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OptumCare& WellMed Career Event for Business Operations and Clinical Professionals August 21st 3:00PM-7PMPlease join OptumCare & WellMed on August 21 st for a Rio Grande Valley area Career Event. You will have an opportunity to learn more about career opportunities within our growing business. The event offers an informal, casual environment where you can meet and chat with business leaders and clinicians from WellMed. You may also bring your resume and have an opportunity to interview at the event!Event Location: Knapp Medical Center1401 East 8th StreetWeslaco, Texas 78596Registration is simple! Click Here: https://uhg.hr/qje2uThe 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.Primary Responsibilities:
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
Required Qualifications:
High School Diploma or GED
2+ years of administrative support experience
Advanced knowledge of Microsoft Office products, including Excel, Word, and Outlook
Must be able to work independently, with some supervision and direction from manager
Possesses medical terminology knowledge base
Possess and demonstrate excellent organizational skills, customer service skills, to include verbal and written communication
Maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all times
Must maintain strict confidentiality at all times
Must adhere to all department/organizational policies and procedures
Preferred Qualifications:
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 stand for extended periods of time
Ability to use fine motor skills to operate office equipment and/or machinery
Ability to properly drive and operate a company vehicle
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 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.Job Keywords: Care Team Associate, UM, Utilization Management, McAllen, TX, Texas
