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)
Positions in this family include those reposnsible for functions in areas such as health services, clinical services and delivery of clinical care.
Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing the admission/discharge information post-notification, working with hospitals and the clinical team. Includes managing incoming calls, managing requests for services from providers/members, providing information on available network services and transferring members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior authorizations. This function includes intake, notification and census roles.
Sr Supervisor coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit. Impact of work is most often at the team level.
Primary Responsibilities:
• Owns output at task level
• Work is generally limited to own function
• Sets priorities for the team to ensure task completion
• Coordinates work activities with other supervisors
• Develops plans to meet short-term objectives
• Identifies and resolves operational problems using defined processes, expertise and judgment
• Decisions are guided by policies, procedures and business plan
• Product, service or process decisions are most likely to impact individual employees and/or customers (internal or external).
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:
• Undergraduate degree or equivalent experience
• Proficiency with Microsoft Office applications to include Word, Excel and Outlook
• Ability to analyze operational data, draw conclusions and make recommendation to management for consideration
• This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
Functional Competencies:
Receive Medical/Behavioral/Clinical Services or Benefits Requests
• Serve as primary point of contact for providers or members regarding medical/behavioral/clinical services or benefits
• Extract and review fax requests for medical or clinical services
• Receive calls requesting medical/behavioral/clinical services or benefits information (e.g., from providers or members)
• Receive electronic referral form requests for medical/behavioral/clinical services
• Utilize phone system to respond to and transfer calls to appropriate individuals
• Ask callers standard questions to understand requests, gather necessary information, and assess urgency
• Access electronic member files using policy or id number
• Determine member eligibility
• Follow protocols to task requests appropriately
• Check procedure codes against notification requirements and benefit coverage to determine next steps
• Reference automated job aid tools via the computer to identify appropriate procedures when needed
Research Information to Respond to Medical/Behavioral/Clinical Services or Benefits
• Access claims information -Review and interpret call history documentation (e.g., case notes)
• Navigate between computer screens and platforms to research information (e.g., medical, clinical, or benefits information)
• Take calls and questions from members and/or providers regarding case status
• Determine whether authorizations are required for requested medical services -Reference automated job aid tools via computer to research relevant rules, regulations, or procedures -Learn computer system and process changes and updates and incorporate into daily work
• Contact internal resources if necessary to clarify information
• Identify appropriate resource (e.g., doctor, resource, contracted provider) to respond to medical requests
Process Medical/Behavioral/Clinical Services or Benefits Requests
• Provide/explain benefit information to members/providers
• Provide/explain authorization information to members/providers
• Communicate with clinical team to ensure provider receives a response when necessary
• Document call history information into relevant computer system
• Enter medical request data into relevant computer system
• Follow standard procedures to complete requests
• Request medical review via relevant computer system as needed
• Review and advise member/provider of status of a request (e.g., notification, authorization)
• Schedule appointments for members based on request
• Provide information regarding appointments and medical services to facilities staff to assist members
Values Based Competencies:
• Integrity Value: Act Ethically
• Comply with Applicable Laws, Regulations and Policies
• Demonstrate Integrity
• Compassion Value: Focus on Customers
• Identify and Exceed Customer Expectations
• Improve the Customer Experience
• Relationships Value: Act as a Team Player
• Collaborate with Others
• Demonstrate Diversity Awareness
• Learn and Develop
• Relationships Value: Communicate Effectively
• Influence Others
• Listen Actively
• Speak and Write Clearly
• Innovation Value: Support Change and Innovation
• Contribute Innovative Ideas
• Work Effectively in a Changing Environment
• Performance Value: Make Fact-Based Decisions
• Apply Business Knowledge
• Use Sound Judgement
• Performance Value: Deliver Quality Results
• Drive for Results
• Manage Time Effectively
• Produce High-Quality Work
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
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)
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.
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. no requirements Employment Type: OTHER