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Senior Provider Relations Advocate - Iowa Telecommute

Sat, 05/16/2015 - 11:00pm
Details: Position Description: Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm) The Senior Provider Relations Advocate is responsible for the full range of provider relations and service interactions within UnitedHealth Group, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training & development of external provider education programs. Senior Provider Relations Advocates design and implement programs to build and nurture positive relationships between the health plan, providers (Home and Community Base Services/Long-Term Support Services), and practice managers. Responsibilities also include directing and implementing strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims.Staff oversight with implementation of tools, education and monitoring provider interactions is included in scope of work for responsibilities.

Case Manager LPN - Broward County, FL Telecommute

Sat, 05/16/2015 - 11:00pm
Details: Position Description: There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm) Responsible for the management of patients in an institution in order to assure that the most appropriate, cost effective and quality care is rendered utilizing appropriate clinical guidelines. The Inpatient Case Manager is able to perform all aspects of theposition with additional responsibilities including but not limited to thoseoutlined below. Primary Responsibilities: Perform effective concurrent review and data entry into the Health Management System, according to established guidelines and time frames. Maintain patient census as directed by the Clinical Team Leader In conjunction with the Clinical Team Leader and Medical Director, performs retrospective review of days while patient still admitted and determines appropriate level of care, and medical necessity of services rendered. Available to attend the daily census meeting on an ad-hoc basis and/or conference in as needed. Adheres to Special Needs Program-Model of Care program goals and objectives in health care cost containment while maintaining a high quality of health care delivery system to meet the patient's individualized health care needs through adherence to program policies and procedures; Direct/telephonic contact and intervention with member, family, facility staff and provider to assure timely and appropriate discharge planning and coordination of care. Appropriately identifies cases for review and intervention of the Medical Director. Assists the Utilization Management Department, Clinical Team Leader and Medical Director in the notification process of non-certifications. Document appropriate case information and provide daily progress reports on inpatient status to the Clinical Team Leader, Medical Director or designee. Reports High Risk, High Costs Cases, Re-admissions, Third Party Liabilities, Mortalities and any other as directed by the AVP of Management or Medical Director. Completion of acute discharge assessment within 24 hours of a member being discharged from the hospital setting. Coordinate the treatment plan to accommodate the health service needs of the patient, benefit availability and community resources Utilizes community resources to assure access to care at the most appropriate level with the intent of minimizing cost and facilitating quality care. Maintain professional relationship with area hospitals and providers. Perform on site and or telephonic review at the hospital or skilled nursing facility. Attend meetings and committees as directed by the AVP of Medical Management. Develop strategies to assist the Medical Director in reducing bed days. Familiar with the provider network, and capitation system Identify potential cases for case management and reports on any quality of care issues, discharge notifications. Follows cares from admission to discharge. Identifies avoidable days and recommends administrative demands Follows correct Expedited Determination process in accordance to Federal Regulations

Financial and Accounting College Intern - Horsham, PA

Sat, 05/16/2015 - 11:00pm
Details: Position Description: Internships at UnitedHealth Group. If you want an intern experience that will dramaticallyshape your career, consider a company that's dramatically shaping our entirehealth care system. UnitedHealth Group internship opportunities willprovide a hands-on view of a rapidly evolving, incredibly challengingmarketplace of ideas, products and services. You'll work side by side withsome of the smartest people in the business on assignments that matter. So herewe are. You have a lot to learn. We have a lot to do. It's theperfect storm. And even better? Join us and you may end up stayingfor a career in which you can do your life's best work . SM Primary Responsibilities: Provide analytic and reporting support forthe OCIO Portfolio and Financial Planning team under general supervision. Data gathering and analysis to develop and maintain accurate reporting of OCIOProject funding and the overall Portfolio. Coordinate with the Portfolio and Financial Planning Team and the Finance teamto develop forecasts, budgets, and resource plans. Complete variance analysis and research variance drivers and explaincause-effect relationships.

