Specialty Navigator II

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Specialty Navigator II (2384213)

Specialty Navigator II - 2384213

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.

Reporting to and working under the general direction of the Supervisor(s) and Manager of the department, reviews complex referral requests and evaluates and assigns appropriate specialists for the patient. Works with patients and providers to understand services being requested. Interviews patients as needed to obtain full understanding of what information is being requested. Works closely with Specialty Nurses to ensure clinical handoffs are safe and appropriate.

Coordinates care both within Atrius Health and Reliant and with external partners.

Schedule:Monday-Friday, 8-hour shifts between 8:30-5pm EST

Location:1177 Providence Hwy. Norwood, MA. If you live near Norwood, MA, you will enjoy the flexibility of a office-based
* role as you take on some tough challenges. Office-based schedule to be determined upon hire. May be required to work onsite at manager’s discretion (for possible training, or if there are connectivity issues, etc.)

Department:Referral/Float Team

• Reviews referral information from clinicians for pertinent information regarding tests, consultations, and procedures
  • Verifies demographics and insurance information
  • Work is highly complex and detail oriented, involving frequent contact with a range of internal and external contacts as well as the need to understand terms and processes of multiple payers
• Reviews referral information from work queue for pertinent information regarding referral requests
• Reviews each external referral for opportunity to convert to internal referral and reviews options with patients
  • Redirect patients with managed care products appropriately ensuring clinical handoff is safe using expertise of specialty nurses. Ensures adequate information is obtained and relayed when care is moved
• Promotes the Atrius Health System of Care by highlighting internal providers and their expertise
• As needed, places orders to start the referral process for the PCP on behalf of patients who have booked appointments and call for the referral. Researches the visit notes to determine if a referral was intended as well as processing referrals for follow-up or annual visits that require a referral
• Schedules patients for tests, consultations, services and procedures with other departments, local private offices, and/or outside vendors/providers
• Answers phone calls, faxed requests and other inquires relating to referrals and communicates with the physicians and clinicians to acquire authorization or to inform them of patient issues or clinical paperwork needed
• Research questions/concerns from patients regarding bills and determines if issue is related to the referral process. Assists in resolving billing and denied referral matters as they relate to the referral process. Refers patients to appropriate staff (e.g., patient account representatives) for billing issues related to insurance benefits and services covered under the benefits plan
• Works in collaboration with the person designated as the Practice’s Benefits Coordinator to maintain cost control, ensure that services provided are within benefit plan guidelines, and that necessary policies and procedures are followed when dealing with non-preferred providers/vendors. May coordinate second opinion requests
• Works with supervisors to ensure patients are receiving timely responses and detailed answers to their complex questions
• Research questions/concerns from patients regarding billing and determines if issue is related to the referral process. Assists in resolving billing and denied referral matters as they relate to the referral process
• Effectively deescalates issues with upset patients and practices. Uses advanced listening techniques to understand the issue and give patients options as they are available. Escalates to…