Referral Navigator Representative - Remote- Kelsey Seybold
Optum · Pearland, TX · 1 mo ago
OTHR$18–$32/hrFull-time
We need to produce HTML fragment with sections: About the role? The posting includes description of role, responsibilities, qualifications, etc. We need to use for section headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We must not repeat job title. Must not include Job ID etc. Remove boilerplate (cookie/navigation/legal/EEO etc). Must preserve all substantive info.
We need to parse the posting for content.
Let's extract:
Intro: "Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together."
That's about the organization; could be "About the role"? Actually "About the role" is more about the job description. But we could treat that as "About the role" maybe. However we have a specific description of the Referral Navigator Representative role later.
We need sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule.
We need to decide which sections have content.
- About the role: Could include the description of the role: "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, and 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, and regulatory processing. The Referral Navigator Representative coordinates with physicians, clinics, facilities, home health agencies, providers, members, nurses, medical reviewers, and internal departments to facilitate timely progression of patient care requests and ensure complete communication throughout the continuum of care. This role also supports the organization's Closed the Loop program by monitoring and coordinating activities necessary to ensure members receive requested services and that 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."
That's a good "About the role" section.
- Responsibilities: Could list duties: supporting referral completion, home health services, DME requests, call center operations, continuity of care activities; initial review, triage, validation of documentation; coordinate with physicians, clinics, facilities, home health agencies, providers, members, nurses, medical reviewers, internal departments; facilitate timely progression of patient care requests; ensure complete communication; support Closed the Loop program by monitoring and coordinating activities to ensure members receive requested services and stakeholders informed of outcomes and next steps. Also flexibility to work remotely, rewarded and recognized, etc. But many of those are also in About the role. We could separate: Responsibilities as bullet list of duties.
- Requirements: Required Qualifications list: High School diploma or GED; 2+ years experience in managed care, utilization management, referral management, care coordination, home health, DME, case management, medical office, hospital, health plan, ACO, or healthcare operations; Experience interacting with providers, physicians, clinical staff, healthcare facilities, members, external vendors regarding healthcare services, authorizations, referrals, or care coordination; Experience utilizing 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.
- Qualifications: Preferred Qualifications list: Graduate from accredited medical assistant program; 5+ years of managed care experience either in a physician office or hospital setting health plan, ACO, or other managed care setting; Experience in creating authorization requests or billing Medicare or private insurance companies; All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
- Skills: Could be derived from knowledge areas: medical terminology, EMR, authorization systems, etc. But maybe we can combine into Skills section: Knowledge of medical terminology, CPT & ICD 10 coding, prior authorization processes; Experience with EMR, authorization systems, payer portals; Ability to interact with providers, etc. However we need to avoid duplication. The instructions: Prefer a few substantive sections over many thin ones. So maybe we combine Requirements and Qualifications into one "Requirements" section? But they said use headings for each if content exists. We could have Requirements (required) and Qualifications (preferred). That's two sections.
- Skills: Could be separate if we have specific skill list not covered elsewhere. The posting mentions "Experience utilizing electronic medical records (EMR), authorization systems, payer portals, or healthcare information systems" and "Knowledge of medical terminology, healthcare delivery systems, referral management, authorization processes, and care coordination principles" and "Knowledge of medical terminology, CPT & ICD 10 coding, and prior authorization processes". Those could be skills. But we could put them under Requirements or Qualifications. However we have separate headings for Skills; we could create a Skills section summarizing those.
- Benefits: The posting mentions: "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." Also "You'll be rewarded and recognized for your performance". Also remote work flexibility. So we can include Benefits section.
- Pay: The posting includes: "The hourly pay for this role will range from $18 - $32 per hour based on full-time employment." Also "Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc." So we have Pay info.
- Schedule: Not explicitly mentioned besides remote work flexibility; no schedule details like full-time, part-time, shift. It mentions full-time employment for pay range. Could infer full-time schedule. But we should not create Schedule section unless posting actually states them. It does not state schedule specifics. So we should omit Schedule.
