Job Closed
This listing is no longer active.
UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Sr Clinical Quality Registered Nurse - Call Center - Remote
Location
United States
Posted
78 days ago
Salary
$72.8K - $130K / year
Seniority
Senior
No structured requirement data.
Job Description
Sr Clinical Quality Registered Nurse - Call Center - Remote
UnitedHealth Group
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. The Clinical Performance Quality (CPQ) Pharmacy Operations team supports Optum’s Care Delivery Organizations by delivering patient-centered, clinically collaborative telephonic outreach to help people live healthier lives. Our team focuses on the design, execution, and delivery of telephonic and digital engagement strategies designed to close Medicare STARS/HEDIS gaps in care, including medication adherence, care for older adults, medication reconciliation post discharge, A1c, Blood pressure and statin therapy in patient with diabetes and cardiovascular disease. Our interdisciplinary service delivery team is comprised of Pharmacists, Registered Nurses, Pharmacy Technicians, and Care Coordinators. The Registered Nurse will report into the Director of Clinical Pharmacy. The Registered Nurse will perform telephonic, patient-centered clinical consults focused on Care for Older Adults annual pain and functional assessments. In addition, the RN will outreach telephonically for Transition of Care following hospital discharge to complete reviews as well as assist with appointment scheduling. The RN will be required to meet or exceed established productivity and quality metrics and work to support the hours of operation of the business (Mon-Fri 9am-6pm Central). If you are located in a Compact State, you will have the flexibility to work remotely* as you take on some tough challenges. Hours are Monday through Friday 8AM - 5PM within your local time zone. Primary Responsibilities: - Strictly adheres to department’s metrics and established advanced protocols and to handle incoming contacts including, but not limited to, prescription refill requests, lab results, x-ray results, medical inquiries, patient education and referral requests - Primarily to make outbound calls and will help manage the inbound call queue from patients, patient representatives, providers, and other medical staff, while strictly adhering to established protocols and scripting - Review patient chart (in EMR) to ensure core measures are being addressed and met per protocol and takes appropriate action when they are not, i.e., schedule services - Complete patient assessments for Transition of Care Medication Reconciliation Post Discharge, Care for Older Adults Pain and Function Assessments - Educate patients on health conditions and necessity of routine screening and assisting with appointment scheduling (A1c, Controlling Blood Pressure, Breast Cancer Screening, Colorectal Cancer Screening, Diabetic Eye Exam, etc.) - Communicate with providers and offices to obtain needed evidence of completed lab work, screenings and care provided - Review available medical records for core measures to submit for closure of HEDIS/STARS measures - Assist patients with identification of and connectivity to community and program resources to assist with non-medical needs - Document thoroughly all calls and actions taken within core systems - Performs all other related duties as assigned 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: - Active, unrestricted Registered Nurse eLNC Compact licensure in state of residency - Currently have or be able to obtain additional RN licensure in one or more of the following states: California, Connecticut, Nevada, New York, Oregon - 5+ years of RN experience, including experience in a managed care setting - 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role - 2+ years of experience with data analysis and/or quality chart reviews. Must be able to review paper and electronic medical records and charts - 1+ years of Call Center experience - Experience using Microsoft office applications, including databases, word-processing, outlook, and excel spreadsheets. Proficient in Excel - Solid knowledge of the Medicare HEDIS/Stars measures - Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels - Demonstrated ability to manage multiple complex, concurrent projects - Demonstrated excellent written and verbal communication and relationship building skills - Demonstrated solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action - Demonstrated excellent customer service skills and communication skills Preferred Qualifications: - Undergraduate degree, post graduate degree - Billing and CPT coding experience - Clinical data abstraction experience - Proven adaptable to change - Proven good business acumen, especially as it relates to Medicare - Bilingual with preference given to Spanish and Vietnamese Physical & Mental Requirements: - Ability to lift up to 25 pounds - Ability to sit for extended periods of time - Ability to use fine motor skills to operate office equipment and/or machinery - Ability to receive and comprehend instructions verbally and/or in writing - Ability to use logical reasoning for simple and complex problem solving - Ability to use fine motor skills to operate office equipment and/or machinery - Ability to stand for extended periods of time *All employees working remotely will be required to adhere to UnitedHealth Group’s 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 requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually 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.
