Senior Clinical Administrative Coordinator - Honolulu, HI at Honolulu

Job Description

Position Description:What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, youll open doors for yourself that simply do not exist in any other organization, anywhere.Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing the admission/discharge information post-notification, working with hospitals and the clinical team. Includes managing incoming calls, managing requests for services from providers/members, providing information on available network services and transferring members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior authorizations. This function includes intake, notification and census roles.Primary Responsibilities:Answer inbound calls in call center and document all callsMake outbound calls to enroll members into Wellness programs Schedule appointments Collaborate with wellness Coaches and NursesAssigns and reassigns members to appropriate Care Coordinator under the direction of the Service Coordination ManagerMonitors member list routinely to assure accurate assignment of all membersQueue Management (EVC/Initial Assessments)Tracks Nursing Facility and Inpatient census data via the Blended Census Reporting Tool (BCRT)Communicates member Inpatient status to the assigned Service CoordinatorPCP selection post initial customer service attemptsUpdates Member demographic and placement changes in CareoneAssists with administrative/enrollment activities for special programs e.g. disease management, complex case management, behavioral health referralsManages incoming communication calls/fax/email/tasking group- members/providersAssists with outgoing communication (calls/fax/email) follow-up to see that new services started, meeting/not meeting needs distribute service plans/plan of care, other communication to members/providers Coordinate details of environmental modifications pharmacy issues (customer service)Completes eligibility related activities- enrollment, disenrollment, tracking Nursing Facility Level Of Care/Waiver eligibility (1148/1147)Posts member related documents that cant be stored in CareOne to electronic filing system (shared drive/SharePoint)Documents all member related activities in CareOneReminds members of need to complete Medicaid paper work to maintain eligibilityUtilizes plan software to generate care coordination reportsUTL/Refused Contact processAssist with requesting HCBS services (find provider, verify hours, and submit task to HCBS)Assist manager/supervisor/HSDPerforms other duties/projects as assignedExtensive work experience within own function.Work is frequently completed without established procedures.Works independentlyMay act as a resource for others. May coordinate others activities.

Job Requirements

Requirements: Bachelors Degree1+ years experience providing telephonic consulting or counseling1+ years experience in a call center (high volume)Intermediate Computer SkillsKnowledge of HIPPA requirements1+ years medicare/medicaid experienceAssets:BilingualMedical/Healthcare experienceExcellent communication and organizational skillsUnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. If youre ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach. This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Country: USA, State: Hawaii, City: Honolulu, Company: UnitedHealth Group.