Universal American (UAM) Registered Nurse (RN) Health Resources Coordinator - Telephonic based On-Site in Houston, Texas
The Health Resources Coordinator in this role is a quality assurance Registered Nurse (RN) who provides support to the STARs team by using their customer service skills in telephonically reaching out to members enrolled in our Medicare Advantage health plans and assisting them with obtaining quality medical care within our network.
Conduct a high volume of outbound calls to members needing services identified on STARs/HEDIS targeted member lists.
Contact members telephonically upon facility discharge to discuss and document reconciliation of outpatient medications against discharge medication to ensure understanding of any change in regimen.
Educate members on the importance of STARs/HEDIS preventive services such as colonoscopy, mammogram, medication adherence, etc.
Must have excellent customer service skills.
Ensure customer satisfaction by providing quality service and assisting members with their health care issues.
Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in the Universal American Corporate and department policies.
And all other duties assigned by the manager and/or supervisor.
Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas.
Organizational skills with the ability to handle multiple tasks and/or projects at one time.
Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from all departments within and outside the Company.
Analytical and interpretation skills including departmental, utilization, financial and operations data.
Decision-making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization.
Creative thinking skills with the ability to ask the needed bigger-picture questions that lead to process and team improvements.
Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time.
Problem solving skills with the ability to look for root causes and implementable, workable solutions.
Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs.
Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization.
Associate Degree and higher in a health related field is required.
Healthcare experience required.
Active State of Texas Registered Nurse (RN) License is required.
Minimum of one (1) year customer service experience in a call center, medical office, clinic or institutional setting or equivalent combination of education and experience required.
Strong office / administrative skills including data entry, phone systems, multi-tasking between computer screens and documenting member information.
Personal computer experience should include working with Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum.
Universal American Corp. is an Equal Opportunity / Affirmative Action Employer and does not discriminate because of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, military veteran status, or any other characteristic protected by law. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.