Manages and evaluates direct reports of UM Prior Authorization Nurses, Inpatient Care Managers, Clinical Coordinators, and other team associates Manages the compliance for UM to meet established performance metrics Oversees inventory and ensures cases completed within regulatory timeframes Manages all aspects of the UM program and service timeframes Actively participates

Communicate directly with families of babies currently admitted or recently discharges from the NICU, physicians, and community/governmental agencies Collaborate with NICU nurses and/or NICU Social Worker/Discharge Planners regarding barriers or challenges families are confronting and assist with solutions to prevent delay in infant's discharge Through direct telephonic a

Provide skilled nursing care for expectant mothers in the home care environment Travel to provide in home patient care and continuous education to patients and family members Continually assess the mothers' condition to ensure they are safe in the home environment Modify care plans as appropriate based on reassessment, change in prescriber orders, the patient's need for f

Provide consultation to providers and/or consumers on a variety of issues including benefit information, safety issues, confirmation of prior authorizations and approvals, procedures for higher levels of care evaluations, and request for an explanation of the level of care, coverage determination, or best practice guidelines Respect confidentiality and maintain confidence

Making outbound calls to assess members' current health status Identifying gaps or barriers in treatment plans Providing patient education to assist with self management Interacting with Medical Directors on challenging cases Coordinating care for members Making referrals to outside sources Coordinating services as needed (home health, DME, etc.) Educating members on dise

Responsible for developing and preparing documentation for NCQA and other accreditation survey submissions Works closely with regional quality staff, health plan staff, and internal business partners to build and document compliance with accreditation standards Interpret complex data and draws conclusions Complete reports that provide analysis of data related to key quali

Home health administrator responsibilities as assigned Special project management as assigned Additional responsibilities as assigned Primary Responsibilities Positively represent the Company to both internal and external customers; always maintain a professional and courteous manner Uphold the Optum core values in the conduct of work Adhere to Company privacy guidelines;

Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer Perform all functions of the UM nurse reviewer Composes denial letter in a manner consistent with federal regulations, state regulations, health plan requirements an

Locate and engage members within a 60 mile radius of a designated region Assess SDOH needs using a standardized screening tool and coordinate with ICT to identify and connect members to available community resources Engage with members post discharge from inpatient setting to facilitate connections with community based services and Peer Support Specialist as needed Provid

Maintain detailed knowledge of State and Federal insurance programs and effectively utilize such programs to insure all eligible are enrolled in appropriate MassHealth programs Maintain detailed knowledge of MassHealth and attend all required MassHealth training forum meetings Assist in eligibility determination and completion of MassHealth applications Monitor, analyze a

Develop Others into a successful team aimed at increasing growth and market permeation by Continually building and nurturing agents through educational support on product information, selling skills, systems, and processes at United Healthcare Actively engage in the management and coaching of agent performance by implementing successful start strategy and guiding agents t

The KA Field Account Manager is accountable for the field based service of small to mid size, standard/non standard customers under 1,000 members. In this position, the KA Field Account Manager is responsible for the following Acts as a strategic partner and consultative resource to the customer, responsible for the customer's total service experience Meets with customers

Own the service experience of customers at the field level by working with the Regional Service Team and other matrix partners as required to ensure issues are resolved promptly and accurately meeting the customer's expectations Develop and maintain strong relationship with internal partners in Service Team to manage customer service experience Fully accountable for suppo

Sales representative for UHC Key Accounts is responsible for broker and direct sales to customers in the 100 5,000 employee range. The principle focus is the sale of new fully insured business, ASO business (both TPA and bundled) with indirect responsibility for the retention of existing accounts New Business Sales Accountable for prospect from presale to implementation w

Assist in end to end provider claims and help enhance call quality Coach, provide feedback and guide others Assist in efforts to enhance ease of use of physician portal and future services enhancements Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers Help implement traini