Senior Application Architect - Telecommute

Sat, 05/16/2015 - 11:00pm
Details: Commit yourself to a culture of performance, collaboration and opportunity. Leverage technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm) Primary responsibilities: Assess and interpret customer needs and requirements Be involved in solving complex problems and/or conduct complex analysis Provide explanation and information to others on difficult issues Coach, provide feedback and guide others Maintain knowledge of current domains and strategic roadmaps Identify/quantify scope and impact of business changes on systems Incorporate software and system architecture into conceptual designs Lead modeling efforts (e.g., data modeling, process modeling, hardware modeling, performance modeling) Lead oversight of conceptual designs to ensure alignment with enterprise architecture governance (e.g., principles, policies, standards, future-state reference architectures) Maintain awareness of current technology assets, and the applicability and capability of each You will be responsible for leading awareness of current business and industry issues/trends and incorporate into enterprise architecture designs as appropriate

Client Configuration Sr Business Analyst - Eden Prairie, MN

Sat, 05/16/2015 - 11:00pm
Details: You believe data can help reshape the future, and you find yourself loving the thrill of diving into challenging analysis. At UnitedHealth Group, you'll find an organization that will recognize those talents and have lots of growth potential. Here, you will be empowered, supported and encouraged to use your analysis expertise to help change the future of health care. Does the challenge intrigue you? As a key member of the Analyst team, you will be part of UnitedHealth Group's mission of helping people live healthier lives. As a Senior Business Analyst, you will grow and develop as you conduct and manage outcomes of various studies. You will be challenged to analyze, review, and forecast data for operational and business planning. As part of this elite team, you will be empowered to impact the health care system through the analysis and interpretation of data, and presenting recommendations for business solutions. Join us! There's never been a better time to do your life's best work.(sm) Primary Responsibilities: Lead the transition from HC3 Facets to the BOSS IBM/ODM solution for client configurations Lead the transformation to a singular Client Configuration Analyst role capable of advising in both SBP and Installation aspects of configuration. Analysts will able to assist with population identification, product set up questions, PVRC codes questions/setup and the ORC set up process. This singular structure will improve support for the IPM and CSM teams, improve accuracy, decrease rework and improve turnaround time Assess and intreprets customer needs regarding client set up SBP, HC3 Facets and ASL as part of the configuration process Identifies solutions to complex client set up requests and problems Solves complex questions regarding configuration with little outside assistance Provides explanations and information to IPMs and CSMs who are working on difficult issues Coaches, mentors and provides guidance to others on the Client Configuration team Acts as a resource and expert to other areas in need of client configuration knowledge and information SME of Client Configuration for customer, account, reporting, program, fulfillment, and data set up in Facets, SBP Oracle DB, BOSS and IBM/ODM. Applications used: Facets, Aqua Data Studios, Cognos, PARMS reporting DB, Excel, Access, Word, Visio, UltraEdit, ASL, HPSM Train staff and customers in account setup in Facets, SBP, ASL, Reporting; how to troubleshoot eligibility issues Maintain and create process documentation and job aides Revise the SBP programs to denote customer specific rules Assign and complete ORC requests - new implementations and change requests Role is considered to be that of a team lead, which involves work on projects with team and other departments/teams. Role is primary source of contact for the team

Spvsr, Clin Appeals

Sat, 05/16/2015 - 11:00pm
Details: Provides clinical support for performing clinical review of appeals, and may also review quality of service issues. Process includes analyzing, reviewing and evaluating appeals in compliance with state and federally mandated turn-around-times and process requirements. Current, valid and unrestricted RN licensure is required -Experience working in a hospital setting preferred but not required -Excellent verbal and written communication skills -Medicare policy knowledge is preferred -Experience working in a Managed Care environment is highly preferred -Strong analytical and research skills -Knowledge of CPT, ICD9 coding

