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. 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-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime. Our office is located at 19500 IH 10 W San Antonio, TX.
We offer weeks of on-the-job training. The hours during training will be 8:00am to 5:00pm, 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
- 1+ years experience in a hospital, physician's office or medical clinic setting
- 6+ months experience using Medical Terminology
- 6+ months experience working in an environment that is based on meeting metrics and daily goals (example - handling 40 case per day )
- Proficiency with Microsoft Office applications, i.e. Microsoft Excel, Microsoft Access
- Ability to work onsite at 19500 W INTERSTATE, San Antonio, TX
- Must be 18 years of age OR older
- Ability to work full-time, Monday - Friday between 8:00am - 5:00pm including the flexibility to work occasional overtime given the business need
Preferred Qualifications: - 2+ years of experience in a hospital, physician's office or medical clinic setting
- Experience working with health care insurance
- Clerical or administrative support background or experience working in a call center environment
- Bilingual language proficiency in English and Spanish
Soft Skills: - Exceptional ability to organize, prioritize and communicate effectively.
- Ability to navigate multiple systems
- Ability to work in a fast-paced environment
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.
