The Care Team Associate (CTA) will effectively support the successful implementation and execution of all Care Management and processes. The Care Team Associate will provide support to the care management case management staff to include CM manager, CM Director, and CM Vice President to ensure applicable program processes and operational responsibilities are met. The CTA provides support for Utilization and Care Management processes. This position is responsible for the daily coordination of weekly Patient Care Committee (PCC) Meetings, daily census management, creates authorizations, and generating written notifications to providers per delegation requirements This position will serve as a liaison with internal/external customers/departments to ensure optimal customer service.
- Documents all patient interactions in a concise manner that is compliant with documentation requirements for Model of Care, NCQA and Center for Medicare and Medicaid Services (CMS) regulations.
- Receives and responds to incoming Care Coordination inquiries from all communication venues: e.g. phone queue, TruCare, portal, claim queue, department e-mail box or Rightfax.
- Coordinates and assists in monitoring of documentation Care Management queues for Concurrent, Complex Care, and Social Work referrals, CTA processes 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, , census management and distribution of materials to appropriate clinical personnel or members.
- Performs daily preparation of Inpatient Census to include monitoring of UM expedited, standard, concurrent in-patient cases in "pend" and informs Care Management Manager of outstanding cases to ensure adherence to CMS regulations.
- Participates in market Patient Care Committees: prepares agenda, documents minutes and distributes to appropriate venue
- Schedules and coordinates patient transportation, follow-up physician appointments in all applicable markets, as applicable.
- Completes timely data entry of in-bound and/or out-bound call member contact information into software applications (Claims Database, TruCare, etc.).
- Provides clerical and/or administrative support to clinical staff and managers for special projects and reporting needs.
- Provides excellent customer service by serving as a resource to all internal and external customers.
- Attends required meetings and participates in adhoc committees as needed.
- Maintains knowledge of all health plan benefits, network, CMS, regulations, health plan policies.
- Maintains monthly logs for Notice of Medicare Non-Coverage (NOMNC) per delegation requirements and distributes to management. 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.
- High School Diploma or GED required.
- 2+ years of administrative support experience.
- Advanced knowledge of Microsoft Office products, including Excel, Word, and Outlook.
- Experience working independently, with some supervision and direction from manager.
- Possesses medical terminology knowledge base.
- Experience possessing and demonstrating excellent organizational skills, customer service skills, to include verbal and written communication. Must maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all times.
- Experience maintaining strict confidentiality at all times.
- Must adhere to all department/ organizational policies and procedures.
- Certified Medical Assistant training or certification
- 2+ years of experience in a physician's clinic or hospital
- Additional years of experience working in a medical care setting as a receptionist or medical assistant.
- Bilingual language proficiency (English/Spanish).
PHYSICAL & MENTAL REQUIREMENTS :
- Ability to lift up to 25 pounds
- Ability to push or pull heavy objects using up to 25 pounds of force
- Ability to sit for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
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 380,000+ 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.