Senior Claims Appeals Representative - Oldsmar, FL

Sat, 05/16/2015 - 11:00pm
Details: Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work. SM The role of an M&R Senior Claims Appeals Representative is to serve as a trusted resource in providing problem resolution and support for our Medicare members regarding their complex appeals or grievances related to their coverage or claims. This means developing and maintaining member relationships both on the phone and in writing through the process of researching and resolving their complex questions and concerns. As a Senior Coordinator, this role is focused on the processing of highly complex and unique cases with minimum assistance. A key requirement of this role is to deal with our members in a compassionate manner - always remembering that there is a real person on the other end of the phone who may not understand their insurance coverage, and is looking for your help and support in navigating the health care system Responsibilities: Independently reviews the members' case file to determine if representative/appellant is authorized party and if complaint is valid. These may include: Medical benefits, eligibility and claim payments Deductible limits and co-payments Pharmacy benefits, eligibility and claims Billing and enrollment inquires Demonstrates proficiency in determining if case requires creation of multiple complaint records and reviews correspond to determine classification and sub-type. Prioritizes workflow on a consistent basis, applies key HIPPA and CMS guidelines in daily workflow, and meets Turnaround Times for assigned cases. Research and investigate complex issues through the use of multiple internal computer databases, external computer systems and supporting technology, such as scanning/imaging. Partners with all service delivery functions ( i.e. clinical, claims, billing and enrollment) to answer member questions/or works with others to resolve escalated issues Develops and delivers timely and professional communication dealing with complex issues at each step of the process to advise members of the progress and status of their issue. (Quality standards means that all correspondence must be error free - no spelling, punctuation, grammatical or other errors.) Maintains system documentation on the tracking and monitoring of all cases as well as the final disposition to ensure overall compliance with Medicare regulations Meets established productivity and quality standards in addition to attendance requirements

Part Time Onsite RN Case Manager - Staten Island NY

Sat, 05/16/2015 - 11:00pm
Details: For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) Field-based (On-site) Case Managers will lead the new frontier in care coordination in the emerging provider market through full partnerships with health systems, hospitals, physicians, communities, patients and their families. In this role, the Case Manager will interact and collaborate daily with hospital licensed caregivers, health system physicians, internal and external vendors, patients and families. The Field-based Case Manager will be integral to the identification of population health management opportunities as well as the strategic development and design of these services. Value is demonstrated through a reduction in the hospital readmission rates of select patients and improved adherence to evidence based medicine guidelines and industry quality standards. The Case Manager implements wide reaching change by contributing to the transformation of a health care system that meets the demand for safe, quality, patient centered and affordable care. Part Time- 20 hours Richmond University Medical Center Primary Responsibilities: Manage targeted population daily census Identify those patients appropriate for face to face contact Meet with patients and caregivers/families while inpatient to establish relationship and engage in transitional case management process Assess adequacy of discharge plan and risk associated with compliance Complete assessments, address any identified barriers to compliance across the continuum Develop care plan and interventions with patient and family input Proactive post discharge follow-up; telephonically or in home as appropriate Coordination of post discharge care with primary care physician Interact in a collegial and collaborative fashion with hospital clinical staff to include: RNs, Social Workers, UR/UM, physicians, and nonclinical support staff Communicate regularly with patients and families, with hospital team, and document regularly in required systems for outcome reporting Promote cost effective health care with aligned health system networks

Licensed Mental Health Care Manager - Eden Prairie MN

Sat, 05/16/2015 - 11:00pm
Details: For those who want to invent the future of health care, here's your opportunity. We're going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) Work in an office environment in Eden Prairie, MN. Consistent schedule of Monday through Friday, 8:00am to 5:00pm- no nights or weekends. There are so many reasons to choose a career with UnitedHealth Group, but the most important things you need to know are, that in this job, you will: Provide telephonic case management in a fast-paced, technology enabled, call center environment. Apply dynamic clinical expertise to support a wide range of medical conditions. Use critical thinking skills to prioritize high impact behavior changes that maximize consumer's ability to address gaps in treatment and successfully leverage the health care system. Care to act and be a transformational force in health care Management and authorization of behavioral health services, including crisis assessment and intervention Integrates a collaborative process which assesses, plans, implements, coordinates, monitors, and evaluates the options and services to meet the enrollee's health needs, using education, communication, and all available resources to promote quality, cost-effective outcomes Completes a Health Risk Assessment on each member as well as an individualized Care Plan to address the member's needs Community visits with members to determine/coordinate treatment or resources to address the member's complex needs Discharge planning or management of transitions between care settings to ensure the appropriate services/resources are in place for quality outcomes Management of medical and behavioral care coordination for all complexity levels Coordinates and authorizes medically appropriate services for members to facilitate cost-effective member outcomes in a timely manner Make outreach calls to members and/or providers for coordination of behavioral and medical services Assist consumers by screening, answering questions, providing program information and education about care coordination program services, network and community resources, and coverage determinations in an accurate and courteous manner Attend/participate in all required Medica facilitated meetings and/or trainings and if a Care Coordinator does not attend, they are responsible to review all materials presented This professional will be on the fast track to becoming a relevant contributor in a consumer centric driven health care environment and experience career growth and opportunities. Some of the advantages include the following: Professional development: Motivational Interviewing coaching skills, advanced certification, ongoing CEUs Act with autonomy as an independent practitioner

