Analyze processes, data and systems to identify improvement opportunities and make improvement recommendations Evaluate downstream business systems, processes, and / or organizational impacts and identify risks and barriers Create effective and compelling visual materials/presentations that support the process improvement impact to the organization and adequately represen

Making outbound calls to assess members' current health status Visiting members in the hospital to prepare for transition home (varies by market) Identifying gaps or barriers in treatment plans Providing patient education to assist with self management Providing clinic and provider education Interacting with Medical Directors on challenging cases Coordinating care for mem

Assist in end to end provider claims processing and resolution Assist in efforts to enhance ease of use of physician portal and future services enhancements Assist in identifying gaps in network composition and services to support network contracting and development teams Use pertinent data and facts to identify and solve a range of problems within area of expertise Inves

Manage and monitor client assignments as well as train sales and account management staff, new hires and ongoing Set team strategy to achieve and surpass goals, and consistently develop and manage staff Develop and execute business plans to drive growth and distribution strategies Effectively forecast and present results to senior leadership Collaborate with local markets

Act as the central coordinator of all initiatives across business functions within UHC Hearing and vendor partners including but not limited to program development, co marketing initiatives, provider contracting, and supply chain operations Complete oversight of AHA/technology requests and coordination within the program and network team Work with senior management to for

This position is external facing and requires travel to customer/broker sites. This role supports complex employer groups within the Milwaukee, WI market Extensive analysis and interpretation of complex healthplan performance analytics from multiple data sources. Synthesize complex datasets to understand risk and opportunity of proposed/implemented solutions in support of

Conducts initial and follow up assessments within designated timeframes on enrollees identified as having complex case management needs (assessment areas include clinical, behavioral, social, environmental and financial) Assess the enrollees' current medical and social circumstances to identify any gaps or barriers that would impact compliance with the prescribed treatmen

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

Fostering and advancing key regulatory relationships with Departments of Insurance, other regulatory agencies, health insurance trade associations and industry members Proactively identifying and resolving legal and related matters impacting healthcare products Supporting product leadership in the development and delivery of new products, processes and initiatives Working

This position is within the Medicare & Retirement Operating Cost Management team. Responsibilities include Collaborate with cross functional teams in conjunction with forecasting and close process Develop into a subject matter expert on Optum services such as RAF and Solutran Maintain financial reports to clearly communicate actual results, forecasted performance, and var

Interpret and analyze claims, premium, capitation and membership data in support of utilization analyses Lead projects to completion by contributing to database creation, statistical modeling and financial reports Create and update automated processes Analyze reporting tools utilized by the internal customer group Research and investigate key business problems through qua

Make outbound calls to assess members' current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self management Interact with Medical Directors on challenging cases Coordinate care for members Make referrals to outside sources Coordinate services as needed (i.e., home health, DME, etc.) Educate members on disease processe

Function as a Manager within the Medicare Optimization & Business Intelligence team that consists of overseeing the work of employees executing data analysis related to plan performance, member compliance outcomes, provider data activities(inclusive of claims, supplemental data Electronic Medical Records) Provide oversight and review of both Prospective and Retrospective

Confirms compliance with the SoonerSelect program regulatory requirements (e.g., quarterly/annual filings) and other program operational areas (e.g., rate changes, fee schedule changes, revenue reconciliation, reporting) and oversees all audit activities Develops, performs and manages analyses of business/financial metrics and performance measures and reports financial an

Enter waivers for extended periods of time Contact internal resources if necessary to clarify information Perform Business Segment Liaison (BSL) activities, as needed Create and maintain SOPs Train peers and deliver updates and changes as needed Host, coordinate, and/or facilitate meetings/external events as needed Reconciling invoices Create mail merge Compiling and subm