Front Facing Practice Level Leadership Targeted Quality Improvement Gaps in Care Closure Relationship Management, Internal and External Community Engagement and Interaction Provider and Practice Education, Quality Oriented Health Topics Supports effective deployment of program at the practice level through strategic partnerships with participating practitioners and practi

Engage members 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, medication management and me

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

Plan Conduct training needs analysis by engaging business/process and system key stakeholders and SMEs Identify training goals, dependencies, audience and timelines Collaborate with business/process and system SMEs/stakeholders to gather training content, information Identify the appropriate delivery approaches, media and methodologies Apply principles of adult learning a

Positions in this function will be responsible for researching and investigating key business problems through quantitative analyses of utilization and healthcare costs data. Develop and improve quantitative data analytics and set performance targets. The main responsibilities will include Interpret and analyze clinical data from various sources and recommend best approac

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

Linking members to applicable community resources Complete field visits for high risk, hard to reach members Telephonic outreach to targeted members Keep the member out of the hospital by supporting regular visits to their primary physician Keep member actively engaged with their primary physician Support the member to ensure pick up of their Rx Proactively engage the 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

Supervise the daily operations of NMC staff Be available to assist staff with risk calls or calls requiring additional consultation Coach and train current staff, deliver information to NMC team regarding new and changed procedures, policies, etc. Monitor and manage individual and team performance; offer constructive and positive feedback to team members and coaching for

Participate in a 10 week internship program that includes a comprehensive and structured training curriculum. This will include training on the Medicare business, systems, and sales processes necessary to serve Medicare eligible members and prospects looking for health care coverage Drive sales/enrollments through effective handling of all telephone inquiries from prospec

Investigate highly 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 information in the Special Investigations Unit's (SIU's) case tracking

improving the quality, cost, and experience of health care. Here, we focus on delivering the best patient care, rather than volume. Through innovation and superior care management, we support patients and your well being as a team member. Join a team at the forefront of value based care and discover the meaning behind. The Nursing Internship Program is full time, 40 hours

improving the quality, cost, and experience of health care. Here, we focus on delivering the best patient care, rather than volume. Through innovation and superior care management, we support patients and your well being as a team member. Join a team at the forefront of value based care and discover the meaning behind. The Nursing Internship Program is full time, 40 hours

Mainly handling inbound calling, NO knocking on doors Answer incoming phone calls from prospective members and identify the type of assistance and information the customer needs with the goal to convert the caller to a qualified lead and ultimately sale Ask appropriate questions and listen actively to identify specific questions or issues while documenting required inform

Handle escalated calls, resolving more complex customer issues Demonstrate outstanding service to identify the source of the caller's issue and work to resolve the inquires in a timely and professional manner Help guide and educate customers about the fundamentals and benefits of consumer driven health care topics such as selecting the best benefit plan options, maximizin