LVN Telephonic Service Coordinator - Telecommute in Harris County, TX

Sat, 05/16/2015 - 11:00pm
Details: Position Description: There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.SM The primary purpose of the LVN Telephonic Service Coordinator is to deliver Telephonic Support Service Coordination, Community Resource integration, and Psychosocial support. This results in consistent, collaborative, and coordinated care based on Member needs and Risk profile. Identifying Member needs begins with early identification of Health Risk factors, as identified by the member. Employees in this position require various Nurse licensure and certification, based on role and grade level. Licensure includes RN and LPN/LVN, depending on grade level, with current, unrestricted licensure in The State of Texas. These roles identify, coordinate, or provide appropriate levels of care under the direct supervision of an RN or MD. This function is responsible for Clinical Operations and Medical Management activities across the continuum of Care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes Case Management, Coordination of Care, and Medical Management Consulting. This role may also be responsible for providing Health education, Coaching and Treatment Decision support for Members. Includes Health Coach, Health Educator, and Health Advocate roles that require an RN. Primary Responsibilities: Basic, structured, and standard approach to work. Requires current and unrestricted LVN Licensure in The State of Texas. Engage Member and Stratify: Respond with appropriate coordination of Care and Services protocol by level of Care assignment. Complete telephonic Risk Stratification Assessment, if necessary. Contact member to explain Care Management process and complete Welcome Call Assessments on New members. Share input into the Plan of Care with appropriate members of the Care team so that Care Team members are working toward uniform Member goals. Utilize Motivational Interviewing techniques to obtain Member information, including: family, caregivers, Providers' reporting, etc. Deliver and Coordinate Services: Identify Formal and Informal resources to meet the Member needs as stated in the Plan of Care. Enter Service notifications/authorizations according to guidelines. Communicate with the Member, Primary Care Physician, and Community partners concerning Service and Behavioral Health needs, as well as alternatives to providing services to meet those needs. Serve as Member advocate and facilitator to resolve issues that may be barriers to Care. Through developing a relationship with the member/family, the Care Manager educates the member/family about their Behavioral Health conditions, Socialization options, Treatment options, Community resources, and Insurance benefits so that informed decisions can be made and Member self-management is promoted. Complete delegated activities from the Health Services Manager, as appropriate, surrounding the provision of information related to Health conditions and Treatment options as a part of the Plan of Care. Ensure appropriate utilization and consistent application of Benefits, and apply Benefits Coordination knowledge. Maintain time-sensitive documentation, including Case Management/Service Coordination interventions and outcomes to assure compliance with regulatory agencies and program goals. Perform other duties, as assigned. The Training Location is at Sugar Creek on the Lake, 14141 Southwest Freeway, Sugar Land, TX 77478.

Senior Clinical Administrative Coordinator - Ridgeland, MS

Sat, 05/16/2015 - 11:00pm
Details: Position Description: Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Due to our expanding business, UnitedHealth Group is seeking Clinical Administrative Coordinators who share our passion for helping others live healthier lives. As one of the world's leading health care companies, UnitedHealth Group is pursuing innovative new ways to operate our service centers and improve on our ability to deliver high-quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Take this opportunity and begin doing your life's best work. (sm) What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. Primary Responsibilities: Connect with members regarding wellness programs Must make 30 calls a day to assist members with scheduling appointments with their providers Utilize the UTD database to identify candidates who need to meet with their providers Follow up with members post wellness visits to make sure that their incentive reward is applicable Other duties as assigned

