Quality and Affordability The Plan CMO has primary responsibility and accountability for Total Medical PMPM performance and targets for the local C&S plan. This will require a close working relationship with UCS clinical operations teams as well as with the C&S and UCS national affordability team. Activities will include conducting hospital Joint Operations Committee meet

Develops strong relationships with their network providers to ensure provider satisfaction in accordance with OptumCare Standards and CDO policies and procedures Ensure that each practice is meeting its financial and quality performance goals, and develop action plans for those practices that are underperforming Act as liaison between Provider Contracting department and o

Answer 60 90 incoming phone calls per day from customers and identify the type of assistance the customer needs Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems Contact care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connect

Handling in bound phone calls professionally, while providing excellent customer service Research and resolve sales agent's questions relating to How to use self service tools Member concerns Medicaid and Medicare verification Application status and eligibility On boarding and certification process Commission inquiries Document call resolution of each contact in various s

Enter prescriptions and verify appropriate and accurate information Contact patients, pharmacists and doctor's offices to resolve claims issues Process prescriptions (from intake to order completion) Resolve customer issues; ensuring accurate information is provided What are the reasons to consider working for UnitedHealth Group? Put it all together competitive base pay,

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

Coordinates the development of the palliative care program in the Colorado market as well as designs program modifications based on measurable outcomes and other continuous improvement activitie Works as a member of the interdisciplinary complex case management team and consults with PCPs, pharmacist, and Medical Director on complex patient care issues Proactively identif

Communicates with all consumers of the mental health center regarding the medication services Genoa provides Recruits and enrolls consumers utilizing enrollment forms and copy the consumer's insurance card Facilitates the collection of prescriptions to be faxed to the pharmacy for dispensing Ensures all consumer insurance information is up to date in the Pharmacy system a

Combine two of the fastest growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. The

Configure a variety of Provider Contracts within Facets System Demonstrate understanding of applicable systems/platforms (e.g., Facets; NetworX; Access; Excel) Demonstrate understanding of on line communication tools (e.g., SharePoint; Outlook; Teams/Personal Communicator) Demonstrate understanding of relevant health care programs (e.g., Medicaid; Medicare; DSNP; CHP+; In

Manage the intake of members or the admission/discharge information post notification Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers Manage the referral process, processing incoming and outgoing referrals and prior authorizations, including intake, notification and census roles Provide appropria

Reviewing client requirements for healthcare analytics tools/databases, and translating those requirements into functional specifications Analyze healthcare membership and claim cost/utilization data from multiple sources Collaborate with data engineers to extract, cleanse, enrich and QA membership and claims data Design and perform QA checks ensuring development efforts

Combine two of the fastest growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. The

Responsible for obtaining all demographics and insurance information Point of service collections Authorizations from patients (or their representatives) and physicians in a courteous and efficient manner for billing. Answering phones Other duties pertinent to optimal patient experience, patient flow, and efficient staff utilization are also expected You'll be rewarded an