- Also we need to include maybe a short paragraph for metadata like location? The posting mentions 40+ locations throughout Houston, remote work anywhere in US. Could be part of About the role or Benefits. But we can include location in About the role.
We must not include boilerplate: EEO, drug test, mission statements, etc. Remove those.
We must preserve all substantive information; do not invent or summarize away detail. So we need to keep all specifics: numbers, etc.
Let's list substantive info:
- Organization: Kelsey-Seybold Clinic, part of Optum family; nation's leading health care org; 40+ locations Houston; team nationally recognized for delivering coordinated and accountable care; multi-specialty clinic with >900 medical providers in 65 specialties; opportunity to drive higher quality, higher patient satisfaction, lower total costs; Caring. Connecting. Growing together.
- Role: Referral Navigator Representative; centralized care navigation and coordination resource within Medical Management Department; supports referral completion, home health services, DME requests, call center operations, continuity of care activities across Kelsey-Seybold Clinic and external providers; performs initial review, triage, validation of clinical and administrative documentation to ensure requests meet foundational criteria for authorization, physician review, regulatory processing; coordinates with physicians, clinics, facilities, home health agencies, providers, members, nurses, medical reviewers, internal departments to facilitate timely progression of patient care requests and ensure complete communication throughout continuum of care; supports Closed the Loop program by monitoring and coordinating activities necessary to ensure members receive requested services and stakeholders informed of outcomes and next steps; flexibility to work remotely from anywhere within U.S.; rewarded and recognized for performance; environment challenges and gives clear direction on what it takes to succeed; provides development for other roles.
- Required Qualifications:
* High School diploma or GED from accredited program
* 2+ years experience in managed care, utilization management, referral management, care coordination, home health, DME, case management, medical office, hospital, health plan, ACO, or healthcare operations
* Experience interacting with providers, physicians, clinical staff, healthcare facilities, members, external vendors regarding healthcare services, authorizations, referrals, or care coordination
* Experience utilizing 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
- Preferred Qualifications:
* Graduate from accredited medical assistant program
* 5+ years of managed care experience either in a physician office or hospital setting health plan, ACO, or other managed care setting
* Experience in creating authorization requests or billing Medicare or private insurance companies
* 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 subject to eligibility)
* Far-reaching choice of benefits and incentives
* Rewarded and recognized for performance
* Flexibility to work remotely from anywhere within U.S.
- Pay:
* Hourly pay range $18 - $32 per hour based on full-time employment
* Pay based on factors: local labor markets, education, work experience, certifications, etc.
* Compliance with minimum wage laws.
We should not include: Application Deadline, EEO statements, drug test, mission, OptumCare EEO, drug-free workplace, etc.
Now we need to output HTML fragment with
for section headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We must not repeat job title. Must not include Job ID etc. Remove boilerplate (cookie/navigation/legal/EEO etc). Must preserve all substantive info.
We need to parse the posting for content.
Let's extract:
Intro: "Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together."
That's about the organization; could be "About the role"? Actually "About the role" is more about the job description. But we could treat that as "About the role" maybe. However we have a specific description of the Referral Navigator Representative role later.
We need sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule.
We need to decide which sections have content.
- About the role: Could include the description of the role: "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, and 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, and regulatory processing. The Referral Navigator Representative coordinates with physicians, clinics, facilities, home health agencies, providers, members, nurses, medical reviewers, and internal departments to facilitate timely progression of patient care requests and ensure complete communication throughout the continuum of care. This role also supports the organization's Closed the Loop program by monitoring and coordinating activities necessary to ensure members receive requested services and that 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."
That's a good "About the role" section.
