Work closely with cross functional teams and leadership to build consensus and successfully lead and support strategic planning and delivery for a variety of Optum strategic initiatives, programs and events Collaborate with internal stakeholders, including C suite executives and matrixed business partners, to understand program and event requirements and goals in order to

Perform thorough telephonic nursing assessment and clinical review to determine appropriate triage protocol to utilize for nurse care advice. Ensure member is directed to appropriate level of care at contracted facilities. Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care

Receive assigned medical charts to code Review medical charts electronically Abstract and code diagnosis and documentation information Document requested information from the medical record Perform ongoing analysis of medical record charts for the appropriate coding compliance The key challenge of this role centers around your ability to work quickly, accurately and indep

Assess, plan, implement, coordinate, monitor, and evaluate case management activities for offenders being released from state and local prison and for those currently residing at the Community Transition Center, across the continuum of care, within the scope of the case manager's license Coordination and service delivery, Physical and psychological factors, Case managemen

Assess, plan and implement care management interventions that are individualized for each patient 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

Assess complaints of alleged misconduct received within the Company Investigate low to medium complex cases of fraud, waste and abuse Detect fraudulent activity by members, providers, employees and other parties against the Company Develop and deploy the most effective and efficient investigative strategy for each investigation Maintain accurate, current and thorough case

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, c

Serve as a liaison for post transition concerns Aid members who lose nursing facility level of care or are ready for discharge from a nursing facility to ensure a successful discharge or transfer to another residential setting Work with the Member Advocate Coordinator and other member focused departments Outreach to and engage a member transitioning between programs to co

Responsible for overall success of Incentive Compensation Management business team, cross team collaboration with key business partners to negotiate win win outcomes. Other primary responsibilities include Day to day management of the ICM team, including staff assignments and talent growth. Overall owner of work that is committed to be delivered on agreed upon timeframe E

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

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

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

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

Facilitate, oversee and monitor on going business processes to support HEDIS data reporting Monitor compliance against relevant process requirements (e.g., turnaround time, accuracy) Evaluate processes and outcomes against benchmarks and metrics and identify potential business impacts of current state Ensure all business requirements are met Demonstrate understanding of r

Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements Engage with requesting providers as needed in peer to peer discussions Be knowledgeable in