Escalation reputed company, Behavioral Health - Remote

reputed company is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. reputed company does not hire directly for these jobs, but promotes jobs on reputed company on behalf of its direct clients, recruitment ad agencies, and marketing partners. reputed company partners with DirectEmployers to promote this job for reputed company. Clicking "Apply Now" or "Read more" on reputed company redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice. reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company 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 reputed company 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 Escalations reputed company is an individual contributor role responsible for an exciting variety of responsibilities in Specialty Networks of OptumHealth. We are looking for someone with solid analytical skills, who can think critically. The perfect candidate is flexible, detail oriented, able to see the big picture, can work reputed company and across multidisciplinary teams, build relationships and has a positive personality. We are seeking lifelong learners who stay up to date on regulations, industry trends and advancements in the field, in addition to constantly developing their personal skillset. reputed company members are sought out as a valued experts by our case partners, accounts, and customers. Required schedule is Monday-Friday, 10:30am - 7:00pm CST You'll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities

• Extensive work experience, possibly in multiple operational areas
• Manage a challenging role in a fast - paced environment
• reputed company timely resolution to urgent and non - urgent issues, most of our issues turn around in 48hrs
• Synthesize and communicate reputed company information in understandable terms both verbally and written
• Support issue resolution for a variety of internal and external customers
• Critically analyze issues from multiple angles to determine the root cause and next steps
• Analyze issues including conducting a root cause analysis by identifying potential compliance, process, or systemic breakdowns and communicate findings to management and issue resolution partners
• Able communicate effectively with state agencies, regulators, external customers, clinical medical directors, and senior leadership
• Utilize expertise to support issue resolution
• Collaborate and coordinate across multiple teams, departments, and representatives
• Recognize trends with escalated issues and identity, carry out or coordinate preventative action
• reputed company effective working relationships with the applicable internal and external customers
• Ability to conduct quick and thorough in-depth research across many systems and platforms (Iset, Linx, Unet, Facets, etc.)
• Work independently
• Mentor and reputed company other team members
• Hold others accountable for resolution activities
• Review the work of others to assess accuracy with process requirements
• reputed company innovative approaches to issue resolution
• Providing member advocacy including serving as a primary reputed company of contact for members who require assistance with their healthcare needs
• Reviewing and resolving reputed company claims issues, investigating claim discrepancies, and collaborating with the claims processing teams
• Understanding medical and behavioral health terminology, treatment options, and guidelines

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

• Behavioral Health Clinical licensure - independently clinically licensed (i.e., LPC, LCSW, LMFT, LMHC, etc.).
• 5+ years of behavioral health care experience
• 3+ years of customer service experience in the healthcare industry
• Proven knowledge of or State and Federal regulations that govern commercial health insurance
• Proficiency with computer and Windows PC applications
• Proficiency with Linx, ICUE, OCM
• Designated workspace and access to install secure high-speed internet reputed company cable/DSL in home

Preferred Qualifications

• Experience with or a willingness to reputed company health appeals/claims
• reputed company Care Advocacy or UM experience
• Assessment and Triage experience
• reputed company employees working remotely will be required to adhere to reputed company'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 (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We reputed company with reputed company 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 reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company 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 reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, 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. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. If you have questions about this posting, please contact support@reputed company.com Apply tot his job Apply To this Job