• Job Description

  Req#: 2188278

  Opportunities at WellMed , part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.

  WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic stat that understands 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 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.

  If you are living in Houston, TX you will have the flexibility to work remotely*, as well as work in the office as you take on some tough challenges. This position is a hybrid role with possible required rotating weekends

  Schedule: Monday - Friday, 9a-6p / 8a-5p

  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
  • Manage administrative intake of members
  • 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
  • Work with hospitals, clinics, facilities, and the clinical team to manage requests for service members and/or providers
  • Process incoming and outgoing referrals, and prior authorizations, including intake, notification, and census roles
  • Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review
  • Handle resolution/inquiries from members and/or providers
  • This is a high volume, customer service environment. Experience with efficient, productive, and thorough work communicating with members over the phone.
  • Must be flexible to work holidays/evenings/weekends on a rotating schedule

  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 administrative support experience
  • Advanced knowledge of Microsoft Office products, including Excel, Word, and Outlook
  • Medical terminology knowledge base
  • Proven ability to maintain strict confidentiality at all times

  
  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)
  • Proven ability to adhere to all department/ organizational policies and procedures
  • Proven ability to work independently, with some supervision and direction from manager
  • Proven ability to maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all times
  • Proven ability to possess and demonstrate excellent organizational skills, customer service skills, to include verbal and written communication

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

  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.

• About the company

  UnitedHealth Group Incorporated is an American multinational managed healthcare and insurance company based in Minnetonka, Minnesota.

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