1+ months

Director Medical Claims Review - WellMed - San Antonio TX

San Antonio, TX 78205
  • Job Code

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)


The Director, MCR Operations is responsible for planning, organizing, and directing the medical claims review process for the Operations team. The Director coordinates team coverage for the Medical Claims Review team to ensure compliance with regulatory, contractual, productivity, quality and accreditation requirements. The success of this position requires the ability to lead and develop people, foster communication, collaboration and teamwork among internal operational leadership, medical claim review staff, medical management leadership, other corporate departments, vendors, and senior leadership as needed.   


Primary Responsibilities:

  • Monitors Medical Claims Review overall performance, ensuring the department adheres to corporate and regulatory standards
  • Oversees departmental functions, workflows, policies and procedures to ensure that all Federal and State regulations and contractual agreements are followed
  • Oversees the implementation of processes and system enhancements which will improve the overall quality and service provided by the MCR team
  • Collaborates with operational teams on process improvements and system enhancements impactful to the team
  • Analyzes trends and identifies / implements departmental initiatives based upon data provided through the reporting of production, quality, financial and audit data
  • Develop and foster root cause mindset for supervisors and individual team members to enhance and improve overall performance and efficiency
  • Provides input into and supports all applicable employee and other training programs for the department staff to ensure that regulatory compliance requirements are disseminated and understood
  • Oversees the recruiting, performance, development and mentoring of service staff
  • Initiates cross functional / departmental discussions and initiatives to remove barriers and improve communications and work flows
  • Identifies/initiates technology solutions to improve employee productivity and quality
  • Actively participates in the management of the annual departmental budget
  • Actively participates in the development of policies and procedures
  • Performs all other related 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.



Posted: 2020-06-19 Expires: 2020-08-19

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Director Medical Claims Review - WellMed - San Antonio TX

UnitedHealth Group
San Antonio, TX 78205

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