Job title: Senior Clinical Administrator Coordinator
Company: CPS Solutions
Job description: This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.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.As a Senior Clinical Administrative Coordinator, you will manage the intake of administrative tasks for admissions through the discharge process. You will also manage the intake of members or the admission / discharge information post notification. You will be working with various hospitals, clinics, facilities and clinical teams to manage requests for service and to assist members and providers with inquiries. You will also be responsible for managing the referral process, which entails processing incoming and outgoing referrals and prior authorizations including intake, notification, and census roles. As a subject matter expert, you’ll be the “go – to” resource for information and will be tasked with resolving challenging circumstances in a positive manner.As a Senior Clinical Administrative Coordinator, you will be responsible for providing administrative support for the clinical teams. Partners with providers and members of the team. You’ll be authorizing request including but not limited to providing approvals, verifying eligibility, coordinating dates of service, and assists with obtaining and processing clinical information for clinical reviewers. you will also be responsible for a quick transition from member to the appropriate level of post – acute care.This position is full time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am – 5:00 pm. It may be necessary, given the business need, to work occasional overtime.We offer 4 – 6 weeks of paid on-the-job training. The hours of the training will be aligned with your schedule or will be discussed on your first day of employment.Primary Responsibilities:
- Maintain benchmark for quality audits, productivity, and utilization
- Manage multiple products and lines of business in the appropriate UM systems
- Manage cases for shared risk, fully insured, partial risk carve – out, and OOA acute inpatient, skilled nursing, AIR and LTAC admissions, in the appropriate UM system
- Route cases to Clinical Reviewers accurately and timely
- Monitor for misrouted cases and route appropriately
- Capture timely discharge date and case closure
- Make outbound calls to providers to provide approvals, verify admission and discharge dates
- Adhere to a work schedule to meet the business needs for department
- Request clinical information for Clinical Reviewers
- Identify new workflow processes and / or modification to existing processes as appropriate to meet program requirements, and increase / maintain member and provider satisfaction
- Process clinical information and upload into DOC360
- Verify member eligibility
- Complete administrative documentation for member records including but not limited to eligibility, provider communications, admission / discharge dates, closure of cases, clinical information requests, clinical information received, administrative approvals
- Establish relationships and communicate to providers, members, other team members
- Run and / or review reports to monitor metrics, assignments, and communication from leadership
- Attend departmental and organizational meetings, educational sessions, and complete learn sources timely
- Manage the intake of members or the admission / discharge information post notification
- Work with hospitals, clinics, facilities, and the clinical team to manage requests for services
- Resolve inquiries from members and / or providers
- Utilize web – based tool enabling improved quality, productivity, and utilization, through real – time tracking of employee activities
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:
- High School Diploma / GED OR equivalent work experience
- Must be 18 years of age OR older
- 2+ years of experience with analyzing and solving customer problems
- 1+ years of experience with working in the health care industry
- 1+ years of experience in working with medical terminology
- Experience with effectively articulating and communicating with manager, team members, and customers
- Experience with quickly adapting to change and drive innovation within team and market
- Experience with working across functions and businesses to achieve business goals
- Experience with developing and maintaining positive customer relationships
- Experience with navigating multiple computer systems and experience using Microsoft Office
- Ability to work any of our full time, shift schedules during our normal business hours of 8:00 am – 5:00 pm. It may be necessary, given the business need, to work occasional overtime.
Preferred Qualifications:
- Experience in working with health care insurance
- Experience in a hospital, physician’s office, OR medical clinic setting
- Experience in working with Medicare, Commercial, and Medicaid memberships
- Clerical OR administrative support background OR experience with working in a call center environment
Telecommuting Requirements:
- Ability to keep all company sensitive documents secure (if applicable)
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Soft Skills:
- Excellent written and oral communication skills
- Must possess a high level of organizational skills, self – motivation, and ability to manage time independently
- Critical thinking skills
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyPay 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 requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 – $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable.Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.
Expected salary: $20 – 35.72 per hour
Location: Orlando, FL
Job date: Sat, 18 Oct 2025 03:37:27 GMT
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