Provides facility level oversight of the following areas Financial Clearance (as assigned) Registration / Check in, including Point of Service Collections Financial Counselling Patient Satisfaction / Customer Service Other duties as assigned by the local client, including but not limited to Patient Scheduling, Bed Management / Patient Placement, MPTL and Switchboard Devel

These roles include, but are not limited to Analysis, design, coding, engineering, testing, debugging, standards, methods, tools analysis, documentation, research and development, maintenance, new development, operations, and delivery With every role in the company, each position has a requirement for building quality into every output This also includes evaluating new to

You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. 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,

Act as a Subject Matter Expert for other team members Ensure member address changes and transitions are processed and submitted to the State upon receipt within contractual time frames Ensure annual LOC redeterminations are submitted to the State (Department of Elder Affairs CARES) upon receipt within contractual timeframes Process incoming mail from the Department of Chi

Ensure contacts and demographics are audited and follow through with all business units to ensure that entire contract and demographics are audited properly to minimize claims issues Interpret and clarify reimbursement methods Monitor data to ensure performance standards for quality and timeliness Recommend methods to improve performance and processes Process audits of lo

Utilize advanced clinical skills to engage and motivate Consumers via a recovery, health and wellness oriented approach Assist consumers and their families/caregivers with connections to appropriate psychiatric, medical, and psychosocial referrals and services Identify and remove barriers to procurement, delivery, participation in and success of services Provide supportiv

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 tr

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

Extensive work experience within own function. Work is frequently completed without established procedures. Works independently. May act as a resource for others. May coordinate others' activities. Extensive work experience within own function. Applies knowledge/skills to a range of moderately complex activities. Demonstrates great depth of knowledge/skills in own functio

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

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 the plan of care, as appropriate, based upon reassessment, change in prescriber orders, the patient's

Review medical records and verify if the requested service meets criteria Review pre service appeals for clinical eligibility for coverage as prescribed by the Plan benefits Review and interpret Plan language Coordinate reviews with the Medical Director Utilize clinical guidelines and criteria Accurately documenting determinations Adherence to all confidentiality regulati

Own project management efforts for the intersegment accounting team and lead initiatives related to new processes or process improvements Manage and complete intersegment audit requests, and coordinate all requests within the team from internal or external auditors Own intersegment business process documentation (process flows, controls, etc.) Coordination and communicati

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

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