Utilization Management Coordinator - WellMed Medical Mgmt, Inc - San Antonio, TX

Utilization Management Coordinator - WellMed Medical Mgmt, Inc - San Antonio, TX -

Beneath the supervision of the UM Operations Supervisor, this place is chargeable for the every day coordination of UM processes. This place serves because the preliminary consumption of pre-service requests, declare evaluations and inpatient hospital coordination. Coordinates UM processes with PHC Medical Administrators, UM Nurses, hospitals, physicians and different numerous PHC departments. Supplies clerical help to PHC medical employees of their medical necessity evaluation course of.

WellMed offers concierge-degree medical care and repair for seniors, delivered by physicians and clinic employees that perceive and care concerning the affected person’s well being. WellMed’s proactive strategy focuses on prevention and the entire coordination of look after sufferers. WellMed is now a part of the Optum division beneath the larger UnitedHealth Group umbrella.

Do you could have compassion and a ardour to assist others? Reworking healthcare and hundreds of thousands of lives in consequence begins with the values you embrace and the eagerness you convey to realize your life’s greatest work.(sm)

Main Duties:
Receives and responds to phone calls by way of the UM Telephone Queue

Coordinates preliminary screening for UM service requests by way of telephone, net portal, mail and fax

Coordinates preliminary screening for UM declare critiques via declare queue

Prepares administrative information for Medical Administrators, UM Nurses and Case Managers

Performs every day Inpatient Census Reconciliation

Screens UM stock to make sure adherence to CMS laws

Participates in market Affected person Care Committees as wanted for clerical help

Maintains information of PHC advantages, community, CMS laws and PHC insurance policies

Conducts supplier schooling periods on PHC UM processes

Non-medical employees shouldn’t be chargeable for conducting any UM exercise that requires interpretation of medical info

Performs all different associated duties as assigned

Qualifications

Required Qualifications:
Excessive Faculty Diploma or GED equal required

Two or extra years of associated expertise required

A number of years managed care expertise in Prior Authorization or Declare Evaluation required

Medical Terminology, ICD-9 and CPT information required

Proficiency with Microsoft Workplace purposes required

Most popular Qualifications:
Medical Assistant (MA) certification most popular

Affiliate’s Diploma in a healthcare associated area most popular

CLICK TO APPLY JOB