Perform initial and concurrent review of inpatient cases applying evidenced based criteria (InterQual criteria) Discuss cases with facility healthcare professionals to obtain plans of care Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management Participation in discussions with the Clinical Services team to improve the pr

Develop and execute treasury solution strategies associated with deposit products, cash management services and payment services offered by the bank Lead a Team of Treasury Professionals responsible for the design, implementation, and ongoing support of banking solutions and systems to support cash collection, concentration and ACH, wire, paper check, payment card and vir

Partner with Optum Bank leadership, technology partners and external vendors to deliver comprehensive treasury system solutions that meet the needs of internal and external customers Collaborate and consult with key internal departments, affiliates, and business partners to improve, restructure and implement treasury services and systems Lead the implementation of banking

Execute the build and implementation of benefit plan adjudication rules Coordinate the integration or conversion of new clients and / or products as needed, often under aggressive timelines Participate in the development and implementation of an enterprise claim platform, providing subject matter expertise on the system configuration and usability components Align operati

Focus on initial and concurrent reviews for higher levels of care Inpatient admission for psychiatric and chemical dependency patients via telephone Make patient assessments and determine appropriate levels of care Obtain information from providers on outpatient requests for treatment. Facility Based Care Advocates only work with providers for outpatient request prior to

Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality, care and concern with each and every internal and external customer Maintains workflow by studying methods, implementing cost reductions, and developing reporting procedures Organizes and distributes correspondence, reports, memos, etc. Deve

Evaluates new and on going claims to determine liability, giving consideration to contract provisions, disability management duration contract guidelines, medical evidence and vocational evidence. Investigates questionable claims. Determines need for additional medical information. Performs periodic follow ups to verify continued existence of a disabling condition. Respon

Promotes wellness and good health habits in the employee population in all activities and interactions while coordinating with Quad/QuadMed and UMR teams With the help of predictive modeling and other tools, identifies high risk and emerging risk members to engage with them for stabilization through ongoing one on one interactions Identifies gaps in care and collaborates

As part of a multi disciplinary care coordination team Addresses the total patient, inclusive of medical, psychosocial, behavioral, cultural, and spiritual needs Involves the individual patient and caregiver, as appropriate, in decision making Facilitates communication and coordination among members of the care team Provides patient care to include patient assessment prio

Evaluating claims cost, loss experience trends and reserves and communicate information effectively to business partners Understanding the operations and relationship between business segments Running workers' compensation reports and interpreting loss data Monitoring the performance of the third party claims administrator to ensure delivery of high level customer service

Key Agent/Agency Performance Agent Development Mentor, coach and engage key agents/agencies through ongoing business and strategy planning. This includes identifying sales opportunities, product positioning, UHC tools, UHC value proposition, compliance, and market education Onboarding Reach out to new agents identified by the PHD to share UHC learning, growth tools and va

Work with a wide range of internal clients and internal/external attorneys to address inquiries, assess development projects, and provide guidance on patentability Mentor and advise inventors on patentability and invention disclosures Assist in the management of a growing docket of patent filings Perform analytics on patent portfolio and create reporting Assist in the dev

Seeking an Accounts Payable Sr. Accounts Payable Processor for an immediate opening This position is within the Corporate Accounts Payable team and reports directly to the Payment Services Accounts Payable Associate Director Responsibilities include, but are not limited to Verifies accuracy on documents electronically submitted for payment, confirms all appropriate suppor

Evaluates, investigates and negotiates settlements on new and pending claims to determine liability, as applicable to all State and Federal statutes and client contract provisions. Documents claim files, assesses potential legal liability exposure, set appropriate claim reserves and negotiate appropriate claim settlements based on thorough investigation and all supporting

Intake/screening/referral, assessment/reassessment, development of support plans, on going case management, monitoring of the Member's health and welfare, documentation of contacts and case management activities in the Department prescribed system, resource development, and case closure Respect confidentiality and maintain confidences as described in the UHG Employee Hand