Customer Service Representative - Wausau, WI

Sat, 05/16/2015 - 11:00pm
Details: Don't wait to apply - we have training classes starting soon that are designed to set you up for success! If you share our all-in approach to excellence, you're going to be amazed at the things we're doing here at OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. As a member of one of our customer service pharmacy teams, you'll be empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.SM The Customer Service Representative is responsible for answering incoming calls from customers while ensuring a high level of customer service and maximizing productivity. The responsibilities of this position are providing customer service support to members, customers, and/or providers. Direct phone-based customer interaction to answer and resolve a wide variety of inquiries. Individuals chosen for this position will answer questions related to pharmacy benefits, mail order and pharmacy assistance calls. Primary Responsibilities: Answers incoming calls; assists customers/pharmacies/physicians with orders and reorders, benefit eligibility questions and prescription status inquiries. Escalates drug related calls to appropriate pharmacist. Assist pharmacies and members on all issues related to processing of pharmacy claims. Determines appropriateness of overriding pharmacy claims edits and error messages. Coordinates internal resolution of claims exceptions and other issues. Makes outbound calls on prescriptions with hold orders and payment issues. May also assist with entering new prescription orders into system. Educates customers on benefits, use of plan, formulary, premiums and status of orders, claims or inquiries. Other duties as assigned. To learn even more about this position, hear from our other Pharmacy Customer Service Representatives. Click here to watch a short video: http://uhg.hr/pharmCSRvideo

Product Operations Support Analyst - Eden Prairie, MN

Sat, 05/16/2015 - 11:00pm
Details: Position Description: The Product Operations Support Analyst will support the hi HealthInnovations Product Operations Support Team by focusing on business systems, processes and data to drive quality, efficiency and productivity. In this role you will develop relationships to work effectively with Sales, IT, Sales Force Support, Finance, Inventory, and Field Appointment/ Field Staff Support Teams in the development of product operations process and procedure enhancements. This role will also create and maintain process and training documentation; ensure Product Operations & regulatory compliance, and provide Service Center reporting and analytics. Primary Responsibilities: Work effectively with internal support teams (IT, Salesforce , Finance, Inventory Control, & Field Support) to assist in developing processes that promote analytical data capture and process improvement. Assist as a key business process subject matter expert (SME) and Product Support liaison in Salesforce and EDGE system and process development. Coordinate end user input and review; organize end user testing of new system and process enhancements. Review the IDEA list and gather additional information for management to determine if the IDEA should be promoted to an enhancement request. Assist the Product Operations Support (PROS) Team in defining requirements for enhancements. Coordinate enhancements with IT and the Sales Force Support Teams to implement and deploy new enhancements. Participate as a SME with continued development & modification of Sales Force utilization including workflow creation, reporting and data management. Coordinate the systematic roll out process for new enhancement processes and procedures with IT, Salesforce Support and the PROS Team. Assist in developing training materials for new process implementations pertaining to the PROS team. Review and update existing training materials for the PROS team as changes occur. Assist PROS Supervisors in presenting and training new processes and procedures at weekly team meetings or in scheduled training sessions. Remain knowledgeable of key processes, business initiatives and internal resources in order to represent the PROS team as a SME. Organize PROS training and procedure releases in shared resources for ease of use. Track versions to comply with FDA QMS requirements. Assist management in ensuring Product Operations Support compliance with FDA Quality Management System (QMS) requirements is met. Track, trend, and report gaps and opportunities for improvement. Run reports and perform periodic audits to ensure FDA requirements for the following areas are met: Product Handling Environmental Control Product Inspection Customer Complaint handling Assist as needed in gathering reports or information for an FDA inquiry. Research health plan Appeals and Grievances (A&G) as requested by the Sales Operations Analyst. Analyze if correct process was followed; coordinate with management and cross functionally to resolve; respond back to the Sales Operations Analyst with the findings of your research. Act as liaison with the hi HealthInnovations Business Segment Liaison (BSL) in coordinating the on-boarding process, equipment set up, and work locations of new PROS staff and the deactivation of PROS staff who leave the team per UHG policies and practices. Maintain reporting tools and manage reports for the Service Center, PROS metrics and Claims to monitor & ensure each department's data is being captured as set forth by management. Provide monthly reports to the manufacturer for business to business reconciliation. Collaborate with the Salesforce Support Team to create, edit or modify reports to ensure capture of needed data for analytics for the PROS team.

LVN for WellMed Kenworthy - El Paso, TX

Sat, 05/16/2015 - 11:00pm
Details: WellMed provides concierge-level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient's health. WellMed's proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella. Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm) In this position, you will provide clinical support functions and professional nursing care to patients using established standards of clinical nursing care and practices approved by WellMed Medical Group. Primary Responsibilities: Assess patient needs using established triage protocol Recommend follow-up as indicated by protocol Schedule same day appointments, as indicated Document all encounters in electronic medical records system Evaluate follow-up on patient condition and/or reaction to drugs and treatments Educate patients, family members and care givers on treatment and care plans Maintain quality control standards (HIPAA/OSHA) Perform all other related duties as assigned

Intermediate Graphic Designer - US Telecommute

Sat, 05/16/2015 - 11:00pm
Details: Position Description: This isn't packaged goods. It's a bigger challenge than that. Here you're making a difference in people's lives, starting with your own. Join us and start doing your life's best work .(sm) Please note: For this position/requisition, "communications" or "content" means "end-user work instructions and performance tools." These materials support Business Operations customers. • Work instructions include Web-based content such as PIs, PRs, SOPs, etc. • Performance tools include automated and manual solutions that are designed and built into an SOP/PI. May also include stand-alone solutions, such as a calculator. This role's primary function is to develop Web-based solutions by creating new and modifying existing end-user content (work instructions). This person defines end-user needs, designs solutions, and collaborates with team members to develop text, images, and programming. The solutions may include programmed features and functionality similar to Web sites and other online content and tools. This work requires an intermediate to advanced knowledge and experience with computer applications used to develop Web content. The outcome produced needs be measurably accurate and efficient—delivering results that align with business goals and requirements. Primary Responsibilities: Lead concept development, design, and implementation of Web-based "document" templates and performance tools. These templates and tools deliver content to end-user customers. BCS team writers and coders use the templates and tools to create and maintain end-user content. Manage/implement design projects to ensure proper implementation (e.g., timelines/milestones, deliverables, addressing issues as they arise) Demonstrate knowledge and proficiency using Web-based technologies, as appropriate (e.g., HTML, HTML5, Flash, CSS) Demonstrate expert knowledge of Web-based design, structure, and functions (e.g., content management systems, site management tools, content and programming maintenance) Demonstrate proficiency in the use of industry-standard desktop tools, such as, Adobe Creative Suite (Photoshop, InDesign, Illustrator, Acrobat, Dreamweaver, After Effects); and MS Office Suite (e.g., Word, Excel, PowerPoint, SharePoint, SharePoint Designer, Visio) Adhere to applicable internal and external standards established for the business (e.g., brand standards/guidelines, internal style guides, legal review, technology specifications, communication) Collaborate and communicate with internal stakeholders, applying knowledge of communications processes and terminology. Internal stakeholders include: writers, designers, programmers, end-user/customers, and leadership/decision-makers) Understand and respond to stakeholders' diverse communication needs (e.g., who they are, where they are, how they understand and use information, which media is suitable). Translate complex concepts into simplified language or graphics that audience will understand. Present proposed concepts and approaches for review/approval by applicable internal stakeholders Secondary Responsibilities Maintain standard templates and tools used by team. Enhance or update with new technology and design when appropriate, and customize for specific business use as needed (e.g., based on business changes, revised work requirements, review cycles, etc.). Identify and engage or recommend resources (e.g., internal team members, talent, technology, vendors). Make recommendations to leadership on software upgrades, industry changes, new applications, and, training opportunities. Collaborate in publishing or distributing communications to ensure/oversee proper implementation. Maintain knowledge of current and emerging trends in Web design, applications, content management, and media that could add value to end-user materials. (e.g., new media, tools, work/social networks, technology, data analytics).

