The Clinical Administrative Coordinator will effectively support the successful implementation and execution of all Care Coordination programs and processes. The Coordinator will provide support to the care coordination nursing staff and managers to ensure applicable program processes and operational responsibilities are met; to include UM processes with PHC Medical Directors, physicians, hospitals, and any other necessary Health Plan or MSO external departments. This position is responsible for the daily coordination of all Interdisciplinary Team Conference (IDTC) processes and weekly Patient Care Committee (PCC) Meetings. Conducts complex initial intake screening for pre-service requests, and inpatient hospital coordination. This position will serve as a liaison with external departments to ensure optimal customer service. You must maintain strict confidentiality at all times to include but limited to patients and coworkers. You must comply with all organizational policies regarding ethical business practices, and you must adhere to all department policies and procedures.

PRIMARY RESPONSIBILITIES:

• Receives and responds to escalated Care Coordination inquiries from all communication venues: e.g. phone queue, portal, claim queue, department e-mail box or fax
• Coordinates and assists initial screening of complex case screening and UM requests via all communication venues; as well as administrative preparation for clinical staff
• Conducts in-bound and out-bound calls for program requirements including, but not limited to: patient scheduling, surveys/screenings, reminder calls, census management and distribution of materials to appropriate clinical personnel or patients
• Performs daily Inpatient Census reconciliation to include monitoring of UM concurrent in-patient cases in "pend" status to ensure adherence to CMS regulations
• Participates in market Patient Care Committees: prepares agenda and minutes
• Assembles and mails various educational materials, supplies, and medical equipment to patients and clinical staff based on need and direction from nursing personnel
• Completes effective data entry of in-bound and/or out-bound call contact information into software applications (Claims Database, DM database, and EMR, CWQI, etc.)
• Utilizes various reports to track patient referrals or no-shows for scheduling visits with clinical staff
• Provides clerical and/or administrative support to clinical staff and managers for special studies, projects and reports
• Provides excellent customer service by serving as a resource to all internal and external customers
• Attends required meetings and participates in special committees as needed
• Coordinates all aspects of IDTC from data mining and reporting by market to scheduling
• Maintains knowledge of all health plan benefits, network, CMS, regulations, health plan and/or MSO policies
• Maintains collating, gathering and logs for Notice of Medicare Non-Coverage (NOMNC)
• Performs all other duties as assigned

You'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 or GED
• 2+ years of administrative support experience
• Ability to utilize Microsoft Office products, including Excel, Word and Outlook
• Ability to work independently, with some supervision and direction from manager
• Knowledge of medical terminology
• Must maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all times
• Possess and demonstrate excellent organizational skills, customer service skills, and verbal and written communication skills to include but not limited to patients, physicians, clinical staff, contracted providers and managers

PREFERRED QUALIFICATIONS:

• Certified Medical Assistant training or certification
• 2+ years of experience in a physician's clinic or hospital
• Bilingual language proficiency (English / Spanish)

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 350,000+ 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.

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.