Clinical Administrative Coordinator - San Antonio, TX - 2285927

UnitedHealth Group; San Antonio (TX); On-site; Confidential; Full time

Job summary

A leading healthcare provider is seeking a full-time MCR Coordinator in San Antonio, TX. The role involves processing Utilization Management inventory, providing clerical support, and coordinating with medical staff. Candidates must have strong customer service skills and be flexible with their schedule. Join a team dedicated to improving healthcare for seniors.

Benefits

2 weeks of paid training

Qualifications

• Knowledge of health plan benefits and CMS regulations.
• Ability to maintain production and quality standards.

Responsibilities

• Research and resolve UM inventory to meet standards.
• Coordinate initial screening for UM claim reviews.
• Contact provider offices for clinical information.

Skills

Customer Service

Coordination

Documentation

Problem Solving

Job description

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

This is a full-time position (4 - 10 hours a day), working Wednesday – Saturday or Sunday - Wednesday. Flexibility to work any of our 10-hour shift schedules during 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:

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

WellMed, partnered with Optum since 2011, provides care across Texas and Florida, focusing on older adults. We are innovators in preventative healthcare, with a network of over 22,000 clinicians caring for more than 900,000 seniors. We are committed to improving healthcare for everyone.

We recognize and reward performance in a challenging environment that offers clear success pathways and development opportunities.