Evaluate and assess each request verifying eligibility and specific product Determine benefit level based on site of service Utilize written criteria to approve, pend or send the case to the medical director for review Send cases for pending process when appropriate Maintain at least 98% accuracy of clinical review case notes in Facets Maintain productivity standards and

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 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

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

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Utilize both company and community based resources to establish a safe and effective case management plan for members Collaborate with patient, family, and healthcare providers Identify and initiate referrals for social s

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

CI/CD Pipeline build and automation Provision cloud environments for various applications Development of automation tools to support various applications Day to Day collaboration with Scrum Teams, providing support to our developers and testers You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on

Finalize required Qualified Health Plan (QHP) Templates owned by business Create and submit product form filings with state and federal regulators Run CMS Provided Review Tools prior to QHP filings Coordinate tracking/analysis of objections for trending and identification of opportunities for business Coordinate Plan Preview/Window Shopping for FFM and SBM Exchanges befor

Positively represent the Company to both internal and external customers; always maintain a professional and courteous manner Uphold the Optum core values in the conduct of work Adhere to Company privacy guidelines; ensure compliance with local, state, and federal regulations Assess patients prior to initiation of home care service for appropriateness of services prescrib

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

Key Agent/Agency Performance Agent Development Mentor, coach and engage key agents/agencies through ongoing business and strategy planning. This includes identifying sales opportunities, product positioning, UHC tools, UHC value proposition, compliance, and market education Onboarding Reach out to new agents identified by the PHD to share UHC learning, growth tools and va

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

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

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

You will work closely with the executive leadership team of these groups as a trusted advisor to help maintain a high performing culture by driving strategic and proactive talent acquisition, development and reward programs that are closely aligned to the overall business and people strategy. Proactively provide advice, guidance, and leadership to executives on organizati