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

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

Make calls to qualified members to provide information and answer questions about health plan programs. Provide "best in class" customer service to enrollees. Meet established productivity, schedule adherence, and quality standards while maintaining good attendance. Identify, qualify, and engage members into the most appropriate health and wellness programs to meet their

Discharge Planning Works with facility Case Manager or Social Worker to coordinate DC process and transition needs based on patient's diagnoses and status Care Coordination and Patient Support Collaboration with the entire clinic team to proactively manage high risk patients by ensuring appropriate Telephonic Post Hospital Discharge Calls Medication Management to include

Monitors daily workload and appropriately distributes work amongst staff Problem solves complex issues related to prior authorizations cases Review and process fax/telephone/computer requests to meet departmental key indicator productivity and accuracy standards; maintain minimum of 95% case data entry accuracy Follow departmental policy regarding accurate documentation o

Answer incoming phone calls from prospective members, identify the type of assistance and information the customer needs with the goal to convert caller to a qualified lead and sale Follow up with members on questions or to review current or new products and services Navigate multiple computer systems to document member information while maintaining active listening and e

Sending correspondence to members Reconciling reports Performing basic data entry functions with proficient PC skills including but not limited to Microsoft products and Quickbooks Analytical and Researching techniques Initiate and assist with developments / changes to increase or change quality and productivity Preparing, processing, and maintaining new member or group e

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

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

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 prior to physician's/nurse practitioner's examination, serv

Perform HEDIS medical record review for physician offices throughout the state of Nevada Complete inter rater reliability testing and required computer training successfully in order to complete this data collection Conduct additional QI audits through medical record review Educates physicians, RNs and other clinical employees in the latter half of the year You'll be rewa

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

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

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

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