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 Vice President of Utilization Management, the supervisor is responsible for the daily operations of the UM department. Daily coordination with Medical Directors, UM Nurses, UM Coordinators, provider network and other various PHC departments and staff to deliver cost effective, quality of care services to PHC members, in accordance with PHC’s policies and processes. Provides administrative and leadership support to staff.
- Performs daily oversight of the UM phone queue to meet established performance metrics.
- Oversees prior authorization inventory and regulatory timeframes.
- Responsible for supervising all aspects of the UM claim review 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 PHC UM processes.
- Performs all other related duties as assigned.
The big challenge is motivating people and leading by example with a positive attitude that's professional, courteous and cheerful.
- High school diploma or GED equivalent
- 3+ years of related experience with at least two 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
- Medical Assistant (MA) certification
- Associate’s Degree in a healthcare related field
Physical and Mental Requirements:
- Ability to lift up to 25 pounds
- Ability to sit for extended periods of time
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
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 240,000+ 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)
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: 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