Job Description

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work. (sm)

WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient's health. WellMed's proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.

The Team Lead UM Coordinator provides support to the UM department in administrative functions. This position utilizes knowledge of Medicare guidelines in order to facilitate and comply with the Utilization Management plan utilizing and established policies and procedures. The Team Lead functions as a subject matter expert, and provides guidance to UM Coordinator on more complex issues. The Team Lead UM Coordinator will provide float coverage for the UM department acting as a resource to staff and support to the supervisor.

If you are located in a commutable distance of a WellMed office and have telecommute experience, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

* Assist with monitoring of daily work / tasks assigned by supervisor
* Serves as administrator for RightFax folder, TruCare queues, Portals, and email box to assist with work distribution to coordinators
* Assist with tracking and reporting statistical information regarding volume, trends and provide feedback for efforts to meet department needs
* Ensures requests are being processed efficiently and accurately to support quality measures.
* Assist with performing audits as assigned
* Provides guidance and acts as a resource to trainers and new hires on benefits, contract interpretations, exclusions, eligibility, policies, standard operating procedures, job aids and workflows to other UM Coordinators in resolving complex issues
* Provides coaching and education to all coordinators
* Assists with escalated issues, and provides guidance as assigned
* Collaborates with management with projects as assigned
* Non-clinical staff is not responsible for conducting any UM activity that requires interpretation of clinical information
* Effective communication with UM Supervisors and Directors
* 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.

Required Qualifications:

* High school diploma or GED
* 2+ years of previous related experience in healthcare, call center, and / or customer service
* 1+ years of managed care experience in Prior Authorization or Claim Review
* 1+ years of leadership experience
* Medical terminology, ICD-9 / 10 and CPT knowledge
* Proficiency with Microsoft Office applications
* Excellent verbal and written skills
* Possess planning, organizing, conflict resolution, negotiation and interpersonal skills
* Independent problem identification / resolution and decision making skills
* Ability to interact with individuals and with multidisciplinary teams
* Ability to demonstrate excellent customer service with patients, providers, and health plan and interacting with other internal departments within the organization
* Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive VoiceResponse (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
* You will be asked to perform this role in an office setting or other company location, however, may be required to work from home temporarily due to space limitations

Preferred Qualifications:

* Associate degree
* Telephonic and/or telecommute experience

Physical & Mental Requirements:

* Ability to lift up to 25 pounds
* 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 550,000+ 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)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity / Affirmative Action employers 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

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

WellMed, Healthcare, Bilingual, Supervisor, Team Lead, Utilization Management, UM, Medical terminology, ICD and CPT, Claims Coder, Carmel, FL, Florida, TX, Texas