Overview
Manager of Clinical Administration/Community Health Workers – Remote in Texas Jobs in Sugar Land, TX at UnitedHealthcare
Full Job Description
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to startCaring. Connecting. Growing together.
If you are in the state of Texas, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
Sets team direction, resolves problems, and provides guidance to members of own team. Impact of work is most often at the team level
Own output at task level
Serve as primary point of contact for Providers or Members, regarding Medical/Behavioral/Clinical services or benefits
Receive calls requesting Medical/Behavioral/Clinical services or Benefits information (e.g., from Providers or Members)
Receive electronic Referral Form requests for Medical/Behavioral/Clinical services
Access electronic Member files using policy or identification number
Determine Member eligibility
Follow protocols to task requests appropriately
Check procedure codes against Notification requirements and Benefit coverage to determine next steps
Reference automated Job Aid tools via the computer to identify appropriate procedures, when needed
Set priorities for the team to ensure task completion
Coordinate work activities with other supervisors
Develop plans to meet short-term objectives
Identify and resolve Operational problems using defined processes, expertise, and judgment
Decisions are guided by policies, procedures, and business plan
Identify appropriate resource (e.g., doctor, resource, contracted provider) to respond to medical requests
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 2+ years of experience working in Medicaid Managed Care
2+ years of experience working with a vulnerable population in meeting the needs of the Member population served (for example, people with Disabilities)
1+ years of experience working for an insurance company or business-related setting supporting operations
1+ years of experience with member outreach
Intermediate level of proficiency experience in Microsoft Office, including Excel and Word
Possess knowledge of the principles of most integrated settings, including federal and state requirements like the federal home and community-based settings regulations
Preferred Qualifications:
2+ years working directly with Long-Term Support Services / Home and Community-Based service providers, Personal Care Management Agencies, and Health Centers
Demonstrated ability with developing strategic plans, attainable goals, drive performance and achieve targets
Experience working with the Medicaid population
Program or Project management experience
All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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 th…
Title: Manager of Clinical Administration/Community Health Workers – Remote in Texas
Company: UnitedHealthcare
Location: Sugar Land, TX
Category:
