WellMed, part of the Optum family of businesses, is seeking a CLINICAL TITLE to join our team in City, ST. Optum is a clinician-led care organization that is changing the way clinicians work and live.
As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.
At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.
The Clinical Administrative Coordinator will effectively support the successful implementation and execution of all Care Management and processes. The CAC will provide support to the care management case management staff to include CM manager, CM Director, and CM Vice President to ensure applicable program processes and operational responsibilities are met. The CAC provides support for Utilization and Care Management processes. This position is responsible for the daily coordination of weekly Patient Care Committee (PCC) Meetings, daily census management, creates authorizations, and generating written notifications to providers per delegation requirements. This position will serve as a liaison with internal/external customers/departments to ensure optimal customer service.
This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm Monday – Friday but one a day a week it will be 7:00am – 4:00pm CST. It may be necessary, given the business need, to work occasional overtime. Our office is located at 3300 N McColl Road McAllen, TX 78501 OR Harlingen Market Office: 3809 west business 83 Harlingen, TX78552
We offer 4 - 6 weeks of on-the-job training. The hours of training will be 8:00am – 5:00pm CST, Monday - Friday
Primary Responsibilities:
Document all patient interactions in a concise manner that is compliant with documentation requirements for Model of Care, NCQA and Center for Medicare and Medicaid Services (CMS) regulations Receive and respond to incoming Care Coordination inquiries from all communication venues: e.g. phone queue, TruCare, portal, claim queue, department e-mail box or Rightfax Coordinate and assist in monitoring of documentation Care Management queues for Concurrent, Complex Care, and Social Work referrals, CTA processes UM requests via all communication venues; as well as administrative preparation for clinical staff Conduct in-bound and out-bound calls for program requirements including, but not limited to patient scheduling, surveys/screenings, census management and distribution of materials to appropriate clinical personnel or members Perform daily preparation of Inpatient Census to include monitoring of UM expedited, standard, concurrent in-patient cases in “pend” and informs Care Management Manager of outstanding cases to ensure adherence to CMS regulations Participate in market Patient Care Committees: prepare agenda, document minutes and distribute to appropriate venue Schedule and coordinate patient transportation, follow-up physician appointments in all applicable markets, as applicable Complete timely data entry of in-bound and / or out-bound call member contact information into software applications (Claims Database, TruCare) Provides clerical and / or administrative support to clinical staff and managers for special projects and reporting needs Provide excellent customer service by serving as a resource to all internal and external customers Attend required meetings and participates in adhoc committees as needed Maintain knowledge of all health plan benefits, network, CMS, regulations, health plan policies Maintain monthly logs for Notice of Medicare Non-Coverage (NOMNC) per delegation requirements and distributes to management
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 Must be 18 years of age OR older 2+ years of administrative support experience Knowledge of Microsoft Office products, including Microsoft Excel, Microsoft Word, and Microsoft Outlook Ability to work full-time, 8:00am – 5:00pm Monday – Friday but one a day a week it will be 7:00am – 4:00pm CST including the flexibility to work occasional overtime given the business need
Preferred Qualifications:
Certified Medical Assistant training or certification 2+ years of experience in a physician’s clinic or hospital Additional years of experience working in a medical care setting as a receptionist or medical assistant Bilingual language proficiency in English and Spanish Must be able to work independently, with some supervision and direction from manager Possess and demonstrate excellent organizational skills, customer service skills, to include verbal and written communication Possess medical terminology knowledge base
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.
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.
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