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Senior Utilization Management Coordinator San Antonio, TX at UnitedHealth Group

Senior Utilization Management Coordinator San Antonio, TX

UnitedHealth Group Work From Home, TX Full-Time

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

Under the supervision of the Correspondence UM Supervisor, this position is responsible for processing Utilization Management (UM) Letters Inventory and provides support to the UM department in administrative functions.  Correspondence UM Coordinator Team Lead position utilizes knowledge of Medicare guidelines in order to facilitate and comply with the Utilization Management plan utilizing and established policies and procedures. The Team Lead functions as a subject matter expert, and provides guidance to UM Coordinator on more complex issues.  The Team Lead UM Coordinator will provide float coverage for the UM department as a resource to staff and support to the supervisor.   Coordinates UM processes with WellMed Medical Directors, UM Nurses, hospitals, physicians and other various departments.  Correspondence UM Coordinator Team Lead is responsible for providing clerical support to WellMed clinical staff for their medical necessity review process.   Correspondence UM Coordinator Team Lead is expected to maintain production and quality standards.

This is a fast-paced environment that requires working various shift hours and rotating/required weekends and holidays.

Primary Responsibilities: 

  • Process UM notification according to standard operating procedures and job aids while meeting productivity and quality standards to include: 
    • TruCare queues
    • Information received through Right Fax
    • Information received through email
    • Or any other methods of receipt (phone calls, etc.) 
  • Assist with monitoring of daily work/tasks assigned by supervisor
  • Serves as administrator for RightFax folder, TruCare queues, Portals, and email box to assist with work distribution to coordinators
  • Assist with tracking and reporting statistical information regarding volume, trends and provide feedback for efforts to meet department needs
  • Ensures requests are being processed efficiently and accurately to support quality measures
  • Assist with performing audits as assigned
  • Provides guidance and acts as a resource to trainers and new hires on benefits, contract interpretations, exclusions, eligibility, policies, standard operating procedures, job aids and workflows to other UM Coordinators in resolving complex issues
  • Provides coaching and education to all coordinators
  • Assists with escalated issues, and provides guidance as assigned
  • Collaborates with management with projects as assigned
  • Exhibits excellent phone and communication skills while providing complete and accurate information to customers
  • Requests additional or supplemental information via correspondence in order to complete UM notification requests
  • Prepares administrative files for Medical Directors, UM Nurses and Case Managers Documents and follows-up on all assigned inventory, utilizing on-line systems and procedures, according to established guidelines 
  • Maintains knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies 
  • Utilize experience and judgement to plan, accomplish goals and effectively resolve each assigned task
  • Attends required meetings and participates in special committees as needed
  • Performs all other related duties as assigned 

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 or GED equivalent 
  • 2+ years of administrative support experience
  • Medical Terminology, ICD-9/ICD-10 and CPT knowledge 
  • Proficiency with Microsoft Office applications and the ability to navigate multiple systems 
  • Ability to work Wednesday through Friday from 10am - 7pm CST and Saturday and Sunday from 8am - 5pm CST
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • Certified Medical Assistant training or certification
  • 2 + years of experience with prior authorization or claims 
  • Exceptional ability to organize, prioritize and communicate effectively 
  • Ability to work independently, with some supervision and direction from manager
  • Ability to work in a fast-paced environment
  • Ability to provide excellent customer service to a varied customer base 

Physical & Mental Requirements: 

  • Ability to lift up to 10 pounds
  • Ability to push or pull heavy objects using up to 10 pounds of force
  • Ability to sit for extended periods of time
  • Ability to stand for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to properly drive and operate a company vehicle
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem solving

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 WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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

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