Preparing and assessing financial, qualitative and valuation analyses Lead special initiatives for corporate senior executives Key liaison to business segment senior leadership, transaction advisors and acquisition targets Developing and coaching junior team members (training, coaching, and mentoring) Defining and negotiating transaction terms Leading and conducting due d

Perform utilization management, utilization review, or concurrent review of behavioral health and substance abuse admissions and continued stays Ensure that behavioral health care services provided are medically necessary per standard guidelines Ensure that behavioral health care services are provided in the most appropriate setting Integrate a collaborative process which

Provide support and strategic counsel on a wide variety of matters including, regulatory compliance and oversight, contracts, STARs, the Inflation Reduction Act, and finance Collaborate with colleagues across the legal, compliance, and regulatory affairs departments You'll be rewarded and recognized for your performance in an environment that will challenge you and give y

Engage directly with care providers, physicians, and office staff via phone calls and faxes Document provider feedback and consult with senior clinical pharmacists if there are questions about treatment, drug efficacy, or authorization status Shadow UHC pharmacists to gain a better understanding of the various roles they have within the UHCP team Collaborate with analytic

Territory will include priority markets in the Central and West Regions with a focus on MN, IL, TX, AZ, CO, and CA Sales VP qualify top prospect utilizing EDGE sales methodology; identifying/creating compelling events that position UHC for success Individual will be an expert at consultative selling with a demonstrated track record of leveraging UHG capabilities to solve

Responsible for managing an average caseload of 45 50 Medicaid members; mostly adult members Responsible for performing assessments to determine members needs, develop care plans, provide education and community resources along with advocating for each member Perform field visits either in the home or long term facility as needed Address social determinants and ensure tha

Assess, plan, and implement care strategies that are individualized by member and directed toward the most appropriate, lease restrictive level of care. Identify and initiate referrals for member transition to community request and provide assist with social service programs, including financial, psychosocial, community and state supportive services. Manage the care plan

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

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

Manage facility based admissions for mental health and substance abuse through the continuum of care Effectively collaborate with treating providers and facilities to ensure consumers are receiving treatment in line with best practice and level of care guidelines Effectively communicate with consumers about their benefit coverage and provide appropriate resources and refe

Engage members either face to face or over the phone to assist with closing gaps in care, linking to necessary services and providing education about their health Review available member service records and relevant documentation (e.g., utilization history, functional level, stratification information, current plan of care) Conduct member health assessment that includes p

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, 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 Com

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

Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies Perform Department of Insurance/Department of

Manage administrative intake of members Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review