Clinical Administrative Coordinator - San Antonio, TX

Optum; San Antonio (TX); On-site; USD 40,000 - 55,000; Full time

Job summary

A leading company is seeking a full-time MCR Coordinator in San Antonio, responsible for processing Utilization Management Inventory and providing clerical support. The role requires flexibility in working hours and involves coordination with various health professionals to ensure compliance with regulations.

Benefits

2 weeks paid training

Qualifications

• Must maintain knowledge of health plan benefits and CMS regulations.
• Flexibility to work various shifts required.

Responsibilities

• Research and resolve UM inventory to meet productivity standards.
• Coordinate initial screening for UM claim reviews.
• Document and follow-up on all assigned inventory.

Skills

Customer Service

Coordination

Documentation

Job description

This position is responsible for processing Utilization Management (UM) Inventory. MCR Coordinator handles customer service or provider calls as needed, coordinating UM processes with WellMed Medical Directors, UM Nurses, hospitals, physicians, and other departments. The role includes providing clerical support to WellMed clinical staff for their medical necessity review process, maintaining production and quality standards.

This is a full-time position (4 - 10 hours a day) scheduled Wednesday - Saturday or Sunday - Wednesday. Flexibility to work any of our 10-hour shifts within normal business hours (9:00 am - 8:00 pm or 7:00 am - 6:00 pm) is required. Occasional overtime may be necessary. The office is located at 19500 W INTERSTATE, San Antonio, TX.

We offer 2 weeks of paid training, with hours from 8:00 am to 5:00 pm, Monday - Friday.

Primary Responsibilities:

1. Research and resolve UM inventory to meet productivity and quality standards, including claims reports reconciliation, information received through Right Fax, email, or other methods (phone calls, etc.).
2. Coordinate initial screening for UM claim reviews through claim queue.
3. Prepare administrative files for Medical Directors, UM Nurses, and Case Managers.
4. Contact provider offices to obtain clinical information for medical review to meet CMS, state, and health plan guidelines/regulations.
5. Document and follow-up on all assigned inventory using online systems and procedures per established guidelines.
6. Maintain knowledge of health plan benefits, networks, CMS regulations, and policies.
7. Use experience and judgment to plan, accomplish goals, and resolve tasks effectively.
8. Respond to telephone calls via the UM Phone Queue as needed.
9. Perform other related duties as assigned.

WellMed, partnered with Optum since 2011, provides care to over 1 million older adults across Texas and Florida through a network of doctors, specialists, and other health professionals. Our focus is on preventative health care, aiming to improve health care for seniors. With over 22,000 clinicians, we are committed to making health care work better for everyone.

We recognize and reward performance in a challenging environment that offers clear success criteria and development opportunities for future roles.