Reviews surgical and other professional claims for correct coding using clinical record Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews Composes, if

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

Accountable for customer (employer) loyalty and satisfaction, as measured by survey results and persistency Establish, cultivate, and manage the customer relationship at multiple levels, serving as a healthcare consultant and trusted business advisor to these customers Establish, cultivate, and manage relationships with consultants and brokers, recognizing the value they

Customer retention, based on established annual goals Strategic planning for multi year initiatives to identify opportunities to better manage healthcare trends Responsible for communicating and managing escalated issues and problem resolution as appropriate Maintains appropriate documentation including action plans, meeting notes, Strategic Customer Business Plans, Sales

Develop key internal and external relationships to facilitate results. Understand and create a strategy based on analysis and reporting of sales and market trends, including sales plan execution, competitive intelligence and new product requirements Drive the development of market sales strategies and value proposition formulation Lead as an expert in our national account

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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

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

Home health administrator responsibilities as assigned Special project management as assigned Additional responsibilities as assigned Primary Responsibilities Positively represent the Company to both internal and external customers; always maintain a professional and courteous manner Uphold the Optum core values in the conduct of work Adhere to Company privacy guidelines;

Locate and engage members within a 60 mile radius of a designated region Assess SDOH needs using a standardized screening tool and coordinate with ICT to identify and connect members to available community resources Engage with members post discharge from inpatient setting to facilitate connections with community based services and Peer Support Specialist as needed Provid

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

The KA Field Account Manager is accountable for the field based service of small to mid size, standard/non standard customers under 1,000 members. In this position, the KA Field Account Manager is responsible for the following Acts as a strategic partner and consultative resource to the customer, responsible for the customer's total service experience Meets with customers

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 Com

Sales representative for UHC Key Accounts is responsible for broker and direct sales to customers in the 100 5,000 employee range. The principle focus is the sale of new fully insured business, ASO business (both TPA and bundled) with indirect responsibility for the retention of existing accounts New Business Sales Accountable for prospect from presale to implementation w

Assist in end to end provider claims and help enhance call quality Coach, provide feedback and guide others Assist in efforts to enhance ease of use of physician portal and future services enhancements Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers Help implement traini