Care Team Associate - WellMed Care Management - San Antonio, TX - Full-time / Part-time

The Care Team Associate (CTA) will effectively support the successful implementation and execution of all Care Coordination programs and processes.  The Care Team Associate will provide support to the care coordination nursing staff and managers to ensure applicable program processes and operational responsibilities are met; to include UM processes with PHC Medical Directors, physicians, hospitals, and any other necessary Health Plan or MSO external departments. This position is responsible for the daily coordination of all Interdisciplinary Team Conference (IDTC) processes and weekly Patient Care Committee (PCC) Meetings.  CTA conducts complex initial intake screening for pre-service requests, and inpatient hospital coordination.   This position will serve as a liaison with external departments to ensure optimal customer service.    



 
  
Primary Responsibilities:


Receives and responds to escalated Care Coordination inquiries from all communication venues: e.g. phone queue, portal, claim queue, department e-mail box or fax

Coordinates and assists initial screening of complex case screening and UM requests via all communication venues; as well as administrative preparation for clinical staff

Conducts in-bound and out-bound calls for program requirements including, but not limited to: patient scheduling, surveys / screenings, reminder calls, census management and distribution of materials to appropriate clinical personnel or patients

Performs daily Inpatient Census reconciliation to include monitoring of UM concurrent  in-patient cases in “pend” status to ensure adherence to CMS regulations

Participates in market Patient Care Committees: prepares agenda and minutes

Assembles and mails various educational materials, supplies, and medical equipment to patients and clinical staff based on need and direction from nursing personnel

Schedules and coordinates patient transportation, follow-up physician appointments in all applicable markets, as needed

Completes effective data entry of in-bound and / or out-bound call contact information into software applications (Claims Database, DM database, and EMR, CWQI, etc.).

Utilizes various reports to track patient referrals or no-shows for scheduling visits with clinical staff

Completes calls / assignments and ensures census management, productivity weekly and monthly standards are me

Provides clerical and / or administrative support to clinical staff and managers for special studies, projects and reports

Provides excellent customer service by serving as a resource to all internal and external customers

Attends required meetings and participates in special committees as needed

Coordinates all aspects of IDTC from data mining and reporting by market, scheduling, notification to members, preparing agenda and recording of minutes

Maintains knowledge of all health plan benefits, network, CMS, regulations, health plan and/or MSO policies

Maintains collating, gathering and logs for Notice of Medicare Non-Coverage (NOMNC)

Non-Clinical staff are not responsible for conducting any UM review activities that require interpretation of clinical information

Performs all other duties as assigned
 
 

Required Qualifications:





High School Diploma or GED

Two years of administrative support experience

Basic knowledge of Microsoft Office products, including Word and Outlook

Must be able to work independently, with some supervision and direction from manager

Possesses medical terminology knowledge base

Must possess and demonstrate excellent organizational skills, customer service skills, and verbal and written communication skills to include but not limited to patients, physicians, clinical staff, contracted providers and managers

Must maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all times

Must maintain strict confidentiality at all times to include but limited to patients and coworkers

Must comply with all organizational policies regarding ethical business practices

Must adhere to all department policies and procedures  
Preferred Qualifications


Certified Medical Assistant training or certification

Two or more years of experience in a physician’s clinic or hospital

Additional years of experience working in a medical care setting as a receptionist or medical assistant

Bilingual language proficiency (English/Spanish)
 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 90,000+ 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: Care Team Associate, Administrative Assistant; Medical Office Specialist; Medical Receptionist; Clinical Assistant; San Antonio, TX, Texas