Clinical Administrative Coordinator - San Antonio, TX

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

This position is full time (4 - 10 hours a day) Wednesday - Saturday or Sunday - Wednesday. Employees are required to have flexibility to work any of our 10-hour shift schedules during our normal business hours of 9:00 am - 8:00 pm or 7:00 am - 6:00 pm. It may be necessary, given the business need, to work occasional overtime. Our office is located at 19500 W INTERSTATE, San Antonio, TX

We offer 2 weeks of paid training. The hours during training will be 8:00 am to 5:00 pm, Monday - Friday.

Primary Responsibilities:

• Research and resolve UM inventory accordingly to meet productivity and quality standards to include:




• Claims reports with reconciliation needs
• Information received through Right Fax
• Information received through email
• Or any other methods of receipt (phone calls, etc.)




• Coordinates initial screening for UM claim reviews through claim queue
• Prepares administrative files for Medical Directors, UM Nurses and Case Managers
• Contacts provider offices to obtain clinical information for medical review by a clinician to meet Center for Medicare and Medicaid Services (CMS), state and health plan guidelines/regulations.
• Documents and follows-up on all assigned inventory, utilizing on-line systems and procedures, according to established guidelines
• Maintains knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
• Utilize experience and judgement to plan, accomplish goals and effectively resolve each assigned task
• Receives and responds to telephone calls through the UM Phone Queue, as needed
• Performs all other related duties as assigned

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors' offices. At WellMed our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.

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.