Ability to manage elements of a health plan compliance program with an understanding of state based government health care programs and products Engage in complex remediation strategy & resolution and promote compliance with applicable laws and contractual obligations for various Medicaid products Ability to flex by working across different markets with varying needs and

Serve as a resource or Subject Matter Expert for team members or internal customers. Handle escalated calls, resolve complex customer issues. Demonstrate outstanding service to identify the source of the caller's issue and work to resolve the inquires in a timely and professional manner. Attend local health events as needed. Assist customers in navigating healthplanofneva

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connect

Contribute to the success of customer implementation through active participation in meetings for new business wins Prepare plan materials such as administrative documents and customer education materials Configure customer benefit structure Research benefit installation issues and develop customer specific resolutions Audit benefit structure configuration for adherence t

Perform initial and concurrent review of inpatient cases applying evidenced based criteria (InterQual criteria) Discuss cases with facility healthcare professionals to obtain plans of care Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management Participation in discussions with the Clinical Services team to improve the pr

Acts as resource to members calling into a customer service setting addressing medical/health questions Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow up with the member Provide process and status on previously submitted prior authorizations or pre determination requests Effectively refers and enrolls memb

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connect

Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs Engage 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 care plans inclusiv

Ensuring delivery of cost effective quality care that incorporates recovery, resiliency and person centered services Responsible for Level of Care guidelines and utilization management protocols Responsible for oversight and management, along with the Clinical Director and Clinical Program Director, utilization review, management, and care coordination activities Provide

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

Lead an analytics team focused on supporting the portfolio of Utilization Management (UM) savings programs for the M&R business. Includes communicating findings and potential opportunities to senior leadership Provide management with unbiased advice regarding medical cost strategy, including review of affordability programs strategy, operational outcomes, and financial me

Identifies opportunities for specialty/enterprise products on all new sales Negotiate with underwriting when necessary Understand and effectively selling multiple products, requiring knowledge of Health Care Reform guidelines and how they differ between level funded and specialty products Develop and maintain solid broker/consultant relationships Properly setting broker a

Perform initial and concurrent review of inpatient cases applying evidenced based criteria (i.e. MCG / Interqual criteria) Discuss cases with facility healthcare professionals to obtain plans of care Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management Participation in discussions with the Clinical Services team to imp

Responsible for researching and resolving payroll tax issues Act as an SME for payroll tax questions and issues, troubleshoot when needed Partner with HR Operations to manage escalated cases related to payroll taxes, including communication directly to employees based on their individual situation, as well as outside tax vendors/organizations Responsible for running queri

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