Certification Management Coordinator - Phoenix, AZ

Sat, 05/16/2015 - 11:00pm
Details: Position Description: Healthcare isn't just changing.It's growing more complex every day. ICD-10 Coding replaces ICD-9. AffordableCare adds new challenges and financial constraints. Where does it all lead?Hospitals and Healthcare organizations continue to adapt, and we are vital partof their evolution. And that's what fueled these exciting newopportunities. Who are we? Optum360. We're a dynamicnew partnership formed by Dignity Health and Optum to combine our uniqueexpertise. As part of the growing family of UnitedHealthGroup, we'll leverage our compassion, our talent, our resources andexperience to bring financial clarity and a full suite of Revenue Managementservices to Healthcare Providers, nationwide. Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work. Positions in this function are responsible for reviewing, researching, investigating, and triaging all types of appeals and grievances. Communicates with appropriate parties regarding appeals and grievance issues The Certification Management Coordinator will provide a full range of Utilization Management (UM) services for assigned hospitals. This position will support the objectives of the Audit Management Unit and the facilities and/or health systems served. This position will play a key role in the certification of inpatient services for all areas served. Primary Responsibilities: Demonstrating excellent customer service skills by facilitating communication between the hospital facilities and the payers. Demonstrating effective assessment skills relative to providing adequate documentation and/or response as requested and/or required by the payers. Accommodating payer requests for clinical reviews. Cooperating with payer requests for medical records. Facilitating verbal discussion between the respective facility and the payer, as required. Becoming knowledgeable of payer assigned time frames. Understanding specific payer UM details. Collaborating and alerting facility Case Managers of: Additional payer needs Requests for concurrent or retrospective review Physician Advisor review Providing support in the certification process to ensure timely authorization of inpatient days followed by timely and accurate documentation. Providing communication and/or documentation, as required, in order to ensure concurrent certification and payer updates via MIDAS. Seeking documentation and clarification, as necessary, for the certification and/or denial of inpatient services. Facilitating the scanning, copying, and mailing of documents for deferred cases or for cases involved in a concurrent clinical appeal. Performing tasks within MIDAS to ensure documentation of TAR and commercial clinical denials. Tracking Medicaid/Medi-Cal cases to ensure timely receipt of any concurrent appeal decision by the payer. Monitoring payer and State portals and websites for documents related to commercial certification, TARs, and SARs. Performing other duties as assigned.

Clinical Coding Nurse Consultant - $3000 Sign on Bonus-San Antonio, TX

Sat, 05/16/2015 - 11:00pm
Details: ***$3000 Sign on Bonus*** Clinical Coding Nurse Consultant There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm) Clinical Coding Nurse Consultant assists in the development of operational framework focused on scalable and repeatable best practices as it relates to Risk Adjustment both within the DataRAP Department and at the market level. This position supports and aligns planning to ensure the key strategic rationale for DataRAP is delivered and the associated revenues and cost savings targets are realized. Responsible for working closely with leaders in all markets to ensure Enterprise initiatives related to DataRAP (Risk Adjustment) are implemented and goals are met. The Clinical Coding Nurse Consultant is imbedded in all markets to provide support and education to all market leaders, Providers and clinic staff. This position identifies, develops and implements simplification and automation to improve the Primary Care Provider (PCP), the market, and ultimately, the member experience. M-F Requires up to 25% travel around the Texas and Florida area. Sign on bonus-$3000 Essential Job Functions Educate practitioners/clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process Ensure all Market Leaders are utilizing established tools and are able to downstream this education in their prospective markets Work collaboratively with market physician leadership in the development and management, project governance and detailed project plans as it relates to assigned market Partner with corporate leadership to identify the most beneficial options and assist in driving the completion of the selected option Partner with business owners to identify methods to execute upon the key strategic visions and lead the initiative to completion Work with corporate operations to develop program success metrics and ongoing performance metrics Provide strong leadership and judgment; effectively build and deepen relationships across assigned market Create a team-oriented work climate that enables professional development and encourages creative solutions and strategies, establishes collaboration and emphasizes quality and cost Provide leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff Provides educational tools which may include presentations as assigned by management Review and update educational materials as approved by Leadership Perform Clinical Chart Audits as business needs dictate Perform Quality Audits to ensure error rate remains within industry standard Maintain compliance with Optum coding standards and CMS Risk Adjustment guidelines Performs all other related duties as assigned

