Care Team Associate – San Antonio, TX

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. 

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

This position is full-time, Monday – Friday. Employees are required to have flexibility to work any of our 8-hours shifts between the hours of 8:00am – 5:00pm CST. It may be necessary, given the business need, to work occasional overtime and weekends. Our office is located at 19500 IH 110 West San Antonio, TX

We offer weeks of on-the-job training. The hours during training will be 8:00am – 5:00pm CST, Monday – Friday.

Primary Responsibilities:

• Documents 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.
• Receives and responds to incoming Care Coordination inquiries from all communication venues: e.g. phone queue, TruCare, portal, claim queue, department e-mail box or Rightfax.
• Coordinates 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.
• Conducts 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.
• Performs 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.
• Participates in market Patient Care Committees: prepares agenda, documents minutes and distributes to appropriate venue
• Schedules and coordinates patient transportation, follow-up physician appointments in all applicable markets, as applicable.
• Completes timely data entry of in-bound and/or out-bound call member contact information into software applications (Claims Database, TruCare, etc.).
• Provides clerical and/or administrative support to clinical staff and managers for special projects and reporting needs.
• Provides excellent customer service by serving as a resource to all internal and external customers.
• Attends required meetings and participates in adhoc committees as needed.
• Maintains knowledge of all health plan benefits, network, CMS, regulations, health plan policies.
• Maintains monthly logs for Notice of Medicare Non-Coverage (NOMNC) per delegation requirements and distributes to management. Performs all other duties as assigned.

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.

Required Qualifications:

• High School Diploma / GED OR equivalent years of experience
• 2+ years of administrative/clerical support experience
• Experience with windows based programs including Microsoft Word, Microsoft Excel and Microsoft Outlook
• Maintain strict confidentiality at all times
• Adhere to department/organizational policies and procedures
• Must be 18 years of age OR older
• Ability to work full-time, Monday – Friday between 8:00am – 5:00pm CST including the flexibility to work occasional overtime given the business need

Preferred Qualifications:

• 2+ years of experience in a physician’s clinic or hospital preferred working as a receptionist or medical assistant
• Certified Medical Assistant training or MA certification
• Bilingual fluency in English/Spanish

Soft Skills:

• Demonstrate excellent organizational skills, customer service skills, to include verbal and written communication.
• Must maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all times.
• Able to work independently, with some supervision and direction from manager.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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.

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