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

Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements Engage with requesting providers as needed in peer to peer discussions Be knowledgeable in

Work with business partners in the design and development of products that deliver operational efficiency during chart chase Interact with multiple teams and roles seamlessly, communicating effectively Translate business partner requirements into consumable format for Engineering consumption Review, reconcile, and troubleshoot issues submitted by business partners during

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

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

Use SQL and Python to support team's automation capabilities. For example, contribute to code development and production of automated client reporting Support the Data Insight team's research efforts to evaluate Surest performance, with a gradual increase in responsibilities Use SQL and Python to design, build, and organize data for analytical purposes Support short and l

Full oversight of the specialty sale to achieve health plan market sales goals and maintain profitability Advocate for specialty voluntary products to support increase in enrollment and size of sale and negotiate based on broker/customer feedback with underwriting; leveraging rate bank, product discount programs and packaged savings to leverage the best value to the custo

Perform initial and concurrent review of inpatient cases applying evidenced based criteria (i.e. MCG/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 impro

Lead a team of Event Planners with effective people leadership through effective coaching, feedback, and people management practices Manage end to end complex conference/event/incentive travel program planning coordination that drives a consistent attendee experience Develop, streamline, and create standards of excellence in designing and executing events while keeping th

Work with CICD frameworks to develop data solutions to support performing analysis, interpreting results, creating actionable insights, and presenting recommendations for use across the company Use business intelligence, data visualization, query, analytic and statistical software to build solutions, perform analysis and interpret data Partnering with stakeholders to unde

Partner with community providers of peer support to expand the network and ensure quality services are available for our members Educate by creating new curriculum specific to state need and facilitate community trainings Model the principles of recovery and provide member perspective to our CM, UM, Network, Product and Affordability partners Advocate for a recovery persp

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, c

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, c

Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements Engage with requesting providers as needed in peer to peer discussions Be knowledgeable in

Conduct coverage review based on individual member plan documents, and national and proprietary coverage review guidelines, render coverage determinations, and discuss with requesting providers as needed in peer to peer telephone calls Use clinical knowledge in the application and interpretation of medical policy and benefit document language in the process of clinical co