Specialty Navigator – Surgery Prior Authorization

June 3, 2026

REMOTE IN MASSACHUSETTSOptum 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, the Specialty Navigator reviews and processes inpatient or outpatient surgical cases. Works with patients and providers to understand services being requested. Works closely with Specialty Nurses to ensure clinical handoffs are safe and appropriate.Schedule (FT, 38.75 hours/week): Monday – Friday 8:30am – 5pm EST or 8:00am – 4:30pm ESTIf you reside within the state of Massachusetts, you will enjoy the flexibility to telecommute* as you take on some tough challenges.Primary Responsibilities:<ul style="padding:revert;" type="disc"><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Reviews referral information from clinicians for pertinent information regarding surgeries</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Verifies demographics and insurance information</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">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</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Reviews referral information from work queue for pertinent information regarding surgical requests</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Ensures adequate information is obtained and relayed when care is moved</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Explains insurance benefits and options to patients</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Explain denials to patients. Keeps patient informed of status of all referrals (approved and denied)</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Notifies patients of scheduled appointments and confirms appointments by mail including confirmed location and map of destination</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Inform patients of any preparation that must be completed prior to the appointment</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Contact patient if insurance coverage issues arise during the referral process so that patient can work directly with the insurance company</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Promotes the Reliant and Atrius Health System of Care by highlighting internal providers and their expertise</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Answers phone calls, faxed requests and other inquiries relating to referrals and communicates with the physicians and clinicians to acquire authorization or to inform them of patient issues or clinical paperwork needed</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Research questions/concerns from patients regarding bills and determines if issue is related to the referral process</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Assists in resolving billing and denied referral matters as they relate to the referral process</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Refers patients to appropriate staff (e.g., patient account representatives) for billing issues related to insurance benefits and services covered under the benefits plan</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">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</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Works with supervisors to ensure patients are receiving timely responses and detailed answers to their complex questions</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">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</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Receives escalated issues and stat same day calls; determine appropriate action and/or works with clinical team for decision</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">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 supervisors only as needed</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Supports roles within the Navigator</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Trains and teaches as needed</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Participates in problem solving activities, focusing on productivity and quality</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Works with supervisors to ensure continuous improvement of the department</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">If needed, contact appropriate parties to obtain referral authorizations and verify coverage (e.g., the Authorization Services Unit (ASU), National Imaging Associates (NIA) or individual insurance companies)</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Certain departments may also need to contact additional outside agencies for approval (e.g., American Imaging Management or Med Solutions)</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeking assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Oral Communications: Ability to comprehend and communicate complex verbal information in</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">English to medical center staff, patients, families and external customers</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Teamwork: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Complies with health and safety requirements and with regulatory agencies</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Complies with established departmental policies, procedures, and objectives</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Enhances professional growth and development through educational programs, seminars, etc.</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Attends a variety of meetings, conferences, and seminars as required or directed</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Regular, reliable and predictable attendance is required</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Performs other similar and related duties as required or directed</li></ul>What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:<ul type="disc"><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Medical Plan options along with participation in a Health Spending Account or a Health Saving account</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">401(k) Savings Plan, Employee Stock Purchase Plan</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Education Reimbursement</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Employee Discounts</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Employee Assistance Program</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Employee Referral Bonus Program</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)</li></ul>You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:<ul type="disc"><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l2 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">High School Diploma/GED</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l2 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">1+ years of receptionist, admin support, or healthcare-related experience</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l2 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Experience with Medical Terminology and CPT Codes</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l2 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Intermediate level of proficiency with MS Office tools</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l2 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Must reside in Massachusetts</li></ul>Preferred Qualifications:<ul style="padding:revert;" type="disc"><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">1+ years of experience working in a medical office position performing duties such as scheduling appointments, checking patients in/out, insurance verification, collecting co-pays and maintaining medical records</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Proficiency in Microsoft Office (Word, Excel and Outlook)</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Knowledge of Epic EMR software</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Ability to learn new software (EPIC/EMR) and flexibility to attend new hire training</li></ul>Soft Skills: <ul style="padding:revert;" type="disc"><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo3;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Ability to work independently and maintain good judgment and accountability </li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo3;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Ability to prioritize tasks to meet all deadlines </li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo3;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Ability to work well under pressure in a fast-paced environment </li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo3;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Demonstrated ability to work well with health care providers </li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo3;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Strong organizational and time management skills </li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l1 level1 lfo3;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others </li></ul>*All Telecommuters will be required to adhere to UnitedHealth Group’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 (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. The hourly pay for this role will range from $17.98 to $32.12 per hour based on full-time employment. We comply with all minimum wage laws as applicable.<span class="eop" style="-webkit-tap-highlight-color:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-variant-caps:normal;font-variant-ligatures:normal;mso-color-alt:windowtext;orphans:2;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;user-select:text;widows:2;word-spacing:0px;"> At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe 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 experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, 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. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN

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