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)
Under the supervision of the Manager of Utilization Management, the supervisor is responsible for the daily operations of the UM department. Daily coordination with UM Nurses, UM Care Team Associates, UM management and other various WellMed departments and staff to deliver cost effective, quality of care services to WellMed members, in accordance with WellMed policies and processes. Provides administrative and leadership support to staff.
This is a fast call center environment that requires answering calls and data entry.
This position requires working various shift hours and rotating/required weekends.
If you are located in a WellMed Location, you will have flexibility to telecommute* as you take on some tough challenges.
- Performs daily oversight of the UM platform queues to meet established performance metrics
- Oversees prior authorization inventory and regulatory timeframes
- Responsible for supervising all aspects of the UM expedited and standard requests inventory and service timeframes
- Assists with the hiring and training of new staff as needed
- Applies employee performance management techniques through job-related coaching, training, and development activities
- Conducts routine audits on UM reviews to ensure adherence to CMS regulations
- Produces daily, weekly, and monthly UM reports
- Conducts routine staff meetings
- Conducts provider education sessions on WellMed UM processes
- 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
- High school diploma or GED equivalent
- 3+ years of related experience with at least 2 years in a supervisory capacity
- 1+ year of managed care experience in Prior Authorization or Claims Review
- Medical terminology, ICD-9, and CPT knowledge
- Proficiency with Microsoft Office applications
- Associate degree in a healthcare related field
- Medical Assistant (MA) certification
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.
*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.
Job Keywords: WellMed, Healthcare, Bilingual, Supervisor, Utilization Management, UM, Medical terminology, ICD and CPT, Claims Coder, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, Floresville, Helotes, 75249, NW PKWY., Texas, TX