patients families and external customers
Knowledge
Ability to demonstrate full working knowledge of standard concepts practices procedures and policies with the ability to use them in varied situations
Teamwork
Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas identifying issues and respecting team members
All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets education work experience certifications etc. In addition to your salary we offer benefits such as a comprehensive benefits package incentive and recognition programs equity stock purchase and 401k contribution all benefits are subject to eligibility
UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others.
What we do
Gain insights on how we work to help people live healthier lives and help make the health system work better for everyone by watching this video.
https://www.youtube.com/watch?v=5PbNyi2IDkY
Caring. Connecting. Growing together.
Being a part of UnitedHealth Group means working to improve health outcomes for everyone, including yourself. Here is how:
• Caring. Your total health and well-being are important to us. Whatever matters most to you — we have resources to help you be your best at work and at home. The benefits range from free Peloton courses to financial counseling. Learn more about what we offer.
• Connecting. We recognize our collective power to make an impact across our communities because we believe the health of any society is measured by the overall health of its people. Learn more about our culture.
• Growing together. UnitedHealth Group is full of inspiring career stories, and we offer a lifetime of opportunities. Discover all the ways you can learn, grow and develop.