Job Location : Alamo,TX, USA
Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind 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, Monday - Friday. Employees are required to have flexibility to work our normal business hours of 8:00am - 5:00pm but once a week it will be 7am – 4pm CST. It may be necessary, given the business need, to work occasional overtime. Our office is located at 3300 N MCCOLL ROAD MCALLEN TX 78501OR Harlingen Market Office: 3809 west business 83 Harlingen Texas 78552.We offer 4-6 weeks of paid training. The hours during training will be 8am to 5pm 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) regulationsReceive and respond to incoming Care Coordination inquiries from all communication venues: e.g. phone queue, TruCare, portal, claim queue, department e-mail box or RightfaxCoordinate 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 staffConduct 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 membersPerform 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 regulationsParticipate in market Patient Care Committees: prepare agenda, document minutes and distribute to appropriate venueSchedule and coordinate patient transportation, follow-up physician appointments in all applicable markets, as applicableComplete 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 needsProvide excellent customer service by serving as a resource to all internal and external customersAttend required meetings and participates in adhoc committees as neededMaintain knowledge of all health plan benefits, network, CMS, regulations, health plan policiesMaintain monthly logs for Notice of Medicare Non-Coverage (NOMNC) per delegation requirements and distributes to managementYou'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 / GEDMust be 18 years old or older2+ years of administrative support experienceKnowledge of Microsoft Office products, including Excel, Word, and OutlookAbility to work our normal business hours of 8:00am - 5:00pm but once a week it will be 7:00am – 4:00pm CST. It may be necessary, given the business need, to work occasional overtime.Preferred Qualifications:Certified Medical Assistant training or certification2+ years of experience in a physician's clinic or hospital1+ years of experience working in a medical care setting as a receptionist or medical assistantMedical terminology knowledge baseBilingual proficiency in English / SpanishAbility to work independently, with some supervision and direction from managerOrganizational skills, customer service skills, to include verbal and written communicationAt 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.#RPO #RED