Key Agent/Agency Performance Agent Development Mentor, coach and engage key agents/agencies through ongoing business and strategy planning. This includes identifying sales opportunities, product positioning, UHC tools, UHC value proposition, compliance, and market education Onboarding Reach out to new agents identified by the PHD to share UHC learning, growth tools and va

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

Telecommute Behavioral Health Advocate/Sign-On Bonus/Fortune 5 Organization!

Utilize the Preferred One medical criteria and those of other regulatory bodies, (i.e. NCQA, DOH), the exempt and focused review programs, and the patient's benefit plan summary to perform medical necessity, level of service and appropriateness review Perform inpatient and outpatient pre admission, concurrent review and decision support based on medical necessity, appropr

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

Care Management allocation Care Management responsibilities 80% time allocation which includes case consultations with a case load of 45 50 Utilization of hotspotting tool and other internal resource tools that identify at risk AI members Community, relationship building, education 20% (Interventions and efforts to be logged and tracked, reviewed with Manager, including o

The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include 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

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Evaluate and assess each request verifying eligibility and specific product Determine benefit level based on site of service Utilize written criteria to approve, pend or send the case to the medical director for review Send cases for pending process when appropriate Maintain at least 98% accuracy of clinical review case notes in Facets Maintain productivity standards and

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

As requested, provide support to consumer or family members in making needed appointments Work with the Clinical Program Managers and the Clinical team to implement intensive, enhanced care coordination when requested, which may include peer support as well as other community based services designed to stabilize the consumer's condition, including working with the consume

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

Telecommute Position! Sign-On Bonus! Great Opportunity! Fortune 5 Organization!

of Job To effectively and promptly Perform the Administration, build, and troubleshooting for Anaplan models within UHC Workforce Planning & Management, including bugs and enhancements, both in the backend and on the front end (UX) Support multiple different Anaplan models and use cases Understand the differences and similarities between models and assist cross functional

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 Co