Translate business rules and business requirements into system level requirements as part of user story refinement, documenting and communicating system changes Generates requirement documents that communicate process workflows and functional needs to both business stakeholders and technical staff. Maintains expertise and understanding of existing system functionality to

Primary focus will be on a Local Market book of business Intricate focus on product integration to maximize company financials Work closely with underwriting and local market sales to derive competitive financial responses Meets quarterly reporting requirements Anticipates customer needs and proactively develops solutions to meet them Serves as a key resource on complex a

Primary focus will be on a Local Market book of business Intricate focus on product integration to maximize company financials Work closely with underwriting and local market sales to derive competitive financial responses Meets quarterly reporting requirements Anticipates customer needs and proactively develops solutions to meet them Serves as a key resource on complex a

Review, validate and maintain financial and other records as they relate to client specific programs for Taft Hartley Fund Responsible for timely reconciliation of all accounts Process payments and retrieve required statements from websites Communicate financial discrepancies and resolve Responsible for all financial exchanges related to participant accounts Identify erro

Perform telephonic customer outreach to improve health quality outcomes in collaboration with clinical pharmacists Provide additional telephonic engagement with providers and pharmacies Assess and interpret customer needs and requirements, triaging to a clinical pharmacist when appropriate Outbound calls to CAHPs detractors and MedAdhmembers to improve member experience a

Provide members with tools and educational support needed to navigate the health care system and manage their health concerns effectively and cost efficiently Assist members with adverse determinations, including the appeal process Teach members how to navigate UMR internet based wellness tools and resources Outreach to membership providing pre admission counseling to mem

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

Support network pricing strategies and tactics, in collaboration with local network field leaders and network managers Analyze financial impact of provider contracts (e.g., facility; physician; ancillary) Analyze payment appendices to provide options for various contracting approaches and methodologies Communicate results of financial impact and analysis to appropriate st

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

The UnitedHealthcare Community Plan of DC proudly serves the Dual Eligible Special Needs (D SNP) population in the District of Columbia and is excited to recruit for our leader of clinical oversight. This individual contributor will report directly to the Executive Director and will support them on coordinating select priorities, as well as have accountability in two key

Telecommute position/Fortune 5/Excellent Benefits!

Assist with care management for high medical risks / needs members with comorbid behavioral health needs As a Care Coordinator Assess 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

Engage members either face to face or over the phone to have a discussion about their health Review available member service records and relevant documentation (e.g., utilization history, functional level, stratification information, current plan of care) Conduct comprehensive member assessment that includes bio psychosocial, functional, and behavioral health needs Utiliz

Manage administrative intake of members Work with hospitals, clinics, facilities, and the clinical team to manage requests for services from members and/or providers Reviewing incoming and outgoing referrals, and prior authorizations, including intake, notification, and census roles Handle resolution/inquiries from members and/or providers Handle incoming crisis calls fro