Job Closed

This listing is no longer active.

UnitedHealth Group

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

Specialty Appeals Pharmacy Care Coordinator

Location

United States

Posted

14 days ago

Salary

$18 - $32 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Specialty Appeals Pharmacy Care Coordinator

UnitedHealth Group

Role Description The Specialty Appeals Pharmacy Care Coordinator fills an integral role in investigating, tracking, and submitting appeals for specialty patients with acute and chronic disease states. In this role, you will be offering appeal assistance to provider offices, tracking appeal letters for submission, obtaining support documents, following up on appeal outcomes, and addressing issues and handling concerns from other corresponding departments. Schedule: - Monday – Friday, will work an 8-hour shift between the business hours of 7am – 7pm CST - Flexibility to telecommute from anywhere within the U.S. Primary Responsibilities: - Communicate with providers, patients, and pharmacy staff to obtain necessary clinical documentation, prior authorization denial letters, and appeal letters. - Access multiple Optum resources to check PA statuses, insurance and appeal outcome statuses and benefits. - Utilization of and proficiency in multiple internal processing systems is required for record keeping, tracking of determinations and potential denied prior authorizations needing an appeal letter/letter of medical necessity. - Complete status checks with provider offices verifying appeal letter receipt and submission to insurance. - Complete status checks with insurances for outcome determination for appeal. - Document case activity, communications, and correspondence in computer system to ensure completeness and accuracy of potential and completed appeal letters. - Facilitate the appeal process between the patient, physician, and insurance company by requesting denial information or additional documentation. - Facilitate obtaining the denial letter from the insurance, patient or physician. - Ensure all clinical information and documentation is obtained. - Process orders to set up patient medication shipment. - Extensive work experience within own function. - Work is frequently completed without established procedures. - Works independently. - May act as a resource for others. - May coordinate others' activities. - Perform other related duties as assigned. Qualifications - High School Diploma/GED - 1+ years of experience in the customer service or healthcare industry - Intermediate level of proficiency with MS Office (Word, Excel, Outlook) - Ability to work independently Monday - Friday, any 8-hour shift between 7am - 7pm CST Requirements - Prior Authorization experience or Appeals experience (Preferred) - Experience in pharmacy or healthcare (Preferred) Benefits - 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 - 401(k) 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.)

Related Categories

Related Job Pages

More Therapist Jobs

Speech Language Pathologist

Parallel

Welcome to a whole new paradigm of well-being.

Therapist14 days ago
Full TimeRemoteTeam 1,001-5,000Since 2014H1B Sponsor

Role Description Are you a dedicated clinician driven to make a meaningful difference in the lives of children with learning differences? Parallel is seeking expert Speech-Language Pathologists to deliver high-impact, personalized teletherapy. Join our mission-focused team and help empower students and their families with the critical tools they need to thrive and succeed. - Provide student-centered, IEP-aligned virtual speech therapy sessions. - Conduct comprehensive speech-language evaluations leveraging Parallel’s proprietary Clinical Test Library and automated Report Writer. - Partner with multidisciplinary teams to design, monitor, and refine Individualized Education Programs. - Participate in IEP meetings and provide dedicated case management for “Speech Only” students as required. - Systematically track session data and student progress to offer insightful IEP consultations. - Develop detailed, goal-oriented progress reports for each reporting cycle. - Deliver specialized state-specific services, including AAC support, Pre-K interventions, speech screenings, and SLPA supervision. Qualifications - Current ASHA Certificate of Clinical Competence (CCC-SLP). - Minimum of 1 year of full-time school-based experience conducting IEP-directed therapy and evaluations (post-CFY). 2+ years of experience is preferred for case management assignments. - Demonstrated expertise in the IEP process, educational eligibility determinations, and writing comprehensive evaluation reports. - Prior experience with Medicaid billing systems is highly advantageous. - Exceptional communication skills and the ability to build rapport with students from diverse cultural and socioeconomic backgrounds. - Tech-savvy with proficiency in virtual telehealth platforms and digital documentation. - Availability during standard school hours (Monday – Friday, 8:00 am – 4:00 pm). - Multilingual fluency is considered a significant asset. Benefits - Thoughtful Student & District Matching: Alignment with your experience, licensure, and expertise to match you with appropriate districts, schools, and student needs. - Efficient Tools and Support: Access to templates, tools, and streamlined systems designed to reduce administrative paperwork and maintain organization. - Billing & Operational Support: Systems that manage billing and documentation workflows, allowing you to prioritize student support and collaboration. - Clinical Resources: Utilization of standardized assessments, progress monitoring tools, and therapy resources to ensure high-quality service delivery. - Innovation & Feedback: Opportunities for your input to directly shape the future of our programs. - Clinical Community: Connection with peers through dedicated office hours, provider meetings, and free continuing education opportunities offered throughout the school year. - A Powerful Mission: The chance to significantly improve the lives of students nationwide. Company Description Parallel is the first tech-forward provider of care for learning and thinking differences across the United States. We believe learning differences are parallel ways of thinking that should be celebrated. Our mission is to provide students with the resources and encouragement to succeed in the classroom and beyond by helping them build confidence in their unique strengths and create strategies to work around their challenges. - Psychological Assessment - Counseling - Speech-Language Services - Special Education - And more Learn more at parallellearning.com.

United States
Circle Medical logo

Vermont MD/DO - Telemedicine Primary Care

Circle Medical

High-quality primary care, accessible through virtual and in-person visits that meet patients where they are.

