Senior Clinical Administrative Coordinator - Honolulu, HI(Job Number:709467)
What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing the admission/discharge information post-notification, working with hospitals and the clinical team. Includes managing incoming calls, managing requests for services from providers/members, providing information on available network services and transferring members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior authorizations. This function includes intake, notification and census roles.
- Answer inbound calls in call center and document all calls
- Make outbound calls to enroll members into Wellness programs
- Schedule appointments
- Collaborate with wellness Coaches and Nurses
- Assigns and reassigns members to appropriate Care Coordinator under the direction of the Service Coordination Manager
- Monitors member list routinely to assure accurate assignment of all members
- Queue Management (EVC/Initial Assessments)
- Tracks Nursing Facility and Inpatient census data via the Blended Census Reporting Tool (BCRT)
- Communicates member Inpatient status to the assigned Service Coordinator
- PCP selection post initial customer service attempts
- Updates Member demographic and placement changes in CareOne
- Assists with administrative/enrollment activities for special programs e.g. disease management, complex case management, behavioral health referrals
- Manages incoming communication calls/fax/email/tasking group- members/providers
- Assists with outgoing communication (calls/fax/email) follow-up to see that new services started, meeting/not meeting needs distribute service plans/plan of care, other communication to members/providers
- Coordinate details of environmental modifications pharmacy issues (customer service)
- Completes eligibility related activities- enrollment, disenrollment, tracking Nursing Facility Level Of Care/Waiver eligibility (1148/1147)
- Posts member related documents that can't be stored in CareOne to electronic filing system (shared drive/SharePoint)
- Documents all member related activities in CareOne
- Reminds members of need to complete Medicaid paper work to maintain eligibility
- Utilizes plan software to generate care coordination reports
- UTL/Refused Contact process
- Assist with requesting HCBS services (find provider, verify hours, and submit task to HCBS)
- Assist manager/supervisor/HSD
- Performs other duties/projects as assigned
- Extensive work experience within own function.
- Work is frequently completed without established procedures.
- Works independently
- May act as a resource for others.
- May coordinate other's activities.
Job Clinical Admin & Processing
Primary Location US-HI-Honolulu
Organization C&S Hawaii ABD LTC
Number of Openings 1