You will work closely with the executive leadership team of these groups as a trusted advisor to help maintain a high performing culture by driving strategic and proactive talent acquisition, development and reward programs that are closely aligned to the overall business and people strategy. Proactively provide advice, guidance, and leadership to executives on organizati

Address any escalated issues sent to them, the SAE, or other field employee Work with the central team and their manager to coordinate resolution Meet with customers quarterly (or more often if requested) to review service related statistics including ideas for improving or enhancing the customer's total service Conduct training/education with customers on UHC eServices,

Organize and manage incoming claims Work through a queue with other team members to identify claim needs Identify billing discrepancies Determine member insurance coverage and eligibility status Ensure compliance with federal and state laws and regulations Sort and organize appeals to identify eligibility needs Communicate with legal teams on appeal status Make offers to

Address any escalated issues sent to them, the SAE, or other field employee Work with the central team and their manager to coordinate resolution Meet with customers quarterly (or more often if requested) to review service related statistics including ideas for improving or enhancing the customer's total service Conduct training/education with customers on UHC eServices,

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connect

Perform initial and concurrent review of inpatient cases applying evidenced based criteria (InterQual criteria) Discuss cases with facility healthcare professionals to obtain plans of care Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management Participation in discussions with the Clinical Services team to improve the pr

Identifies opportunities for specialty/enterprise products on all new sales Negotiate with underwriting when necessary Understand and effectively selling multiple products, requiring knowledge of Health Care Reform guidelines and how they differ between level funded and specialty products Develop and maintain solid broker/consultant relationships Properly setting broker a

Collaborates with the University Bursar, Registrar, IT Services and Web Services departments to ensure smooth processes throughout the insurance plan year. Coordinates the administrative aspects of a competitive bid process for USHIP and the optional insurance plans. Maintains the University Student Health Insurance Administration Tool, which tracks students' annual enrol

The following duties cover what are generally believed to be principal and essential functions of the job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties. Support enterprise initiatives and product management needs via analysis and consultations Consults with business partners who deliver 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

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

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connect

Perform initial and concurrent review of inpatient cases applying evidenced based criteria (i.e. MCG / Interqual criteria) Discuss cases with facility healthcare professionals to obtain plans of care Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management Participation in discussions with the Clinical Services team to imp

Organize and manage incoming claims Work through a queue with other team members to identify claim needs Identify billing discrepancies Determine member insurance coverage and eligibility status Ensure compliance with federal and state laws and regulations Sort and organize appeals to identify eligibility needs Communicate with legal teams on appeal status Make offers to