Acts as resource to members calling into a customer service setting addressing medical/health questions Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow up with the member Provide process and status on previously submitted prior authorizations or pre determination requests Effectively refers and enrolls memb

Provide advocacy and system navigation of behavioral health services and social services and supports Build partnerships with individuals, families, youth, and key stakeholders to promote recovery, resiliency, and wellness Oversee the provision of, and ensure the availability of, Peer Support services by having access to reports to monitor, track, and trend these services

Determine that the case is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial) Validate that cases/requests for services require additional research Identify and utilize appropriate resources to conduct non clinical research (e.g., benefit documents, evidence of coverage, state/federal mandates, online resources) Prioritize cases based on ap

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

Apply clinical knowledge to Case Managers behavioral health reviews to enrollee's identified as needing or receiving behavioral health services Conduct behavioral health consults with Case Managers, daily and maintain a quarterly schedule for identified members needing or receiving behavioral health services Serve as member advocate by addressing stigma, following Guiding

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

Engage members face to face and/or 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, medicati

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

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 outbound calls and receive inbound calls to assess members' current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self management Make referrals to internal and external sources as outlined by member's benefit plan design Provide a complete continuum of quality care through close communication with members via on

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

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

Perform telephonic customer outreach to improve health quality outcomes in collaboration with clinical pharmacists Provide additional telephonic engagement with providers and pharmacies Assess and interpret customer needs and requirements, triaging to a clinical pharmacist when appropriate Document and track member engagement You'll be rewarded and recognized for your per

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

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