Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Co

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us and start doing

Investigate medium to highly complex cases of fraud, waste, and abuse Detect fraudulent activity by members, providers, employees and other parties against the Company Develop and deploy the most effective and efficient investigative strategy for each investigation Maintain accurate, current and thorough case information in the Special Investigations Unit's (SIU's) case t

Clinical operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating) Case management and coordination of care Takes lead role in setting direction and participating in or developing new programs Sets team direction, resolves problems and provides guidance to members of the team Ensures team meets established perform

Educate members on health education and condition management (formal and informal), as well as plan specifics and member resources, in collaboration with OptumHealth Referral of employees to available clinical programs including premium designated physicians Create, manage and implement employer specific programs based on employer needs Monitors and analyzes customer spec

Mainly handling inbound calling, NO knocking on doors Answer incoming phone calls from prospective members and identify the type of assistance and information the customer needs with the goal to convert the caller to a qualified lead and ultimately sale Ask appropriate questions and listen actively to identify specific questions or issues while documenting required inform

Use of own Recovery experience and training to assist families and consumers with defining their Recovery goals, and developing the skills and knowledge needed for the consumer's recovery Experience working with consumers that have co occurring Disorder, i.e., Mental Health and Substance Use Disorder Support the creation and assist with the implementation of a comprehensi

Investigate and manage escalated claim/call/appeals issues through root cause analysis and communicate outcome (in person, telephonically or via written communication) Assist with navigating the healthcare system by providing resources for scheduling appt. and assisting with issues related to prolong periods for scheduling appts Assist participants with completing health

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

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

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

Assess, plan and implement care management interventions that are individualized for each member and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals for both healthcare and community based services; including but not limited to financial, psychosocial, community and state supportive services Develop and implement care