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Company Name:

UnitedHealth Group

Location:

Gonzales, TX

Approximate Salary:

Not Specified

Job Category:

Posted

July 17, 2018

Team Lead, Utilization Management, Healthcare, WellMed - San Antonio, TX

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)



The Team Lead UM Coordinator provides support to the UM department in administrative functions. This 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.



This position will provide float coverage for the UM department as a resource to staff and support to the supervisor.



Primary Responsibilities:



  • 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
  • Non-clinical staff is not responsible for conducting any UM activity that requires interpretation of clinical information
  • Effective communication with UM Supervisors and Directors
  • Performs all other related duties as assigned

Required Qualifications:



  • High School diploma or GED
  • 2+ years of previous related experience in healthcare, call center, and/or customer service
  • 1+ years of managed care experience in Prior Authorization or Claim Review
  • 1+ years of leadership experience
  • Medical Terminology, ICD-9/10 and CPT knowledge
  • Proficiency with Microsoft Office applications
  • Excellent verbal and written skills
  • Possess planning, organizing, conflict resolution, negotiation and interpersonal skills
  • Independent problem identification/resolution and decision making skills
  • Ability to interact with individuals and with multidisciplinary teams
  • Ability to demonstrate excellent customer service with patients, providers, and health plan and interacting with other internal departments within the organization

Preferred Qualifications:



  • Associates Degree

Physical & Mental Requirements:



  • Ability to lift up to 25 pounds
  • Ability to sit for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem solving

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 240,000+ 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)




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.




Job Keywords: WellMed, Healthcare, Bilingual, Team Lead, Utilization Management, UM, Medical terminology, ICD and CPT, Claims Coder, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, Floresville, Helotes, 75249, NW PKWY., Texas, TX



Company Name:

UnitedHealth Group

Location:

Gonzales, TX

Approximate Salary:

Not Specified

Posted

July 17, 2018

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