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Job Details

UnitedHealth Group

Utilization Management Supervisor - Telecommute (107621519)





San Antonio, Texas, United States

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

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.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. 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
  • Responsible for supervising all aspects of the inventory and coordination
  • Serves as a primary point of contact and provides explanations for members, providers, and internal partners regarding processes, roles and responsibilities within their department
  • Receives telephone calls, electronic, and faxed requests from members, providers, health plans, and other departments for questions related to correspondence or appeal coordination
  • Identifies appropriate resources to respond to calls, fax, and 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
  • Utilizes care management electronic documentation system, claims system, and provider EMR to locate requested information, determine member eligibility, and to assess information
  • 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 new versions of care management system and for market expansions to ensure smooth transition
  • 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:

  • Undergraduate degree or equivalent experience
  • 5+ years of related experience with at least two years in a supervisory capacity
  • 1+ years of managed care experience in Utilization Management
  • Medical terminology, ICD and CPT knowledge
  • Proficiency with Microsoft Office applications
  • Must be willing to work on call, rotating weekends

Preferred Qualifications:

  • Associate’s Degree in a healthcare related field
  • Claims coder certification or equivalent experience
  • Medical Assistant (MA) certification

Physical & Mental Requirements:

  • Ability to lift up to 25 pounds
  • Ability to sit for extended periods of time
  • Ability to stand for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem solving

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

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 550,000+ 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)

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.

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $45,100 to $80,200. The salary range for Connecticut/Nevada residents is $49,800 to $88,200. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.