Provider Data Quality Reporting Analyst - Telecommute

Sat, 05/16/2015 - 11:00pm
Details: You believe data can help reshape the future, and you find yourself loving the thrill of diving into challenging analysis. At UnitedHealth Group, you'll find an organization that will recognize those talents and have lots of growth potential. Here, you will be empowered, supported and encouraged to use your analysis expertise to help change the future of health care. Does the challenge intrigue you? As a key member of the Analyst team, you will be part of UnitedHealth Group's mission of helping people live healthier lives. As a Senior Business Analyst, you will grow and develop as you conduct and manage outcomes of various studies. You will be challenged to analyze, review, and forecast data for operational and business planning. As part of this elite team, you will be empowered to impact the health care system through the analysis and interpretation of data, and presenting recommendations for business solutions. Join us! There's never been a better time to do your life's best work.(sm) Position will consult with blackbelt resources to identify, obtain, review and analyze data in support of process improvement projects. This position requires extensive knowledge to analyze, review and present data to blackbelts in support of current projects. This work also includes assisting in the development and implementation of effective project solution benefit tracking strategies. Work Scope typically includes: Work directly with blackbelt resources to understand data analytical needs Assist with the design of data requests to the field level Pull sample/test reports from Galaxy to verify data request accuracy Coordinate submission of full report request to be delivered by others Ability to coordinate and consolidate data from multiple sources including ORS call center data to deliver on complex report requests Ensuring that reporting is accurate and that customer timelines and deliverable due dates are met Ability to communicate and consult with customers and business partners as needed throughout the data request timeline to ensure needs are met Ability to work with little direction Primary Responsibilities: Understands larger business requirements and drives results to meet identified goals Review and research physician and hospital claims on multiple platforms Works through complex requests or issues to completion Assesses and interprets customer needs and requirements Identifies and delivers solutions to non-standard requests and problems Translates concepts into practice & provides explanations & information on difficult issues Uses existing procedures and facts to solve problems or conduct analysis Solves moderately complex problems and/or conducts moderately complex analyses Uses pertinent data and facts to identify and solve a range of problems within area of expertise Investigates non-standard requests and problems, with some assistance from others Works with minimal guidance; seeks guidance on only the most complex tasks

Director, Creative Services (Minnetonka, MN)

Sat, 05/16/2015 - 11:00pm
Details: This isn't packaged goods. It's a bigger challenge than that. Here you're making a difference in people's lives, starting with your own. Join us and start doing your life's best work.(sm) The Sr. Director of Creative Services is responsible for developing and implementing the creative strategy and deliverables for all prospect, member-facing and internal initiatives. This individual will help provide leadership to further the development of UnitedHealthcare Medicare & Retirement brand and marketing efforts. This individual will work closely with the various marketing teams, as well as our agency resources to create, brand-consistent marketing assets for use in communications and campaigns. In addition, this individual will lead a team of creative services experts and to ensure requests are appropriately prioritized and fulfilled. Candidates should bring a passion for how health care is changing and have significant marketing experience in creative services & brand strategy. Responsibilities: Provide creative management, strategic direction and process optimization for a multichannel organization Provide leadership, motivation and inspiration to talented Creative teams comprised of creative directors, manager, writers and designers. * Partner with Consumer Insights & Analytics Teams to derive actionable insights Partner with Sales & Customer Service to ensure coordinated efforts to maximize results * Manage marketing agency relationships to produce all requested collateral, campaign material, brand identity * In conjunction with marketing departments, produce effective and best-in-class customer-facing creative messaging and communications that reflect the unique personality and value proposition of UnitedHealthcare to all customer types Ensure consistent use of our brand through all marketing efforts * Ensure projects are within budget, scope and timelines Develop excellent working relationships with counterparts from across the enterprise. Communicate clearly and regularly to stakeholders to drive alignment and execution success.

ASSISTANT STORE MANAGER – retail / customer service / sales

Sat, 05/16/2015 - 11:00pm
Details: POSITION The Assistant Store Manager will be part of an enthusiastic and motivated team of financial service professionals. You will be helping our customers get the cash they need, when they need it, and you will be working in a friendly environment with great opportunities and benefits, where talented employees can get ahead. KEY RESPONSIBILITIES Provide exceptional customer service with every existing and potential customer Educate customers on all product offerings Process loan applications and make loans Safeguard and maintain customer records Make collection calls on overdue loans Open and close the store

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