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Clinical Administrative Coordinator - Albuquerque, NM

UnitedHealth Group

Albuquerque, NM
Job Code:
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Job Details

Clinical Administrative Coordinator - Albuquerque, NM(Job Number:712610)

Position Description:

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)

Our customer service teams have a serious responsibility to make every contact informative, productive, positive, and memorable for what it says about how much we care.

As a Member Advocate working with our NM Centennial Care members, you will be calling members to make welcome calls and introduce them to the services provided. You will be reviewing health education, health risk assessments, medical history and benefits. In addition, you will assist the member navigate the benefits, coordination of care and assist in locating a PCP.  You will be doing administrative work and supporting internal customers in the field.

Primary Responsibilities: 
  • Respond to incoming provider and member calls 
  • Resolve customer service inquiries which could include: 
  • Enter notifications, Providers status of an existing notification and determining if notification is required
  • Complete notification wizard along with ICD-9 and CPT coding
  • Initial triage of members, managing incoming calls from providers and members, managing requests for services from providers/members, providing information on available network services and transferring members as appropriate to clinical staff.
  • Organize work and develop strategies to adapt to constantly changing workload as evidenced by:
  • Performing multiple administrative tasks while concurrently triaging phone calls and triaging customer calls
  • Timely response to customer and care coordination team needs
  • Work via an auto-dialer or manually dial members to complete the Health Risk Assessment (HRA) for Level 1 members following the New Mexico HRA as programmed into CareOne. 
  • Welcome the member to the health plan by verifying key information about the member (home address, PCP assignment, etc.) and discussing the benefits available through the plan.
  • When possible, correct member information in CareOne, including the member’s address, PCP assignment.
  • When appropriate, encourage members to appropriately utilize services in an effort to improve the health and well-being of all members.  This might include education about the importance of using the ER only in true emergencies.
  • Following a call anatomy, connect with the member to establish a trusting relationship and utilizing job aids and critical thinking skills, assess the barriers that are prohibiting the member from seeking the proper care and answer member’s questions about benefits.
  • If barrier to care is provider related, the Member Advocate will assist the Member with finding a new doctor and working with provider’s office to set up new appointment.
  • If Member is identified as having an issue meeting basic needs, the Member Advocate would help connect the member to community resources.
  • Responsible for the resolution of escalated Member calls that are received by the Member Advocate team.  This could include connecting members with community resources, assisting members to locate a specialist, and resolving other nonstandard member requests
  • Work offline to resolve member barriers to care requiring more research and follow-up with the member to help remove care barriers.
  • When necessary, transfer the member to Member Services for advanced benefit questions.
  • Document Member/Provider responses and call outcomes in CareOne as appropriate.
  • Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance.
  • Assist with faxes and emails

Job Clinical Admin & Processing
Primary Location US-NM-Albuquerque
Other Location 
Organization C&S New Mexico ABD LTC
Schedule Full-time
Number of Openings 1
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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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