Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease 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

Full oversight of the specialty sale at the direction of the AE/SAE to achieve health plan market sales goals and maintain profitability Advocate for specialty voluntary products to support increase in enrollment and size of sale and negotiate based on broker/customer feedback with underwriting; leveraging rate bank, product discount programs and packaged savings to lever

Oversee performance of end to end provider servicing Resolve complex problems and provide guidance to members of own team Drive the design and implementation of programs that build / nurture positive relationships between the health plan, providers, and practice managers Ensure implementation of training and education programs for external providers Identify gaps in netwo

Utilize advanced clinical skills to engage and motivate Consumers via a recovery, health and wellness oriented approach Assist consumers and their families/caregivers with connections to appropriate psychiatric, medical, and psychosocial referrals and services Identify and remove barriers to procurement, delivery, participation in and success of services Provide supportiv

Develops and maintains a collegial relationship with contracted and affiliate dentists to support the business efforts of the organization Grievance and Appeals maintains an active liaison with Dental Consultants, reviews dental and medical/dental cases, and oversees the representation of the plan at State level Fair Hearings as requested Works with Quality Director to im

Participate in telephonic outreach for collaboration with treating providers. This will include discussion of evidence based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expenses Responsible to collaborate with operational and business partners on clinical and quality initiatives at the site and cust

Telecommute position/Fortune 5/Excellent Benefits!

Solid understanding of self funded marketplace and pricing disciplines Establish and maintain "solid and appropriate" level relationships with customers and consultants; ensure UHG senior management has customer specific "board level" contacts Develop and monitor client financial performance including renewal planning, negotiation and profitability levels Detailed underst

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

Assist digital team members with the development of display and paid social campaign strategy Management of programs to ensure campaigns are optimally structured, setup, trafficked and are tracking correctly Manage daily campaign optimization, testing, tracking and performance measurement Oversee creative development and approval process Develop reporting and key insights

Support short and long term operational/strategic business activities through data and claims analysis Recommend, develop, and implement business solutions through research and analysis of data, claims, and business processes Utilize project management skills including planning, development, coordination, monitoring, reporting, and evaluation of program/initiatives Assist

Sending correspondence to members Reconciling reports Performing basic data entry functions with proficient PC skills including but not limited to Microsoft products and Quickbooks Analytical and Researching techniques Initiate and assist with developments / changes to increase or change quality and productivity Preparing, processing, and maintaining new member or group e

Intake/screening/referral, assessment/reassessment, development of support plans, on going case management, monitoring of the Member's health and welfare, documentation of contacts and case management activities in the Department prescribed system, resource development, and case closure Respect confidentiality and maintain confidences as described in the UHG Employee Hand

Evaluates new and on going claims to determine compensability and liability, giving consideration to contract provisions, disability management duration contract guidelines, medical evidence and vocational evidence. Investigates questionable claims. Determines needs for additional medical information. Determine appropriate benefit calculations and payments. Performs revie

Make Extra Money/Fortune 5 Company/Friendly Work Environment!