- Responsibilities: Could list duties: supporting referral completion, home health services, DME requests, call center operations, continuity of care activities; initial review, triage, validation of documentation; coordinate with physicians, clinics, facilities, home health agencies, providers, members, nurses, medical reviewers, internal departments; facilitate timely progression of patient care requests; ensure complete communication; support Closed the Loop program by monitoring and coordinating activities to ensure members receive requested services and stakeholders informed of outcomes and next steps. Also flexibility to work remotely, rewarded and recognized, etc. But many of those are also in About the role. We could separate: Responsibilities as bullet list of duties.
- Requirements: Required Qualifications list: High School diploma or GED; 2+ years experience in managed care, utilization management, referral management, care coordination, home health, DME, case management, medical office, hospital, health plan, ACO, or healthcare operations; Experience interacting with providers, physicians, clinical staff, healthcare facilities, members, external vendors regarding healthcare services, authorizations, referrals, or care coordination; Experience utilizing 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.
- Qualifications: Preferred Qualifications list: Graduate from accredited medical assistant program; 5+ years of managed care experience either in a physician office or hospital setting health plan, ACO, or other managed care setting; Experience in creating authorization requests or billing Medicare or private insurance companies; All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
- Skills: Could be derived from knowledge areas: medical terminology, EMR, authorization systems, etc. But maybe we can combine into Skills section: Knowledge of medical terminology, CPT & ICD 10 coding, prior authorization processes; Experience with EMR, authorization systems, payer portals; Ability to interact with providers, etc. However we need to avoid duplication. The instructions: Prefer a few substantive sections over many thin ones. So maybe we combine Requirements and Qualifications into one "Requirements" section? But they said use headings for each if content exists. We could have Requirements (required) and Qualifications (preferred). That's two sections.
- Skills: Could be separate if we have specific skill list not covered elsewhere. The posting mentions "Experience utilizing electronic medical records (EMR), authorization systems, payer portals, or healthcare information systems" and "Knowledge of medical terminology, healthcare delivery systems, referral management, authorization processes, and care coordination principles" and "Knowledge of medical terminology, CPT & ICD 10 coding, and prior authorization processes". Those could be skills. But we could put them under Requirements or Qualifications. However we have separate headings for Skills; we could create a Skills section summarizing those.
- Benefits: The posting mentions: "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." Also "You'll be rewarded and recognized for your performance". Also remote work flexibility. So we can include Benefits section.
- Pay: The posting includes: "The hourly pay for this role will range from $18 - $32 per hour based on full-time employment." Also "Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc." So we have Pay info.
- Schedule: Not explicitly mentioned besides remote work flexibility; no schedule details like full-time, part-time, shift. It mentions full-time employment for pay range. Could infer full-time schedule. But we should not create Schedule section unless posting actually states them. It does not state schedule specifics. So we should omit Schedule.
- Also we need to include maybe a short paragraph for metadata like location? The posting mentions 40+ locations throughout Houston, remote work anywhere in US. Could be part of About the role or Benefits. But we can include location in About the role.
We must not include boilerplate: EEO, drug test, mission statements, etc. Remove those.
We must preserve all substantive information; do not invent or summarize away detail. So we need to keep all specifics: numbers, etc.
Let's list substantive info:
- Organization: Kelsey-Seybold Clinic, part of Optum family; nation's leading health care org; 40+ locations Houston; team nationally recognized for delivering coordinated and accountable care; multi-specialty clinic with >900 medical providers in 65 specialties; opportunity to drive higher quality, higher patient satisfaction, lower total costs; Caring. Connecting. Growing together.
- Role: Referral Navigator Representative; centralized care navigation and coordination resource within Medical Management Department; supports referral completion, home health services, DME requests, call center operations, continuity of care activities across Kelsey-Seybold Clinic and external providers; performs initial review, triage, validation of clinical and administrative documentation to ensure requests meet foundational criteria for authorization, physician review, regulatory processing; coordinates with physicians, clinics, facilities, home health agencies, providers, members, nurses, medical reviewers, internal departments to facilitate timely progression of patient care requests and ensure complete communication throughout continuum of care; supports Closed the Loop program by monitoring and coordinating activities necessary to ensure members receive requested services and stakeholders informed of outcomes and next steps; flexibility to work remotely from anywhere within U.S.; rewarded and recognized for performance; environment challenges and gives clear direction on what it takes to succeed; provides development for other roles.
