Supervisor Medical Claims Review – San Antonio, TX

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Under the supervision of the Director, Utilization Management, the supervisor is responsible for the daily operations of the UM coordinators within the department which includes prioritization of prior authorization requests, determination notification to members and providers, meeting regulatory turnaround time, managing incoming calls for appeals, and providing in-network information to member.  Daily coordination with Medical Directors, UM Nurses, UM Coordinators, Intake, provider network and various other departments and staff to deliver cost effective, quality of care services to members, in accordance with WellMed’s policies and processes.  This position provides administrative and leadership support to the team and manages to six or more employees.

This position is full-time. Employees are required to work our normal business hours of 7:00am – 4:00pm CST, Monday – Friday. It may be necessary, given the business need, to work occasional overtime. Employees are required to work some days onsite and some days from home.

This will be on-the-job training. The hours of the training will be based on schedule or will be discussed on your first day of employment.

If you are within commutable distance to the office at 19500 IH 10 W Bldg 2, 4th floor, San Antonio, TX, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.

 

Primary Responsibilities:

• Performs daily oversight and coordination of the UM queues and email box to meet established performance metrics
• Oversees inventory related to prior authorization, claims review, and concurrent review inventory and regulatory timeframes
• Supervising all aspects of the inventory and coordination
• Serves as a primary point of contact and provides explanations for internal partners regarding processes, roles and responsibilities within their department
• Receives requests from  providers, health plans, and other departments for questions related to correspondence or appeal coordination
• Identifies appropriate resources to respond to electronic messages
• Ability to complete work with established procedures and demonstrates proactive solutions to non-standard or complex requests
• Facilitate team staff meetings in order to review and implement processes that allow for smooth and efficient operations
• Review with management individualized reports reflecting daily production and quality in order to accurately measure and monitor predetermined company, department and individual goals
• Applies a team approach to solve complex problems
• Sets priorities for the team to ensure task completion
• Coordinates work activities with other supervisors
• Assists with the hiring and training of new staff as needed
• Applies employee performance management techniques through job-related coaching, training and development activities
• Produces daily, weekly, monthly, and ad hoc UM reports
• Works independently and acts as a resource for others by quick reference of standard operating procedures, ability to research regulatory information, and policies and procedures
• Provides user testing for system updates
• Performs all other related 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
• Must be 18 years of age OR Older
• 1+ years of managed care experience in Utilization Management
• 2+ years in a supervisory capacity
• 4+ years of claims, disputes, prior authorizations experience
• Medical terminology, ICD 10 and CPT knowledge
• Proficiency with Microsoft Office applications (Outlook, Teams, Word, Excel, Powerpoint)
• Ability to work our normal business hours of 7:00am – 4:00pm CST, Monday – Friday. It may be necessary, given the business need, to work occasional overtime

 

Telecommuting Requirements:

• Reside within commutable distance to the office at 19500 IH 10 W Bldg 2, 4th floor, San Antonio, TX
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

 

The salary range for this role is $49,300 to $96,400 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 

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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