Participate in a 10 week internship program that includes a comprehensive and structured training curriculum. This will include training on the Medicare business, systems, and sales processes necessary to serve Medicare eligible members and prospects looking for health care coverage Drive sales/enrollments through effective handling of all telephone inquiries from prospec

As part of a multi disciplinary care coordination team Addresses the total patient, inclusive of medical, psychosocial, behavioral, cultural, and spiritual needs Involves the individual patient and caregiver, as appropriate, in decision making Facilitates communication and coordination among members of the care team Provides patient care to include patient assessment prio

Establish a trusting relationship with youth and family Keep youth and family actively engaged in the planning and implementation of their wraparound care Identifies and build on strengths and culture of youth, family, and support system to create individualized and integrated care plan Collaborate with youth and family's identified support team (community, providers, int

Evaluation of member discharge needs including delays in care and readmission prevention plan Collaboration with providers and members to coordinate care post discharge Participate in rounds with the Medical Director to discuss cases as needed Identification of internal or community based program support or resources Coordination with the facility Discharge Planner to ens

Investigate highly complex cases of fraud, waste, and abuse Detect fraudulent activity by members, providers, employees, and other parties against the Company Develop and deploy the most effective and efficient investigative strategy for each investigation Maintain accurate, current, and thorough case information in the Special Investigations Unit's (SIU's) case tracking

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

Assess, plan and implement care management interventions that are individualized for each member and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals for both healthcare and community based services; including but not limited to financial, psychosocial, community and state supportive services Develop and implement care

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

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

Provide an exceptional customer service experience when responding to and resolving 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 Research complex issues (such as Medical, Dental, Flex Spending, Pharmacy, etc.) across multiple da

Manages a caseload by coordinating services and collaborating with other health care professionals in the provision of health care services for injured workers Determines the necessity and appropriateness of health care services for patients Evaluates and reports on outcomes Provides Health Education, coaching and treatment decision support for injured workers Meets with

Serves as primary care manager for members with primary high behavioral needs members Engage members through a variety of modalities (telephonically) to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, socioeconomic and SDOH needs Develops and implements individualized, person centered care plans inclusive of go

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care Utilize the NYS UAS Assessment as needed in the home or via telehealth to develop a person center service plan to meet the member's needs Identify and initiate referrals for social service programs, including financial, p

Extensive work experience within own function. Work is frequently completed without established procedures. Works independently. May act as a resource for others. May coordinate others' activities. Extensive work experience within own function. Applies knowledge/skills to a range of moderately complex activities. Demonstrates great depth of knowledge/skills in own functio

Maintain general ledger accounts and related activities for the production of financial statements and reports Reconcile, analyze and review general ledger accounts in preparation for month end close Prepare journal entries and review accounting classifications, in accordance with generally accepted accounting principles Prepare documentation in support of external and in