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Responsible for establishing and maintaining positive relationships and actively marketing to referral sources within the hospital, physician offices, or healthcare facilities. Information resource for home health service/SNF services Resources for early intervention Assist complex patient conferencing as needed. Daily rounds on hospital floors and morning meetings with all case managers to colla
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Under limited supervision, applies the appropriate diagnostic and procedural codes to individual patient health information for data retrieval and analysis and claims processing Abstracting pertinent information from patient records Assigning ICD 10 CM / PCS or HCPCS codes, creating APC or DRG Group assignments Queries physicians when code assignments are not straightforward or documentation in th
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Assessment of business capability requests to determine current and future infrastructure needs Work with end users to improve business and system capabilities Work with and coordinate appropriate IS staff to implement solutions which will meet or exceed customer expectations Communicate complex infrastructure concepts at multiple levels across the business partner landscape effectively driving co
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Manage unit cost budgets, target setting, performance reporting and associated financial models Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards and other key process controls Ensure that net
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Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management Develop and execute strategies for a function or discipline that span a large business unit or multiple markets / sites Apply network configuration and incentive based payment models as appropriate to improve quality and efficiency Direct others t
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Consult and partner with executive leaders to develop and execute internal communication plans that reinforce the business plans, strategies, mission and values of Optum and Optum Care Mountain West. Collaborate with applicable stakeholders to help define their communications needs and preferences (e.g., business objectives or issues to be addressed, desired outcomes, root cause analysis) Write an
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Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence Educate customers about the fundamentals and benefits of consumer driven health care, guiding them on topics such as selecting the best benefit plan options, maximizin
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Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members Execute applicable provider incentive programs for health plan Assist in the review of medical records to highlight Star opportunities for the medical staff Activities include data collection, data entry, qual
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Provide exceptional customer service to all customers while following best practices of call greeting, call handling, call documentation, call resolution and call closure. Provide 1st level technical support by creating and/or resolving ServiceNow Incident and Request cases. Troubleshoot problems with network connectivity, web access, Windows, Outlook access, Exchange, SQL connectivity, and propri
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Serve as a resource or Subject Matter Expert (SME) for other team members or internal customers Handle escalated calls, resolving more complex customer issues in a one and done manner Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)
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The candidate will assist with insurance verification, calling patients, collecting data and maintaining reports, managing faxes, and mailing referrals. The candidate also supports the department leadership with projects and other duties as needed. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to suc
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UnitedHealth Group is working to create the Healthcare system of tomorrow and you can help. Already Fortune 7, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good. Through our family of businesses and a lot of inspired individuals, we're building a high p
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Field inbound calls on a queue from members and providers for the purpose of assessment and triage Focus on initial inpatient admission for psychiatric and chemical dependency patients Make patient assessments and determine appropriate levels of care Determine if additional clinical treatment sessions are needed Manage inpatient mental health cases throughout the entire treatment plan Administer b
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Receive, review, and coordinate all information required to initiate a referral for pre authorization for health care services for multiple practices Follow protocols set up by New West Physicians and contracted payors. Utilized New West Physicians Practice Guidelines as required Advise providers concerning the adequacy of the information contained in the referral. Maintain accurate documentati
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Provide full scope primary care services to pediatric, adult and senior patients Examine diagnose and treat patients for acute injuries, infections, and illnesses Counsel and educate patients and families about acute and chronic conditions or concerns Complete timely and thorough documentation using our EMR system Formulate diagnostic and treatment plans Prescribe and administer medications, thera
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