Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at 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

The UHC Director Compensation will lead all total rewards related strategies and activities in support of the Segment goals including Provide a full spectrum of consulting and analytical compensation services by translating business and segment strategic direction into meaningful compensation programs Consults on all total rewards programs and partners with the enterprise

Serves as the advocate for providers by demonstrating accountability and ownership to resolve issues Quickly and appropriately triage contacts from healthcare professionals (i.e. physician offices, clinics, billing offices) Seek to understand and identify the needs of the provider, answering questions and resolving issues (e.g. benefits and eligibility, billing and paymen

Work Life Balance/$15,000 Sign-On Bonus/Fortune 5 Company/Excellent Benefit Package!

Make outbound calls, receive inbound calls, coordinate initial orders for home health nursing, enter authorizations, seek/review clinical records every 60 days and documentation The High Risk Nurse would interact with prescribers to offer recommendations to treatment plans, including cost effective alternatives, such as outpatient clinical supports, pharmacy supports or r

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

Assist with care management for high medical risks / needs members with comorbid behavioral health needs As a Care Coordinator Assess 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

Addresses the total patient, inclusive of medical, psychosocial, behavioral, cultural, and spiritual needs Involves the individual patient and caregiver, as appropriate, in decision making Facilitates communication and coordination among members of the care team Provides patient care to include patient assessment prior to physician's/nurse practitioner's examination, serv

Partner with UMR operations and Vendor partner, own the service experience of customers at the field level by working with the UMR Operations Team and other matrix partners as required to ensure issues are resolved promptly and accurately meeting the customers' expectations Develop and maintain solid relationship with internal partners in the UMR Service Team to manage cu

Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies Perform Department of Insurance/Department of

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

Full oversight of the specialty sale at the direction of the AE/SAE to achieve health plan market sales goals and maintain profitability Advocate for specialty voluntary products to support increase in enrollment and size of sale and negotiate based on broker/customer feedback with underwriting; leveraging rate bank, product discount programs and packaged savings to lever

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease 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

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at 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

Build high performance data pipelines from POC to mature algorithmic data cubes Implement automated workflows and routines using workflow scheduling tools Develop set processes for data mining, data modeling, and data production Integrate new data management and engineering tools into existing structures Build and use tools to understand data lineage and eliminate data du