Therapist14 days ago
ContractRemoteTeam 201-500Since 2015H1B No Sponsor

Role Description Seeking Telemedicine Family/Internal Medicine Providers. Circle Medical is an adult-only primary care practice committed to the empanelment of primary care providers resulting in high quality, continuity of care for our patients through a telemedicine-first approach. - Evidence-based practice leveraging proprietary, HIPAA-compliant EHR. - Delightful and safe experience for patients and providers via two-way, video-audio appointments. - Pay is fee-for-service; PCPs earn $50 (MD/DO) per patient encounter. - Appointments range from 15 to 30 mins. - Earning potential is limitless with robust incentive programs for top-performing PCPs. - Applicants must reside in the United States of America. - True Primary Care Experience rooted in provider empanelment and continuity of care. - 7-day-a-week operation offering PCPs the freedom to set their own recurring schedules, including evenings and weekends. - Supported by a strong team of patient care advocates and a licensed medical team. - High degree of technical skill utilizing software required. - Open mind to fast-paced improvements driven by product and engineering teams. - In network with most PPO insurance plans. - Help patients understand their coverage so providers can focus on care. Qualifications - Completed an accredited nursing or medical program with a national certification. - Currently licensed in Vermont with the ability to obtain additional state licenses as needed. - Valid Vermont DEA Registration in good standing with all schedules to prescribe medications, including S2. - Ideal candidates will have experience as primary care providers in a clinical setting. - At least 2 years post-residency practice experience is strongly preferred. - Must be Board Certified in Family or Internal Medicine. - Commitment to evidence-based medicine. - Willingness to learn how to diagnose and treat a variety of adult/primary care conditions. - A PC with Windows 11 Pro or a Mac newer than 2020 is required.

United States
$50 / year

Physical Therapist

Confluent Health

About Confluent Health, LLC and its affiliates: Equal opportunity employers committed to building a diverse and inclusive workforce Do not discriminate based on race, color, religion, sex, sexual orientation, gender, national origin, marital status, age, disability, veteran status, or other legally protected characteristics If you need assistance or would like to request an accommodation due to a disability, please contact us at careers@goconfluent.com

Therapist14 days ago
Full TimeRemoteTeam 5,001-10,000

Role Description Is growth potential or possibly starting a residency program important to you? Do you love the idea of working with a company that prioritizes you living your best life along with your work life? Do you love the outdoors, nature, and being active? If so, our position at ProActive PT Specialists in Battle Ground WA might be just what you have been looking for. - Applying your clinical reasoning to assess movement dysfunction and identify underlying causes through patient history and physical examination. - Collaboratively developing and adjusting evidence-based plans of care that reflect each patient’s goals, needs, and lifestyle. - Delivering skilled interventions, including therapeutic exercise, manual therapy, neuromuscular re-education, and modalities, to improve function and reduce pain. - Tracking meaningful patient outcomes and adjusting your approach based on progress and clinical presentation. - Serving as a trusted resource and advocate for your patients throughout their recovery journey. Qualifications - Licensed Physical Therapist (or ability to obtain licensure in the state of WA). - Passion for evidence-based, patient centered care. Requirements - Pay down your student loans faster – up to $25K in repayment support through our student loan repayment program, paid directly to your loan servicer. - Benefits include generous paid time off, medical, dental, vision, disability, and 401(K) with a 4% employer match. - A care model designed to support quality outcomes and efficiency. - AI clinical documentation support, built to significantly reduce after hours charting – so work stays at work. - Structured mentorship and career development. - Industry-leading continuing education through Evidence in Motion (EIM) including residency, fellowship, and board certification support. - Multiple career pathways: clinical excellence, hybrid roles, and leadership. Benefits - Compensation: $80K - $100K/year + $5K Sign on bonus, inclusive of productivity incentives, with additional compensation opportunities for certifications. - Generous paid time off. - Medical, dental, vision, disability, and 401(K) with a 4% employer match. Company Description Confluent Health, LLC and its affiliates are equal opportunity employers committed to building a diverse and inclusive workforce. We do not discriminate based on race, color, religion, sex, sexual orientation, gender (including pregnancy, childbirth, or related medical conditions), gender identity or expression, national origin, marital status, age, disability, veteran status, or other applicable legally protected characteristics. If you need assistance or would like to request an accommodation due to a disability, please contact us at careers@goconfluent.com.

United States
$80K - $100K / year
GPDQ logo

Senior MSK Physiotherapist

GPDQ

Taking Care of Health

Therapist14 days ago
Part TimeRemoteTeam 11-50Since 2015H1B No Sponsor

• Deliver high-quality telephone and video consultations for patients presenting with MSK conditions • Conduct 15-minute remote assessments and clinical triage appointments • Provide clinical diagnoses and evidence-based self-management plans • Manage patient pathways to achieve the most appropriate clinical outcomes • Arrange onward referrals where clinically appropriate • Assess patient needs and provide tailored advice and support • Deliver remote guidance on exercise techniques, rehabilitation programmes, injury prevention, and self-management strategies • Provide ongoing support, motivation, and progress reviews throughout a patient's rehabilitation journey • Maintain accurate clinical documentation using telehealth and electronic medical record systems • Stay up to date with developments in MSK practice and participate in continuing professional development activities • Deliver consistently high standards of patient-centred care

United Kingdom
£35 - £40 / hour