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Supervisor, Utilization Management, Healthcare, WellMed - San Antonio, TX

UnitedHealth Group


Location:
San Antonio, TX
Date:
02/16/2018
2018-02-162018-03-17
Job Code:
747635
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Job Details

747635 Supervisor Utilization Management Healthcare WellMed San Antonio TX

Supervisor, Utilization Management, Healthcare, WellMed - San Antonio, TX (747635)

Position Description

Up for the challenge of a lifetime? Join and lead a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of our millions of customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.(sm)

 

Under the supervision of the Director, Utilization Management, the Supervisor is responsible for the daily operations of the UM coordinators within the department which includes prioritization of prior authorization requests, determination  notification to members and providers, meeting regulatory turnaround time, managing incoming calls for appeals, and providing in-network information to member. Daily coordination with Medical Directors, UM Nurses, UM Coordinators, Intake, provider network and various other departments and staff to deliver cost effective, quality of care services to members, in accordance with WellMed’s policies and processes. This position provides administrative and leadership support to the team and manages to six or more employees.   

 

Primary Responsibilities:

  • Performs daily oversight and coordination of the UM queues and email box to meet established performance metrics
  • Oversees inventory related to prior authorization, claims review, and concurrent review inventory and regulatory timeframes
  • Responsible for supervising all aspects of the inventory and coordination
  • Serves as a primary point of contact and provides explanations for members, providers, and  internal partners regarding processes, roles and responsibilities within their department.
  • Receives telephone calls, electronic, and faxed requests from members, providers, health plans, and other departments for questions related to correspondence or appeal coordination
  • Identifies appropriate resources to respond to calls, fax, and electronic messages
  • Ability to complete work with established procedures and demonstrates proactive solutions to non-standard or complex requests
  • Facilitate team staff meetings in order to review and implement processes that allow for smooth and efficient operations 
  • Review with management individualized reports reflecting daily production and quality in order to accurately measure and monitor predetermined company, department and individual goals
  • Applies a team approach to solve complex problems
  • Sets priorities for the team to ensure task completion
  • Coordinates work activities with other supervisors
  • Assists with the hiring and training of new staff as needed
  • Applies employee performance management techniques through job-related coaching, training and development activities
  • Produces daily, weekly, monthly, and ad hoc UM reports
  • Utilizes care management electronic documentation system, claims system, and provider EMR to locate requested information, determine member eligibility, and to assess information
  • Works independently and acts as a resource for others by quick reference of standard operating procedures, ability to research regulatory information, and policies and procedures
  • Provides user testing for new versions of care management system and for market expansions to ensure smooth transition
  • Performs all other related duties as assigned

Required Qualifications:

  • Undergraduate degree or equivalent experience
  • 5+ years of related experience with at least 2 years in a supervisory capacity
  • 1+ years of managed care experience in Utilization Management
  • Medical terminology, ICD and CPT knowledge
  • Proficiency with Microsoft Office applications

Preferred Qualifications:

  • Claims coder certification or equivalent experience
  • Medical Assistant (MA) certification
  • Associate’s Degree in a healthcare related field

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 90,000+ 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, Supervisor, 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

Job Details

  • Contest Number747635
  • Job TitleSupervisor, Utilization Management, Healthcare, WellMed - San Antonio, TX
  • Job FamilyMedical and Clinical Operations
  • Business SegmentOptumCare

Job Location Information

  • San Antonio, TX
    United States
    North America
  • Other LocationsNEW BRAUNFELS, TX
    SEGUIN, TX
    Gonzales, TX
    Shiner-Texas, TX

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelManager
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusExempt

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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