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Job Details

UnitedHealth Group

Credentialing Specialist II - Remote


Clinical Care Specialist/Staff Nurse


Redlands, California, United States

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

Compassion. It’s the starting point for health care providers like you and it’s what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you’re also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life’s best work.(sm)

Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California, to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

The Credentialing Specialist job family is distinguished by the level and type of experience performing routine versus independent credentialing processes, education and training that would lead to NCQA regulatory requirements and CPCS certification and the scope of handling multiple tasking processes in an efficient manner to ensure the timely and thorough credentialing of assigned physicians.

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

Primary Responsibilities:

  • Assists the Credentialing Supervisor and Credentialing Specialist II’s in gathering credentialing and re-credentialing on all providers according to the Policies and Procedures in place for each group
  • Assists in completing Medi-Care and Medi-Cal provider applications for all newly employed credentialed providers for select groups
  • Assists in tracking and maintaining of all provider licensure and updating provider database with all current information
  • Assists in the maintenance of filing for all providers credentialing files
  • Assists Credentialing Supervisor and internal staff with any special projects or requests from Health Plans or State programs regarding credentialing issues
  • Assists in compliance with Meaningful Use tasks
  • Processes the credentialing and re-credentialing on all providers according to the Policies and Procedures in place for each group
  • Maintains all physician provider files and provider database files with current information and documentation
  • Works with health plans, hospitals, and other healthcare organizations to provide current physician information on all employed and contracted providers, and with hospitals to ensure current staff privileges for all initial appointment and reappointment employed physicians
  • Tracks provider licensure for all employed and contracted providers including frequent interaction with the Accounts Payable department
  • Assists the Credentialing Supervisor in the preparation of NCQA, IMQ, and other related health plan audits of provider credentialing files
  • Attends and supports the Credentials Committee

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:

  • High School diploma, GED, or equivalent experience
  • 1+ years of experience working in an office, customer service, or in the medical field

Preferred Qualifcations:

  • 2+ years of work clerical or administrative experience in a healthcare setting
  • 2+ years of recent credentialing experience in a managed care organization, IPA/Medical Group organization and/or hospital setting, which included provider database processing
  • 2+ years of clerical/administrative experience in a managed care organization, IPA/Medical Group organization and/or hospital setting
  • Basic knowledge of medical terminology
  • Solid multitasking and typing skills

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $18.17 to $32.26. The hourly range for Connecticut / Nevada residents is $20.00 to $35.53. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.