Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
Under the supervision of the Supervisor, Utilization Management, the supervisor is responsible for the daily operations of the UM coordinators within the department which includes prioritization of prior authorization requests, determination notification to members and providers, meeting regulatory turnaround time, managing incoming calls for appeals, and providing in-network information to member. Daily coordination with Medical Directors, UM Nurses, UM Coordinators, Intake, provider network and various other departments and staff to deliver cost effective, quality of care services to members, in accordance with WellMed’s policies and processes. This position provides administrative and leadership support to the team and manages to six or more employees.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Performs daily oversight and coordination of the UM queues and email box to meet established performance metrics
- Oversees inventory related to prior authorization, claims review, and concurrent review inventory and regulatory timeframes
- Responsible for supervising all aspects of the inventory and coordination
- Serves as a primary point of contact and provides explanations for members, providers, and internal partners regarding processes, roles and responsibilities within their department
- Receives telephone calls, electronic, and faxed requests from members, providers, health plans, and other departments for questions related to correspondence or appeal coordination
- Identifies appropriate resources to respond to calls, fax, and electronic messages
- Ability to complete work with established procedures and demonstrates proactive solutions to non-standard or complex requests
- Facilitate team staff meetings in order to review and implement processes that allow for smooth and efficient operations
- Review with management individualized reports reflecting daily production and quality in order to accurately measure and monitor predetermined company, department and individual goals
- Applies a team approach to solve complex problems
- Sets priorities for the team to ensure task completion
- Coordinates work activities with other supervisors
- Assists with the hiring and training of new staff as needed
- Applies employee performance management techniques through job-related coaching, training and development activities
- Produces daily, weekly, monthly, and ad hoc UM reports
- Utilizes care management electronic documentation system, claims system, and provider EMR to locate requested information, determine member eligibility, and to assess information
- Works independently and acts as a resource for others by quick reference of standard operating procedures, ability to research regulatory information, and policies and procedures
- Provides user testing for new versions of care management system and for market expansions to ensure smooth transition
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.
- Undergraduate degree or equivalent experience
- 5+ years of related experience with at least two years in a supervisory capacity
- 1+ years of managed care experience in Utilization Management
- Medical terminology, ICD and CPT knowledge
- Proficiency with Microsoft Office applications
- Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
- Associate Degree in a healthcare related field
- Claims coder certification or equavalent experience
- Medical Assistant (MA) certification
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination 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)
Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $43,200 to $76,700. The salary range for Connecticut/Nevada residents is $47,700 to $84,400. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.
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: Supervisor, Utilization Management, Telecommute, Telecommuter, Telecommuting, Work at Home, Remote