Handle escalated calls, resolving more complex customer issues Demonstrate outstanding service to identify the source of the caller's issue and work to resolve the inquires in a timely and professional manner Help guide and educate customers about the fundamentals and benefits of consumer driven health care topics such as selecting the best benefit plan options, maximizin

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 spe

Responsible for handling inbound calls, from providers and members in a call center environment Conduct initial clinical assessments and determine appropriate levels of care, based on medical necessity Explain and administer benefits according to plan descriptions for all levels of care (OP, IOP,PHP,RTC,IP) Ability to quickly assess and meet time sensitive deadlines withi

Work closely with Finance, Actuarial, and Affordability partners to develop financial projections and forecasts of expected savings from key affordability programs. Also, build comparisons of actual to expected results and develop explanations of variances Provide management with unbiased advice regarding medical cost strategy, including review of affordability programs s

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. Conne

Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered care plans inclusiv

Handle escalated calls, resolving more complex customer issues Demonstrate outstanding service to identify the source of the caller's issue and work to resolve the inquires in a timely and professional manner Help guide and educate customers about the fundamentals and benefits of consumer driven health care topics such as selecting the best benefit plan options, maximizin

Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies Perform Department of Insurance/Department of

Provide support and strategic counsel on a wide variety of matters including, regulatory compliance and oversight, contracts, STARs, the Inflation Reduction Act, and finance Collaborate with colleagues across the legal, compliance, and regulatory affairs departments You'll be rewarded and recognized for your performance in an environment that will challenge you and give y

Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered care plans inclusiv

Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered care plans inclusiv

Positions in this function are responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating, and resolving all types of appeals and grievances Communicates with appropriate parties regarding appeals and grievance issues, implications, and decisions Analyzes and identifies trends for all appeals and grievances May re

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

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

Accountable for customer (employer) loyalty and satisfaction, as measured by survey results and persistency Establish, cultivate and manage the customer relationship at multiple levels, serving as a healthcare consultant and trusted business advisor to these customers Establish, cultivate and manage relationships with consultants and brokers, recognizing the value they br