- Required Qualifications:
* High School diploma or GED from accredited program
* 2+ years experience in managed care, utilization management, referral management, care coordination, home health, DME, case management, medical office, hospital, health plan, ACO, or healthcare operations
* Experience interacting with providers, physicians, clinical staff, healthcare facilities, members, external vendors regarding healthcare services, authorizations, referrals, or care coordination
* Experience utilizing 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
- Preferred Qualifications:
* Graduate from accredited medical assistant program
* 5+ years of managed care experience either in a physician office or hospital setting health plan, ACO, or other managed care setting
* Experience in creating authorization requests or billing Medicare or private insurance companies
* 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 subject to eligibility)
* Far-reaching choice of benefits and incentives
* Rewarded and recognized for performance
* Flexibility to work remotely from anywhere within U.S.
- Pay:
* Hourly pay range $18 - $32 per hour based on full-time employment
* Pay based on factors: local labor markets, education, work experience, certifications, etc.
* Compliance with minimum wage laws.
We should not include: Application Deadline, EEO statements, drug test, mission, OptumCare EEO, drug-free workplace, etc.
Now we need to output HTML fragment with headings and - for lists,
for prose.
We need to decide which sections to include: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay. Possibly Skills could be omitted if we incorporate into Requirements/Qualifications. But we have separate headings for Skills; we could create a Skills section summarizing knowledge areas: medical terminology, EMR, authorization systems, payer portals, CPT & ICD 10 coding, prior authorization processes, healthcare delivery systems, referral management, authorization processes, care coordination principles. However that duplicates content from Requirements. To avoid duplication, maybe we omit Skills section and keep Requirements and Qualifications. The instruction: "Prefer a few substantive sections over many thin ones." So better to have fewer sections. We could combine Requirements and Qualifications into one "Requirements" section that includes both required and preferred? But they are distinct. However we could have "Requirements" for required, and "Qualifications" for preferred. That's two sections. That's fine.
We could also have "About the role" as prose, "Responsibilities" as list, "Requirements" as list (required), "Qualifications" as list (preferred), "Benefits" as list, "Pay" as prose (maybe list). That's six sections.
We need to ensure we don't create empty sections.
Now we need to format.
Let's craft:
About the role
... (prose)
Responsibilities
- Support referral completion, home health services, durable medical equipment (DME) requests, call center operations, and continuity of care activities across Kelsey-Seybold Clinic and external providers.
- Perform
- for lists,
for prose. We need to decide which sections to include: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay. Possibly Skills could be omitted if we incorporate into Requirements/Qualifications. But we have separate headings for Skills; we could create a Skills section summarizing knowledge areas: medical terminology, EMR, authorization systems, payer portals, CPT & ICD 10 coding, prior authorization processes, healthcare delivery systems, referral management, authorization processes, care coordination principles. However that duplicates content from Requirements. To avoid duplication, maybe we omit Skills section and keep Requirements and Qualifications. The instruction: "Prefer a few substantive sections over many thin ones." So better to have fewer sections. We could combine Requirements and Qualifications into one "Requirements" section that includes both required and preferred? But they are distinct. However we could have "Requirements" for required, and "Qualifications" for preferred. That's two sections. That's fine. We could also have "About the role" as prose, "Responsibilities" as list, "Requirements" as list (required), "Qualifications" as list (preferred), "Benefits" as list, "Pay" as prose (maybe list). That's six sections. We need to ensure we don't create empty sections. Now we need to format. Let's craft:
About the role
... (prose)
Responsibilities
- Support referral completion, home health services, durable medical equipment (DME) requests, call center operations, and continuity of care activities across Kelsey-Seybold Clinic and external providers.
- Perform