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

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

Ability to manage elements of a health plan compliance program with an understanding of state based government health care programs and products Engage in complex remediation strategy & resolution and promote compliance with applicable laws and contractual obligations for various Medicaid products Ability to flex by working across different markets with varying needs and

Telecommute position/Fortune 5/Excellent Benefits!

Forge relationships with key customers and consultants, and act as main contact for UnitedHealthcare and as "CEO" of their account Renew the customer year over year in the 100 3000 lives segment Clearly demonstrate the value propositions for specialty and ancillary business to improve customer growth and retention Develop and monitor client financial performance, includin

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

Partner with UMR operations and Vendor partner, own the service experience of customers at the field level by working with the UMR Operations Team and other matrix partners as required to ensure issues are resolved promptly and accurately meeting the customers' expectations Develop and maintain solid relationship with internal partners in the UMR Service Team to manage cu

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

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

Care Management allocation Care Management responsibilities 80% time allocation which includes case consultations with a case load of 45 50 Utilization of hotspotting tool and other internal resource tools that identify at risk AI members Community, relationship building, education 20% (Interventions and efforts to be logged and tracked, reviewed with Manager, including o

Make Extra Money/Fortune 5 Company/Friendly Work Environment!

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

Investigate medium to 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 tr

Serve as a resource or Subject Matter Expert for team members or internal customers. Handle escalated calls, resolve 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. Attend local health events as needed. Assist customers in navigating healthplanofneva

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