Finalize required Qualified Health Plan (QHP) Templates owned by business Create and submit product form filings with state and federal regulators Run CMS Provided Review Tools prior to QHP filings Coordinate tracking/analysis of objections for trending and identification of opportunities for business Coordinate Plan Preview/Window Shopping for FFM and SBM Exchanges befor

Positively represent the Company to both internal and external customers; always maintain a professional and courteous manner Uphold the Optum core values in the conduct of work Adhere to Company privacy guidelines; ensure compliance with local, state, and federal regulations Assess patients prior to initiation of home care service for appropriateness of services prescrib

Make outbound calls to assess members' current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self management Interact with Medical Directors on challenging cases Coordinate care for members Make referrals to outside sources Coordinate services as needed (home health, DME, etc.) Educate members on disease processes Enco

Are you a registered nurse looking for a unique opportunity focused on Home Health? We’re offering a six month paid residency with clinical training, mentorships, classroom training, and in field training for the role of Home Health Case Manager. There will be open positions throughout the year based on the needs of the agency. Primary Responsibilities Classroom tra

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

Coordinate and complete projects across various functional areas Define and report on performance results Track and develop best practices and requirements to best support each State's unique needs Understand and promote MOTE process best practices Provides subject matter expertise in areas including project scope definition, risk identification, project methodology, reso

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

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

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

Evaluates new and on going claims to determine compensability and liability, giving consideration to contract provisions, disability management duration contract guidelines, medical evidence and vocational evidence. Investigates questionable claims. Determines needs for additional medical information. Determine appropriate benefit calculations and payments. Performs revie

Sales representative for the UHC Key Accounts responsible for broker and direct sales to customers in the 100 5000 employee range. The principle focus is the sale of new fully insured and self funded business with indirect responsibility for the retention of existing accounts New Business Sales Identifies potential healthcare business customers Accountable for prospect fr

Partner with UMR operations and Vendor partner, own the service experience of customers at the field level by working with the UMR Operations Team and other matrix partners as required to ensure issues are resolved promptly and accurately meeting the customers' expectations Develop and maintain solid relationship with internal partners in the UMR Service Team to manage cu

Work collaboratively with the interdisciplinary care team, specifically external entities such as OhioRise, Care Management Entities, and Provider Practices; to ensure an integrated team approach Engage members either face to face or over the phone to assist with closing gaps in care, linking to necessary services and providing education about their health Review availabl

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

Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medicati