POSITION DESCRIPTION

Under the supervision of the UM Operations Supervisor, this position is responsible for the daily coordination of UM processes in the Intake Call Center. This position serves as the initial intake of pre-service requests, claim reviews and inpatient hospital coordination and diabetic supplies. Coordinates UM processes with Medical Directors, UM Nurses, hospitals, physicians and other various departments. Provides clerical support to clinical staff in their medical necessity review process. UM Coordinator is expected to maintain production and quality standards

PRIMARY RESPONSIBILITIES :

• Managing authorizations / notifications and other service requests received via incoming phone calls, faxes and portal submission
• Providing excellent customer service, including the ability to handle escalated callers
• Determining authorization or notification requirements
• Preparing authorization cases for Medical Directors, UM Nurses and Case Managers
• Providing administrative approvals (depends on line of business)
• Handling expedited authorizations, authorization updates and status checks
• Confirming member eligibility
• Responsible for outreaches to providers and/or Patient to complete authorization requests and prescriptions
• Maintaining knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
• Utilizing experience and judgement to plan, accomplish goals and effectively resolve each assigned task
• Non-Clinical staff is not responsible for conducting any UM activity that requires interpretation of clinical information
• Performs all other related 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.

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

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.

REQUIRED QUALIFICATIONS :

• High School Diploma or GED equivalent
• 2+ years of related experience in any of the following or combination thereof: healthcare, call center, and/or customer service setting using the telephone and computer as the primary instrument to perform job duties
• Medical Terminology, ICD-9/ICD-10 and CPT Knowledge
• Proficiency with Microsoft Office applications required, i.e Excel, Access, Outlook
• Ability to work the hours of 9am-6pm Monday-Friday and the hours of 8am-5pm on rotating weekends and holidays
• In and/or out-of-town travel required as deemed necessary by business need

PREFERRED QUALIFICATIONS:

• Associate's Degree in a healthcare related field

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.