Discharge Planning Works with facility Case Manager or Social Worker to coordinate DC process and transition needs based on patient's diagnoses and status Care Coordination and Patient Support Collaboration with the entire clinic team to proactively manage high risk patients by ensuring appropriate Telephonic Post Hospital Discharge Calls Medication Management to include

Manage caseload of members with behavioral health concerns Utilize advanced clinical skills to engage and motivate members via a recovery, health, and wellness oriented approach Assist members and their families/caregivers with connections to appropriate psychiatric, medical, and psychosocial referrals and services Comply with all policies, procedures, and documentation s

Driving and contributing to effective advocacy efforts to advance and protect the Company's objectives at the federal level Actively engaging in lobbying activities by communicating and advocating for priorities and building and deepening the Company's relationships with federal legislative and executive branch officials and staffs Anticipating, influencing and monitoring

Answer incoming phone calls from prospective members, identify the type of assistance and information the customer needs with the goal to convert caller to a qualified lead and sale Follow up with members on questions or to review current or new products and services Navigate multiple computer systems to document member information while maintaining active listening and e

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

Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered care plans inclusiv

Receive assigned provider inquiries and perform a code review on both professional and facility claims Make determinations on cases after a coding review is complete Review various edits on cases and complete audit of medical records received to ensure proper editing is applied Review medical charts electronically Abstract and code diagnosis and procedures from the medica

This is a hands on position that requires strong debugging and troubleshooting skills within Electrical, Mechanical, Pneumatic and PLCs Identify training needs and tracks OJT to ensure craftsmen base is maintained and improving Install, setup, troubleshoot, and maintain various mail order pharmacy equipment and prototyping/testing new improvement projects Ability to troub

Key Agent/Agency Performance Agent Development Mentor, coach and engage key agents/agencies through ongoing business and strategy planning. This includes identifying sales opportunities, product positioning, UHC tools, UHC value proposition, compliance, and market education Onboarding Reach out to new agents identified by the PHD to share UHC learning, growth tools and va

Participate in a 10 week internship program that includes a comprehensive and structured training curriculum. This will include training on the Medicare business, systems, and sales processes necessary to serve Medicare eligible members and prospects looking for health care coverage Drive sales/enrollments through effective handling of all telephone inquiries from prospec

Linking members to applicable community resources Complete field visits for high risk, hard to reach members Telephonic outreach to targeted members Keep the member out of the hospital by supporting regular visits to their primary physician Keep member actively engaged with their primary physician Support the member to ensure pick up of their Rx Proactively engage the mem

Perform HEDIS medical record review for physician offices throughout the state of Nevada Complete inter rater reliability testing and required computer training successfully in order to complete this data collection Conduct additional QI audits through medical record review Educates physicians, RNs and other clinical employees in the latter half of the year You'll be rewa

Provide members with tools and educational support needed to navigate the health care system and manage their health concerns effectively and cost efficiently Assist members with adverse determinations, including the appeal process Teach members how to navigate UMR internet based wellness tools and resources Outreach to membership providing pre admission counseling to mem

Assess, plan, implement, coordinate, monitor, and evaluate case management activities for offenders being released from state and local prison and for those currently residing at the Community Transition Center, across the continuum of care, within the scope of the case manager's license Coordination and service delivery, Physical and psychological factors, Case managemen

Serve as primary care manager for members with complex medical/behavioral needs Engage members telephonically to complete a comprehensive needs assessment, including assessment of medical, functional, cultural, and socioeconomic (SDOH) domains Develop and implement person centered care plans to address needs including management of chronic health conditions, health promot