Quality Management Coordinator - San Diego, CA

Caring. Connecting. Growing Together.

Completes intake form and requests appropriate medical records for member complaints, member appeals, and provider appeals.

Primary Responsibilities:

• Completes intake form accurately for each complaint or appeal received from members or providers
• Requests appropriate medical records, compiles all documents needed for additional clinical review
• Consult with Clinical Compliance Manager as needed
• Coordinate with Network Management as needed to obtain provider response or network information
• Forwards complaint/appeal packet to Health Plan with the requested supporting documentation within the required time frames as specified by the Health Plan request
• Enters all complaints and appeals data accurately into the database on a concurrent basis
• Performs other duties as assigned

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:

• 1+ years of experience managed care experience with a medical group or health plan
• 1+ years of experience in customer service
• Knowledge of medical terminology
• Proficient with Microsoft office (word, excel, outlook, etc.)
• Based in San Diego, CA area
• Demonstrated ability and willingness to work 4 days/ 10-hour days 6:30am - 5:00pm PST
• Office based position during the first 30-90 days for training

Preferred Qualifications:

• 1+ years of experience in member/guest/patient customer service
• Medical billing or claims experience
• Experience managing patient issues and feedback
• Experience in the medical field, medical office, hospital, or health plan
• Proven excellent interpersonal and communication skills
• Proven excellent writing and speaking skills with proven ability to effectively respond promptly and effectively to complaints both verbally and in writing.
• Proven solid organizational skills, good judgment and attention to detail

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.74 to $31.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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 the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.