Part of a team of dedicated actuaries and data scientists to study the usage of ML based algorithms applied to historical pharmacy, inpatient notification data, prior authorization data and ultimate utilization and claims data to identify predictive capabilities that can enhance UHC's current trend forecasting models Work with the operational team to identify opportunitie

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

Perform telephonic customer outreach to improve health quality outcomes in collaboration with clinical pharmacists Provide additional telephonic engagement with providers and pharmacies Assess and interpret customer needs and requirements, triaging to a clinical pharmacist when appropriate Document and track member engagement You'll be rewarded and recognized for your per

Growth Define, develop and implement a data driven, locally focused membership growth strategy for the DC health plan. This includes areas/skills such as Strategic thinking and planning, including project management Market research and analysis Sponsorship and budget planning and management Collaboration with national and health plan teams Community Engagement Thoughtfull

Serve as a supervisor overseeing CMA Case Management functions and associated staff. Assumes HSS Coordinator duties when necessary Respect confidentiality and maintain confidences as described in the UHG Employee Handbook and acknowledged through signature by all employees. The ability to maintain confidentiality is a critical and essential component of this position Cond

Evaluate and assess each request verifying eligibility and specific product Determine benefit level based on site of service Utilize written criteria to approve, pend or send the case to the medical director for review Send cases for pending process when appropriate Maintain at least 98% accuracy of clinical review case notes in Facets Maintain productivity standards and

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

Primary Responsibilities Conducts clinical evaluation of members per regulated timelines, determining who may qualify for complex case management based on clinical judgment, changes in member's health, social determinants, and gaps in care Creates and implements a case management plan in collaboration with the member, caregiver(s), provider(s), and/or other appropriat

Forge relationships with key customers and consultants, and act as main contact for UnitedHealthcare and as "CEO" of their account Renew the customer year over year in the 100 3000 lives segment Clearly demonstrate the value propositions for specialty and ancillary business to improve customer growth and retention Develop and monitor client financial performance, includin

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

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 prior to physician's/nurse practitioner's examination, serv

Telecommute Position! Sign-On Bonus! Great Opportunity! Fortune 5 Organization!

Build an Elite Team of Field Account Managers As a Director of Account Management, you will be responsible for leading a team of Field Account Managers to support execution of the client's daily activities Execution of customer satisfaction and retention Work directly with Strategic Account Executives, Project Manager, and Operation team to ensure your team is executing o

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 Com

Predicts emerging customer (state, health plan and functional partner) needs and develops innovative solutions to meet them Solves unique and complex problems with broad impact on the business Participates in the development of business strategy Develops and manages business plans to achieve objectives Leads large, complex projects related to policy, advocacy and influenc