[Hiring] Referral Navigator Representative @UnitedHealth Group

Role Description

The Referral Navigator Representative serves as a centralized care navigation and coordination resource within the Medical Management Department, supporting:

• Referral completion
• Home health services
• Durable medical equipment (DME) requests
• Call center operations
• Continuity of care activities across Kelsey-Seybold Clinic and external providers

This position performs initial review, triage, and validation of clinical and administrative documentation to ensure requests meet foundational criteria for:

• Authorization
• Physician review
• Regulatory processing

The Referral Navigator Representative coordinates with:

• Physicians
• Clinics
• Facilities
• Home health agencies
• Providers
• Members
• Nurses
• Medical reviewers
• Internal departments

This role also supports the organization’s Closed the Loop program by monitoring and coordinating activities necessary to ensure:

• Members receive requested services
• All stakeholders involved in the patient’s care remain informed of outcomes and next steps

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. 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.

Qualifications

• High School diploma or GED from an accredited program
• 2+ years of experience in a managed care, utilization management, referral management, care coordination, home health, durable medical equipment (DME), case management, medical office, hospital, health plan, accountable care organization (ACO), or healthcare operations environment
• Experience interacting with providers, physicians, clinical staff, healthcare facilities, members, and external vendors regarding healthcare services, authorizations, referrals, or care coordination activities
• Experience utilizing electronic medical records (EMR), authorization systems, payer portals, or healthcare information systems
• Knowledge of medical terminology, healthcare delivery systems, referral management, authorization processes, and care coordination principles
• Knowledge of medical terminology, CPT & ICD 10 coding, and prior authorization processes

Requirements

• Graduate from accredited medical assistant program (preferred)
• 5+ years of managed care experience either in a physician office or hospital setting health plan, ACO, or other managed care setting (preferred)
• Experience in creating authorization requests or billing Medicare or private insurance companies (preferred)
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)
• Hourly pay for this role will range from $18 - $32 per hour based on full-time employment

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.