Supervisor CTA UM Prior Authorization Healthcare Texas

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.  

 

Under the supervision of the Manager of Utilization Management, the supervisor is responsible for the daily operations of the UM department. Daily coordination with UM Nurses, UM Care Team Associates, UM management and other various WellMed departments and staff to deliver cost effective, quality of care services to WellMed members, in accordance with WellMed policies and processes.  Provides administrative and leadership support to staff.

 

This is a fast call center environment that requires answering calls and data entry.

 

This position requires working various shift hours and rotating/required weekends.

 

If you are located in the state of Texas, 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 of the UM platform queues to meet established performance metrics
• Oversees prior authorization inventory and regulatory timeframes
• Supervising all aspects of the UM expedited and standard requests 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 WellMed UM processes
• 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 or GED equivalent
• 3+ years of related experience with 2+ years in a supervisory capacity
• 1+ years of managed care experience in Prior Authorization or Claims Review
• Medical terminology, ICD-9 and CPT knowledge
• Proficiency with Microsoft Office applications
• You will be asked to perform this role in an office setting or other company location

 

Preferred Qualifications:

• Medical Assistant (MA) certification

 

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.