Related Guides
Related Categories
Related Job Pages
More Call Center Representative Jobs
We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more – in our careers and in our communities. Job Description Summary: The Patient Service Representative I role may be the initial point of contact for patients, physicians, and the public at large. This position provides exceptional public relations/customer service during encounters with patients, families, visitors and Ohio Health physicians and associates. The primary responsibilities are scheduling/registration or patient billing follow up, and identify and execute a plan meeting the needs of the caller. Responsibilities And Duties: The Patient Service Representative I may be expected to perform any of the following and other duties as assigned: Provides exceptional customer service during every encounter with patients, families, visitors and OhioHealth physicians and associates Accept inbound calls within a specific response-to-call timeframe following customer service standards at all time Makes outbound calls with according to the standard work and following customer service standards. Accurately identifies patient in the EMR system. Adhere to the department Standard Work Obtains and enters accurate patient demographic and financial information while maintaining patient confidentiality Uses critical thinking skills to make decisions, resolve issues, or escalate concerns Verifies insurance eligibility using online eligibility system, payer websites or by phone call Processes faxes and transcribes information into the system’s EMR. Follow protocols for directly contacting the care centers regarding urgent patient requests and ensure timely follow up Schedules outpatients appointments Generates, prints, and provides patient estimates utilizing price estimator products Inform patient of any outstanding balance, collect balance and co-payment or provide financial assistance information Answers questions or concerns regarding insurance residuals and self-pay accounts Uses knowledge of CPT codes to accurately select codes from clinical descriptions Identifies and/or determines patient Out of Network acceptance into the organization Explains billing procedures, hospital policies and provides appropriate literature and documentation Update/notate all accounts using appropriate standard work Reviews insurance information and determines need for referrals and/or financial counseling. Educates patients on MyChart, including activation Adhere to policy and procedures Participate in and contribute to development of Lean processes. Complies with all organizational, state and federal laws and regulations related to patient privacy and confidentiality (ie. PHI, HIPAA, etc.) Work collectively in a professional manner Confirms physician's orders/visit purpose Verifies multidisciplinary patient schedules for Outpatient visits to expedite patient processing Obtains Release of Information authorization from patients to release medical records Uses conflict resolution skills and service recovery to handle customer service concerns Resolve patient complaints and concerns and, if unable to resolve, escalate appropriately Provides information to physician offices and other hospital departments when needed Minimum Qualifications: High School or GED (Required) Additional Job Description: Typing of 40 wpm, excellent communication, organization, and basic computer skills. KIND and LENGTH of EXPERIENCE 1-2 years of previous experience in the service industry with a focus on delivering exceptional customer service or 1-2 years previous experience in a Medical Office setting or 1-2 years previous experience in a Call Center or 1-2 years previous experience in Collections Work Shift: Day Scheduled Weekly Hours : 40 Department Patient Contact Center Join us! ... if your passion is to work in a caring environment ... if you believe that learning is a life-long process ... if you strive for excellence and want to be among the best in the healthcare industry Equal Employment Opportunity OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment Remote Work Disclaimer: Positions marked as remote are only eligible for work from Ohio.
The Senior Analyst, Contact Center Modeling & Planning provides analytical support to InnovAge’s contact center and operational teams through forecasting, capacity modeling, and initiative impact sizing. This role develops and maintains models that determine staffing requirements, workload projections, and operational performance expectations. The analyst partners with Operations, Finance, HR, and IT to support budget planning, call volume forecasting, and data driven decision-making. This position is ideal for an experienced analyst with strong quantitative skills and proven experience in contact center forecasting or Workforce Management environments. Essential Functions & Responsibilities Functional Category: Forecasting & Workload Modeling Estimated % of Time: 35% - Create and maintain forecasting models for call volume, workload, service demand, and key operational drivers. - Produce short-term, midterm, and long-range forecasts to support service levels, planning cycles, and budget inputs. - Analyze historical trends, seasonality, routing impacts, and productivity to improve forecast accuracy. Functional Category: Capacity & Staffing Planning Estimated % of Time: 30% - Build staffing models incorporating AHT, shrinkage, adherence, occupancy, and productivity metrics. - Produce weekly, monthly, and annual capacity plans that drive operational staffing decisions. - Analyze variance between forecasted and actual performance and recommend adjustments to leadership. Functional Category: Business Initiative Sizing & Impact Analysis Estimated % of Time: 15% - Conduct scenario modeling to evaluate the impact of new initiatives, policy changes, and technology enhancements. - Quantify workload, staffing, and cost impacts to support leadership decision-making. - Provide concise, actionable insights supported by clear analytical rationale. Functional Category: Analytics, Reporting & Insights Estimated % of Time: 15% - Develop dashboards and reporting for forecasting accuracy, staffing efficiency, call-volume trends, and key operational KPIs. - Provide executive-ready insights and recommendations that highlight risks, opportunities, and performance trends. - Identify areas for process improvement and resource optimization. Functional Category: Cross‑Functional Collaboration Estimated % of Time: 5% - Partner with Finance to support labor planning, budget cycles, and cost modeling. - Collaborate with IT and data teams to ensure data integrity, routing logic accuracy, and reporting consistency. - Work closely with Operations leaders and HR Recruiting to align models to real-time conditions and business priorities. Travel Requirements 5% travel across centers and markets, including onsite meetings Qualifications Required - Bachelor’s degree required in Business, Finance, Economics, Mathematics, Statistics, Data Analytics, Operations Management, Industrial Engineering, or a related field. - 5+ years in forecasting, Workforce Management, capacity planning, or operational analytics. - Strong quantitative and modeling skills with advanced Excel proficiency. - Experience working in contact center environments (multi-channel preferred). - Ability to translate complex data into clear, actionable recommendations for leaders. - Experience with WFM or forecasting tools (e.g., NICE, Verint, Calabrio). Preferred - Master’s degree required in Business, Finance, Economics, Mathematics, Statistics, Data Analytics, Operations Management, Industrial Engineering, or a related field. - Experience supporting multi-site or high-volume operational functions. - Background in business operations, FP&A, or continuous improvement. - Experience with SQL, Power BI, Tableau, or other analytics tools. - Advanced experience creating or scaling capacity and forecasting models. InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge, our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge, you'll work alongside talented, respectful, and passionate colleagues within a patient-centered care model. InnovAge is committed to equal opportunity and affirmative action, and we strive to create a diverse and inclusive workplace. We consider all qualified candidates for employment without discrimination based on race, color, religion, sex, sexual orientation, gender identity/expression, national origin, disability, protected veteran status, pregnancy, or any other protected status. Salaries are determined by various factors such as qualifications, experience, and location, and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/vision insurance, short and long-term disability, life insurance and AD&D, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays. Applicants are considered until the position is filled. $103,300 - $134,400 Compensation Disclaimer The pay may vary depending on job related factors, such as work location, experience, knowledge, skills, education, certifications, training and internal equity. InnovAge offers a comprehensive benefits package, which includes medical, dental, vision, 401(k) plan with company match, short and long-term disability, life insurance, supplemental life insurance, ADD, flexible spending account, paid time off and company paid holidays. Attention Florida Applicants This position requires a background screening through the Florida Care Provider Background Screening Clearinghouse. For more information, please visit the Clearinghouse Education and Awareness website: https://info.flclearinghouse.com Agency Disclaimer InnovAge will not accept unsolicited resumes from search firms for this employment opportunity. Regardless of past practices, all candidates/resumes submitted by search firms to InnovAge by any means without a valid written search agreement in place for that position will be deemed the property of InnovAge and no fee will be paid in the event such candidate is hired by InnovAge.
Call Center Scheduler
APDermAPDerm is proud to be an equal employment opportunity and affirmative action workplace. We consider all qualified applicants without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, military and veteran status, disability, genetics, or any other category protected by federal law or APDerm policy. Please email humanresources@apderm.com if you need a disability accommodation for any part of the employment process.
Role Description Schedule all general dermatology appointments. Answer all incoming calls and triage to the correct department or individual. Also responsible for rescheduling cancelled appointments or follow-up appointments. Demonstrates sensitivity to patient’s needs and requirements. Demonstrates superior telephone and interpersonal skills. This is a primarily remote position but you must reside in MA, NH, RI, NY or CT. - Answers telephone calls promptly and in a friendly manner saying one’s name at the beginning of the call. - Pre-Registers all New Patients which includes: - Name - Sex - Date of birth - Home address - Home telephone number - Work telephone number - Cell/pager number - Insurance information which includes: - Plan name - Plan ID # - Plan group # - Subscriber name if other than ‘self’ - Subscriber’s date of birth - Primary care physician’s name - Co-payment amount - Verifying every caller’s information which includes: - Date of birth - Home address - Home telephone number - Work telephone number - Cell/pager number - Checking patients' insurance eligibility status by one click of a button - Insurance information which includes: - Plan name - Plan ID # - Plan group # - Subscriber name if other than ‘self’ - Subscriber’s date of birth - Primary care physician’s name - Co-payment amount - Scheduling the patient with the correct appointment type code, scheduling the patient with the correct amount of time, documentation of appointment reason for every patient is essential, and confirming appointment date, time, provider they are seeing and office location. - Putting patient on call wait list if patient wishes to be seen sooner. - Checking the wait list daily when cancellations come through. - Notifying appropriate office of same day add-ons and cancellations. - Triages all calls to appropriate personnel. - Responsible for scheduling queue voicemail throughout the day and returning patient calls within 30 minutes of received message. If a patient cancels an appointment via voicemail you are to call the patient back to try to reschedule even if they have stated they will call to reschedule. - Responsible for patient reschedules and patient reminders. - Entering faxed referral registration requests from primary care and urgent care offices. Calling patients to schedule appointments and documenting in Athena charts when they are not reached. - Informing patients about proper protocols. - Informing patients if their insurance requires a referral. - Maintains a ONETeam mindset using the foundation of our core values, the 3Ps: Positivity, Productivity, and Professionalism. - Support APDerm’s mission and culture of high-quality standards by carrying out applicable policies, procedures and established industry standards, laws and regulations. Examples include adhering to privacy and data protection practices, ensuring a safe workplace, and reporting observed or suspected behavior and actions that do not meet APDerm standards. - Complete all assigned required training by the deadline including, but not limited to the Code of Conduct, Privacy & Data Security, and OSHA. Qualifications - High school diploma or equivalent. - Two years’ experience in physician practice or customer service-related background. - Exceptional articulate communication skills. - Able to demonstrate concern for patient’s problems. - Cares for patients as one would wish to be treated. - Conveys enthusiasm. - Ability to empathize with geriatric and disabled people. - Good problem-solving skills. - Knowledge of Microsoft Word. Requirements - The salary for this role will range from USD $19.00 to 28.50 per hour based on full-time employment. Salary offers are based on a wide range of factors including but not limited to years of experience, location, relevant skills, training, education, etc. - Certain roles may be eligible for performance-based incentive compensation and/or long-term incentives. Benefits - APDerm supports your life's needs through an extensive offering comprehensive, competitive and inclusive set of health, financial and other benefits that support your total well-being. Company Description APDerm is proud to be an equal employment opportunity and affirmative action workplace. We consider all qualified applicants without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, military and veteran status, disability, genetics, or any other category protected by federal law or APDerm policy. Please email humanresources@apderm.com if you need a disability accommodation for any part of the employment process.
Position Overview About Us: At Athletico, we believe in the power of support – because a little help can lead to extraordinary achievements. Physical therapy isn’t just about recovery; it’s about transformation. Our team thrives on providing life-changing care for our patients, and we know that achieving this begins with taking care of our own. Our mission is simple yet powerful: Extraordinary people improving lives. Position Summary: Ensures optimum reimbursement and works improve the day-to-day operations of the revenue cycle. Essential Duties and Responsibilities: - Responsible for timely responses to internal and external customers. - Works as part of a multi-departmental team to provide answers to billing inquiries. - Provides a variety of revenue cycle support services in connection to day-to-day operations. - Processes and follows up on payer issues with various entities for completion. - Researches and resolves straightforward account activity. - Provides communication on the methods and principles used for billing to the customers and resolve concerns. - Participates in the flow of the account throughout the revenue cycle process. - Maintains accuracy and integrity of the revenue cycle system and accounts therein. - Collectively works with team to meet organizational targets. Qualifications: - Education: - High school diploma required - Work Experience: - Minimum 1 year of revenue cycle experience preferred - Certification/Licensure: - None required - Knowledge and Technical Skills: - Working knowledge of Revenue Cycle systems - Working knowledge of Microsoft Office - Ability to understand and follow HIPAA regulations Language Skills: - Ability to read, write and speak English proficiently Physical Demands: The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. - Ability to fulfill office activities including but not limited to remain stationary for extended periods of time (i.e., while working at a desk), stoop/kneel/crouch, travel around the office, communicate with others (verbal and written), and use fine motor skills including fine hand manipulation and keyboarding. - Ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus. Work Environment: - Consistent with standard office environment, noise level is low with little to no extraordinary environmental factors. Additional Benefits offered with this full-time position: - Medical & Rx, Dental and Vision (eligibility begins day one of employment) - HSA, Healthcare FSA, Dependent Care FSA - Progyny Fertility Benefit - Critical Illness, Accident, & Hospital Indemnity Insurance - Company Paid Basic Life / AD&D - Supplemental Life Insurance (Employee, Spouse, Child) - Company Paid Short-Term & Long-Term Disability - Long-Term Disability Buy-Up Option - Company Paid Maternity & Parental Leave - Adoption & Surrogacy Expense Reimbursement - KinderCare Discount - Legal & Credit Monitoring - PTO (accruing starts immediately upon hire) - 6 Major Holidays off plus 2 floating holidays yearly - Physical Therapy/Occupational Therapy benefits as an employee - Bereavement Time Off & Resources - Commuter: Pre-Tax Transit & Parking - Retirement 401(k) w/ Per-Pay Company Match - SoFi Financial Wellness Tools & Loan Resources - HUSK Fitness Resources & Gym Discounts - Home, Auto, and Pet Insurance - Employee Assistance Program (EAP) - Employee Discount Program - Learn more by checking out our 2026 Athletico's Benefits Summary. Athletico provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Salaried ranges listed are for full time (40 hour) employees. Additional pay such as incentive, GAP, overtime, and stipends are subject to the rules of each program and may not be available in all locations. Individual base pay depends on various factors, in addition to primary work location, such as complexity and responsibility of role, job duties/requirements, and relevant experience and skills. Base pay ranges are reviewed and typically updated each year. Offers are made within the base pay range applicable at the time. Minimum Salary/Wage USD $17.50/Hr. Maximum Salary/Wage USD $20.50/Yr.

