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 Com

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

Make outbound calls and receive inbound calls to assess members' current health status Make referrals to outside sources Identify gaps or barriers in treatment plans Provide patient education to assist with self management Provide a complete continuum of quality care through close communication with members via in person or on phone interaction Support members with condit

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

Set strategy for experience improvement that supports FP member NPS and retention goals Establish a culture focused on our people obsessed with continual improvements to our members' experience Present strategy to senior management and measure against the strategy Identify, develop, and support the implementation of operational process changes & innovative solutions that

Collect pertinent patient data (e.g., vital signs; complaints; medications and allergies; health screening information) in order to identify care needs Provide relevant medical services/care as directed by physicians (e.g., injections; procedures; treatments) Support and/or coordinate safe transportation of patients to and from medical appointments/facilities (e.g., drive

Oversee initial inpatient admission requests for psychiatric and chemical dependency patients Make patient assessments and determine appropriate levels of care Administer benefits, review treatment plans, and coordinate transitions between various areas of care Obtain information from providers on outpatient requests for treatment Provide utilization management concurrent

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

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Investigate medium to 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 t

Clinical operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating) Case management and coordination of care Takes lead role in setting direction and participating in or developing new programs Sets team direction, resolves problems and provides guidance to members of the team Ensures team meets established perform

Front Facing Practice Level Leadership Targeted Quality Improvement Gaps in Care Closure Relationship Management, Internal and External Community Engagement and Interaction Provider and Practice Education, Quality Oriented Health Topics Supports effective deployment of program at the practice level through strategic partnerships with participating practitioners and practi

Educate members on health education and condition management (formal and informal), as well as plan specifics and member resources, in collaboration with OptumHealth Referral of employees to available clinical programs including premium designated physicians Create, manage and implement employer specific programs based on employer needs Monitors and analyzes customer spec

Responsible for conducting telephonic or face to face holistic evaluations of Member's individual dynamic needs and preferences gathering relevant data and obtaining further information from Member/family identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services, and long term services and sup

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 Com