Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer Perform all functions of the UM nurse reviewer Composes denial letter in a manner consistent with federal regulations, state regulations, health plan requirements an

Maintain detailed knowledge of State and Federal insurance programs and effectively utilize such programs to insure all eligible are enrolled in appropriate MassHealth programs Maintain detailed knowledge of MassHealth and attend all required MassHealth training forum meetings Assist in eligibility determination and completion of MassHealth applications Monitor, analyze a

The KA Field Account Manager is accountable for the field based service of small to mid size, standard/non standard customers under 1,000 members. In this position, the KA Field Account Manager is responsible for the following Acts as a strategic partner and consultative resource to the customer, responsible for the customer's total service experience Meets with customers

Assist in end to end provider claims and help enhance call quality Coach, provide feedback and guide others Assist in efforts to enhance ease of use of physician portal and future services enhancements Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers Help implement traini

Maintenance and enhancement of existing EDI solution built on EDI Fabric in C# Troubleshoot and resolve EDI technical issues, including diagnosis and root cause analysis Troubleshoot claim workflow issues from EDI intake through EDI export Develop and maintain monitoring tools to ensure EDI connectivity meets service level agreements Analysis and design of systems and con

Manage administrative intake of members Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review

Manages and evaluates direct reports of UM Prior Authorization Nurses, Inpatient Care Managers, Clinical Coordinators, and other team associates Manages the compliance for UM to meet established performance metrics Oversees inventory and ensures cases completed within regulatory timeframes Manages all aspects of the UM program and service timeframes Actively participates

Communicate directly with families of babies currently admitted or recently discharges from the NICU, physicians, and community/governmental agencies Collaborate with NICU nurses and/or NICU Social Worker/Discharge Planners regarding barriers or challenges families are confronting and assist with solutions to prevent delay in infant's discharge Through direct telephonic a

Provide skilled nursing care for expectant mothers in the home care environment Travel to provide in home patient care and continuous education to patients and family members Continually assess the mothers' condition to ensure they are safe in the home environment Modify care plans as appropriate based on reassessment, change in prescriber orders, the patient's need for f

Making outbound calls to assess members' current health status Identifying gaps or barriers in treatment plans Providing patient education to assist with self management Interacting with Medical Directors on challenging cases Coordinating care for members Making referrals to outside sources Coordinating services as needed (home health, DME, etc.) Educating members on dise

Locate and engage members within a 60 mile radius of a designated region Assess SDOH needs using a standardized screening tool and coordinate with ICT to identify and connect members to available community resources Engage with members post discharge from inpatient setting to facilitate connections with community based services and Peer Support Specialist as needed Provid

Develop Others into a successful team aimed at increasing growth and market permeation by Continually building and nurturing agents through educational support on product information, selling skills, systems, and processes at United Healthcare Actively engage in the management and coaching of agent performance by implementing successful start strategy and guiding agents t

Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medicati

Sales representative for UHC Key Accounts is responsible for broker and direct sales to customers in the 100 5,000 employee range. The principle focus is the sale of new fully insured business, ASO business (both TPA and bundled) with indirect responsibility for the retention of existing accounts New Business Sales Accountable for prospect from presale to implementation w

Analyze and report on financials Assist in the development of program forecasts, budgets, and plans Research economic progressions to assist with the organization's financial planning Create annual budget templates Prepare spreadsheets to effectively show financial results and financial forecasts You'll be rewarded and recognized for your performance in an environment tha