WellMed, part of the Optum family of businesses, is seeking a Clinical Administrative Coordinator to join our team in San Antonio, TX. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.

At Optum , you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

This position is responsible for processing Utilization Management (UM) Inventory. MCR Coordinator is responsible for handling customer service or provider calls as needed. Coordinates UM processes with WellMed Medical Directors, UM Nurses, hospitals, physicians and other various departments. MCR Coordinator is responsible for providing clerical support to WellMed clinical staff for their medical necessity review process. MCR Coordinator is expected to maintain production and quality standards.

This position is full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am – 4:00 pm. It may be necessary, given the business need, to work occasional overtime. Our office is located at 19500 W. Interstate 10, San Antonio, TX 78257.

We offer 3-4 weeks of paid onsite training, and you will be onsite for an additional 90 days for a paid ramp up period. The hours during training and ramp up will be 7:00 am to 4:00 pm, Monday – Friday.

If you are within commutable distance to the office at San Antonio, TX, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.

Primary Responsibilities:

• Research and resolve UM inventory accordingly to meet productivity and quality standards to include:

• Claims reports with reconciliation needs

• Information received through Right Fax

• Information received through email or any other methods of receipt (phone calls, etc.)

• Coordinates initial screening for UM claim reviews through claim queue

• Prepares administrative files for Medical Directors, UM Nurses and Case Managers

• Contacts provider offices to obtain clinical information for medical review by a clinician to meet Center for Medicare and Medicaid Services (CMS), state and health plan guidelines/regulations.

• Documents and follows-up on all assigned inventory, utilizing on-line systems and procedures, according to established guidelines

• Maintains knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies

• Utilize experience and judgement to plan, accomplish goals and effectively resolve each assigned task

• Receives and responds to telephone calls through the UM Phone Queue, as needed

• 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/ GED

• 18 years or older

• 2+ years managed care experience in Prior Authorization or Claim Review

• 6+ months experience using Medical Terminology, ICD-9/ICD-10 and CPT

• 6+ months experience working in an environment that is based on meeting metrics and daily goals (example – handling 40 cases per day)

• Proficiency with Microsoft Office applications (examples -Microsoft Outlook, Microsoft Access, Microsoft Word, Microsoft Excel)

• Ability to work onsite at 19500 W. Interstate 10, San Antonio, TX 78257 three days a week and from home two days a week after training and ramp up period

• Ability to work any of our 8-hour shift schedules during our normal business hours Monday to Friday from 7:00 am – 4:00 pm. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• Proficient with Medicare processing guidelines, working knowledge of medical contracts

Telecommuting Requirements:

• Reside within commutable distance to the office at San Antonio, TX.

• Ability to keep all company sensitive documents secure (if applicable)

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.

• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

• Exceptional ability to organize, prioritize and communicate effectively.

• Ability to navigate multiple systems

• Ability to work in a fast-paced environment

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The hourly range for this role is $16.88 to $33.22 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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 .

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