Quality Management Coordinator – San Diego, CA

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. 

 

Postion Summary – Brief overview of the most important position duties. Provides internal and external health plan notification of provider adds, terms and changes. Completes intake form and requests appropriate medical records for member complaints and provider appeals. 
 

Primary Responsibilities: 

This description is not exhaustive and may be modified on a temporary or regular basis at the discretion of SCPMCS. SCPMCS expects that its’ employees will need to assume other “non-essential functions” not listed herein which support company business objectives. This may include duties that fall outside of the normal position scope. 

• 60% Completes intake form accurately for each complaint or appeal received from members or providers. Requests appropriate medical records, assembles all documents for additional medical review
• 25% Forwards member complaint/appeal to Health Plan with supporting documentation within the required time frames as specified by the Health Plan request
• 15% Enters all complaint and appeal data accurately into the database on a concurrent basis

 

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: 

• Managed care experience with a medical group or health plan
• Proficient with computer, Microsoft Windows environment, database management
• Customer service skills with health plan members or providers

 

Impact of Decisions: 

• Timely response to health plan inquires can prevent overturns of medical group’s denials when appealed by the member
• Timely completion and distribution of provider changes promotes utilization of contracted providers

 

Internal/External Contacts: 

• Internally interacts with all levels of the organization
• Externally interacts with physicians, physician office staff, health plan employees, ancillary providers and members and/or their family

 

Supervision Given/Received: 

• Does not supervise employees. Receives direct supervision from Director, Medical Management

 

The hourly range for this role is $16.88 to $33.22 per hour 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.   

 

 

OptumCare  is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 

 

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment