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Data Entry, Utilization Management Coordinator, Healthcare, WellMed - San Antonio, TX

UnitedHealth Group


Location:
San Antonio, TX
Date:
04/28/2017
Job Code:
1736364
Apply on the Company Site
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Job Details


Data Entry, Utilization Management Coordinator, Healthcare, WellMed - San Antonio, TX(Job Number:709452)
Description

WellMed provides concierge-level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient’s health. WellMed’s proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.

 
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)
 
This is a call center environment near NW PKWY/ M – F: 7AM – 6PM (8HRS) / Rotating - Sat. – Sun.: 8AM – 5PM
 
Under the supervision of the UM Operations Supervisor, this position is responsible for the daily coordination of UM processes. This position serves as the initial intake of pre-service requests, claim reviews and inpatient hospital coordination. Coordinates UM processes with PHC Medical Directors, UM Nurses, hospitals, physicians and other various PHC departments. Provides clerical support to PHC clinical staff in their medical necessity review process.
 
Primary Responsibilities:
  • Receives and responds to telephone calls through the UM Phone Queue
  • Coordinates initial screening for UM service requests via phone, web portal, mail and fax
  • Coordinates initial screening for UM claim reviews through claim queue
  • Prepares administrative files for Medical Directors, UM Nurses and Case Managers
  • Performs daily Inpatient Census Reconciliation
  • Monitors UM inventory to ensure adherence to CMS regulations
  • Participates in market Patient Care Committees as needed for clerical support
  • Maintains knowledge of PHC benefits, network, CMS regulations and PHC policies
  • Conducts provider education sessions on PHC UM processes
  • Non-clinical staff is not responsible for conducting any UM activity that requires interpretation of clinical information
  • Performs all other related duties as assigned

 


Job Patient Services
Primary Location US-TX-San Antonio
Other Location US-TX-Shiner-Texas, US-Texas, US-TX-Yoakum-Texas, US-TX-Gonzales, US-TX-NEW BRAUNFELS, US-TX-BOERNE, US-TX-SEGUIN, US-TX-Helotes, US-TX-FLORESVILLE
Organization WellMed Medical Mgmt, Inc
Schedule Full-time
Number of Openings 3
Apply on the Company Site

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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