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)
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 located within commutable distance of a WellMed office in Texas or Florida, you will have the flexibility to telecommute* as you take on some tough challenges.
- Document 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
- Receive and respond to incoming Care Coordination inquiries from all communication venues: e.g. phone queue, TruCare, portal, claim queue, department e-mail box or Rightfax
- Coordinate 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
- Conduct 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
- Perform 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
- Participate in market Patient Care Committees: prepare agenda, document minutes and distribute to appropriate venue
- Schedule and coordinates patient transportation, follow-up physician appointments in all applicable markets, as applicable
- Complete timely data entry of in-bound and/or out-bound call member contact information into software applications (Claims Database, TruCare)
- Provide clerical and/or administrative support to clinical staff and managers for special projects and reporting needs
- Provide excellent customer service by serving as a resource to all internal and external customers
- Attend required meetings and participates in adhoc committees as needed
- Maintain knowledge of all health plan benefits, network, CMS, regulations, health plan policies
- Maintain monthly logs for Notice of Medicare Non-Coverage (NOMNC) per delegation requirements and distribute to management
- Maintain strict confidentiality
- Adhere to all department / organizational policies and procedures
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.
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
- 2+ years of administrative support experience
- Advanced knowledge of Microsoft Office products, including Excel, Word, and Outlook
- Medical terminology knowledge base
- You will be asked to perform this role in an office setting, however, may be required to work from home temporarily due to space limitations
- Certified Medical Assistant training or certification
- 2+ years of experience in a physician’s clinic or hospital
- Experience working in a medical care setting as a receptionist or medical assistant
- Able to work independently, with some supervision and direction from manager
- 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
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
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 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: WellMed, Healthcare, Bilingual, Care Team Associate, Concurrent Authorization, Utilization Management, UM, Medical Terminology, ICD and CPT, Claims Coder, San Antonio, Austin, Dallas, Corpus Christi, Fort Worth, New Braunfels, El Paso, Florida, Fl., Texas, TX