Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community Be knowledgeable on and apply all necessary regulatory requirements for assigned re

Assess, plan, and implement care strategies that are individualized by member and directed toward the most appropriate, lease restrictive level of care. Identify and initiate referrals for member transition to community request and provide assist with social service programs, including financial, psychosocial, community and state supportive services. Manage the care plan

Manage projects from inception to completion through QI science methodology documentation including Project charters, PDSA cycles, Key Driver Diagrams, GEMBAs, Run Charts and Paretos Complete data analysis for projects to determine progress and if SMART aims are achieved or root causes of performance Lead multidisciplinary teams to complete project tasks Recommend appropr

Acts as resource to members calling into a customer service setting addressing medical/health questions Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow up with the member Provide process and status on previously submitted prior authorizations or pre determination requests Effectively refers and enrolls memb

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

Full oversight of the specialty sale 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 leverage the best value to the custo

Financial management of the UnitedHealthcare and UHG Global real estate portfolios Includes all day to day financial support both Operations costs and Capital costs for those portfolios month end, forecast, financial analysis, project tracking, etc. Customer relationship management (CRM) coordinate & lead review meetings; recommend and establish strategies, plans, and pro

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

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

Work with CICD frameworks to develop data solutions to support performing analysis, interpreting results, creating actionable insights, and presenting recommendations for use across the company Use business intelligence, data visualization, query, analytic and statistical software to build solutions, perform analysis and interpret data Partnering with stakeholders to unde

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

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

Care Management allocation Care Management responsibilities 80% time allocation which includes case consultations with a case load of 45 50 Utilization of hotspotting tool and other internal resource tools that identify at risk AI members Community, relationship building, education 20% (Interventions and efforts to be logged and tracked, reviewed with Manager, including o

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

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