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1 forms found in the DOM

POST

<form class="component-reset-password__form" method="post" id="complete-registration-form" autocomplete="off" novalidate="novalidate">
  <div class="component-reset-password__password component-reset-password__field">
    <div class="component-reset-password__label">
      <label for="job-title">Job Title*</label>
    </div>
    <input class="job-title" data-rule-required="true" id="edit-job-title" name="job-title" type="text" value="">
  </div>
  <div class="component-reset-password__password component-reset-password__field">
    <div class="component-reset-password__label">
      <label for="edit-job-function">Job Function</label>
    </div>
    <select class="form-control" id="edit-job-function">
      <option></option>
      <option value="Administrative Staff"> Administrative Staff </option>
      <option value="Board Member"> Board Member </option>
      <option value="CEO, President, or Partner"> CEO, President, or Partner </option>
      <option value="Chief Officer (CXO)"> Chief Officer (CXO) </option>
      <option value="Consultant"> Consultant </option>
      <option value="Director"> Director </option>
      <option value="Executive Assistant"> Executive Assistant </option>
      <option value="Health Care Practitioner"> Health Care Practitioner </option>
      <option value="Manager"> Manager </option>
      <option value="Specialist"> Specialist </option>
      <option value="VP or SVP"> VP or SVP </option>
    </select>
  </div>
  <div class="component-reset-password__password component-reset-password__field">
    <div class="component-reset-password__label">
      <label for="edit-department">Department</label>
    </div>
    <select class="form-control" id="edit-department">
      <option></option>
      <option value="Administration"> Administration </option>
      <option value="Behavioral Health"> Behavioral Health </option>
      <option value="Business Development and Strategy"> Business Development and Strategy </option>
      <option value="Cardiology"> Cardiology </option>
      <option value="Communications and Marketing"> Communications and Marketing </option>
      <option value="Emergency Medicine"> Emergency Medicine </option>
      <option value="Facility Planning and Architecture"> Facility Planning and Architecture </option>
      <option value="Finance"> Finance </option>
      <option value="General Surgery"> General Surgery </option>
      <option value="Health Care Informatics (HIM)"> Health Care Informatics (HIM) </option>
      <option value="Human Resources (HR)"> Human Resources (HR) </option>
      <option value="Information Systems and Technology (IT)"> Information Systems and Technology (IT) </option>
      <option value="Legal Services"> Legal Services </option>
      <option value="Medical"> Medical </option>
      <option value="Medical Groups"> Medical Groups </option>
      <option value="Neuroscience"> Neuroscience </option>
      <option value="Nursing"> Nursing </option>
      <option value="Oncology"> Oncology </option>
      <option value="Operations"> Operations </option>
      <option value="Orthopedics"> Orthopedics </option>
      <option value="Patient Experience"> Patient Experience </option>
      <option value="Pharmacy"> Pharmacy </option>
      <option value="Philanthropy"> Philanthropy </option>
      <option value="Post-Acute"> Post-Acute </option>
      <option value="Quality"> Quality </option>
      <option value="Radiology and Imaging"> Radiology and Imaging </option>
      <option value="Research"> Research </option>
      <option value="Revenue Cycle"> Revenue Cycle </option>
      <option value="Risk and Compliance"> Risk and Compliance </option>
      <option value="Sales"> Sales </option>
      <option value="Service Line"> Service Line </option>
      <option value="Women's and Children's"> Women's and Children's </option>
    </select>
  </div>
  <p>Passwords must contain at least:</p>
  <ul>
    <li id="minchar">At least eight (8) characters</li>
    <li id="minlower">One (1) lowercase letter</li>
    <li id="minupper">One (1) uppercase letter</li>
    <li id="mindigit">One (1) digit</li>
    <li id="minspecial">One (1) special character</li>
    <li id="minmatch">Passwords must match</li>
  </ul>
  <div class="component-reset-password__password component-reset-password__field">
    <div class="component-reset-password__label">
      <label for="new-password">New Password*</label>
    </div>
    <div class="component-reset-password__password-field">
      <input type="password" name="new-password" class="new-password" data-rule-required="true" id="password-new-field">
      <span toggle="#password-new-field" class="field-icon show toggle-password"></span>
    </div>
  </div>
  <div class="component-reset-password__password component-reset-password__field">
    <div class="component-reset-password__label">
      <label for="confirm-password">Confirm Password*</label>
    </div>
    <div class="component-reset-password__password-field">
      <input type="password" name="confirm-password" class="confirm-password" data-rule-required="true" id="password-confirm-field">
      <span toggle="#password-confirm-field" class="field-icon show toggle-password"></span>
    </div>
  </div>
  <div class="component-reset-password__button component-reset-password__field">
    <input type="submit" value="Create Account">
  </div>
</form>

Text Content

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Select Your Employer*
Optum - Eden Prairie - MN Optum Advisory Services - Washington - DC Optum
Corporate - Eden Prairie - MN Optum Global Advantage - London - United Kingdom
Optum Growth & Commercial Office - Eden Prairie - MN Optum Health - Eden Prairie
- MN Optum Insight - Eden Prairie - MN Optum- Other Business Segments - Eden
Prairie - MN Optum Rx - Irvine - CA OptumCare - Eden Prairie - MN The Advisory
Board Company - Washington - DC UHC Clinical Services - New York - NY UHG
Corporate - Minnetonka - MN UnitedHealthcare Community & State - New York - NY
UnitedHealthcare Corporate - New York - NY UnitedHealthcare Employer &
Individual - New York - NY UnitedHealthcare Medicare & Retirement - New York -
NY

Address

11000 Optum Circle
Eden Prairie, MN 55344

Help, my employer isn't listed. Contact Us

Job Title*
Job Function
Administrative Staff Board Member CEO, President, or Partner Chief Officer (CXO)
Consultant Director Executive Assistant Health Care Practitioner Manager
Specialist VP or SVP
Department
Administration Behavioral Health Business Development and Strategy Cardiology
Communications and Marketing Emergency Medicine Facility Planning and
Architecture Finance General Surgery Health Care Informatics (HIM) Human
Resources (HR) Information Systems and Technology (IT) Legal Services Medical
Medical Groups Neuroscience Nursing Oncology Operations Orthopedics Patient
Experience Pharmacy Philanthropy Post-Acute Quality Radiology and Imaging
Research Revenue Cycle Risk and Compliance Sales Service Line Women's and
Children's

Passwords must contain at least:

 * At least eight (8) characters
 * One (1) lowercase letter
 * One (1) uppercase letter
 * One (1) digit
 * One (1) special character
 * Passwords must match

New Password*

Confirm Password*


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