Antigo Jobs - Career Builder

Details: Great sales are the result of strong purpose, conviction and pride - pride in your ability and your product. UnitedHealth Group offers a portfolio of products that are greatly improving the life of others. Bring along your passion and do your life's best work.(sm) The Sales Manager is responsible for managing a team of Sales Account Manager's functioning as consultative sales representatives of the Optum Care Clinical model specifically designed for long term care residents of Skilled Nursing Facilities and Assisted Living Facilities. The sales team is responsible for direct enrollment on Medicare Advantage plans contracted with Optum Care as well as Network transfers for members currently on plans supported by the Optum clinical model of care. The sales team interacts directly with nursing home residents, assisted living residents, their families and/or legal representatives. Primary Responsibilities: Manage staff performance by providing feedback and coaching on key performance indicators and productivity Organize and lead the efforts of staff to achieve effective and efficient coordination across the territory Effectively recruit and hire qualified staff and provide for their training and development Communicate performance expectations and goals, evaluate performance results, provide feedback to staff and administer appropriate rewards Foster a cohesive and supportive team environment Facilitate cooperative behavior across the team, other departments (including all sales channels), departments, strategic partners, etc. in achieving goals Achieve/Exceed Assigned Business Targets and Goals Travel throughout the territory (Territory includes AZ counties of Maricopa, Pima. Expansion to Yavapai County is planned for 2016 Maintain and build referral relationships with Nursing Facility and Assisted Living Facility staff and physicians Executes a sales plan that includes strategies and revising strategies as dictated by market changes, sales results and other factors Understanding of CMS regulations and state and federal Medicare requirements including MIPPA and HIPPA Guidelines Conducts regular ride-along with staff member to ensure both compliance with CMS standards and that sales goals are met Continues to enhance and maintain a solid knowledge of Medicare regulations, the managed care industry, the competitive environment, pertinent legislation, etc Establishes and maintains effective client/business relationships

Details: If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm) The Director, Strategy is a seasoned business strategist and advisor with responsibility for partnering with Optum corporate leadership and business unit executives to provide thought leadership, strategic direction, and market analysis to guide strategic direction and operational excellence. This person must convince Optum leaders and operators of his/her value, earn their trust and time, and work collaboratively to build actionable strategies. The Director, Strategy will work with Market group leadership (Provider, Payer, Government, Life Sciences, Employer, Consumer) to frame the market, identify market opportunities, build analytics-based strategic plans, and drive actionable decisions. In order to do this, the Director, Strategy will have a strong understanding of market and competitive dynamics, customer needs, regulatory impacts, market trajectory, and Optum capabilities. In addition, the Director, Strategy will "tell the story" throughout the organization to gain support and fuel execution planning. The Director, Strategy will also make connections across the Optum and UHG as necessary, and support corporate development activity. Primary Responsibilities: Build deep advisory relationships with Optum's senior most leaders Lead and support cross-Optum initiatives spanning growth strategy and operational excellence by directly scoping, executing, controlling and closing strategy projects Lead large, complex projects to achieve key business objectives by working across Optum units and UnitedHealth Group as needed Deliver data-driven insights to support actionable strategic direction, corporate prioritization, and strategy communication (Executive management, Board, investors, company) Analyze industry trends, customer needs, competitive threats, expansion opportunities and internal performance Lead in a team environment within the strategy team and with business partners/customers Influence Senior Leadership at Optum and UHG to adopt new ideas, products and/or approaches and gain commitment on cross-company initiatives Nurture and develop strong relationships with Optum corporate and business unit leaders Support the corporate planning process and ad hoc projects for executives, corporate requests, and special events Promote professional development of strategy team members; enhance their skills and capabilities through project work and one-to-one coaching Lead strategy team development initiatives including recruiting, organizational capability building, etc.

Details: This isn't HR. This is Human Capital at UnitedHealth Group. Here, you're expected and empowered to be your best, to grow and to develop your skills. Join us and help people live healthier lives while doing your life's best work.(sm) Real relationships, remarkable care, right here. This is healthcare reimagined. We are the first to unite relationship-driven primary care with user-friendly health insurance in one simple plan. We are built around the needs of members, creating a dedicated home base for health that reconnects the face-to-face care experience. Our doctors, health coaches and support teams operate within community-based clinics to put remarkable care within more people's reach. We are a community of people devoted to our members' health and an experience that makes you feel better just by walking through the door. We get health care right. Positions in this function are involved in designing and delivering engaging claims and service training programs. This position offers the opportunity to join an emerging department that is working to dramatically improve the healthcare experience. Primary Responsibilities: Collaborate with appropriate resources (e.g., instructional designers, business partners, SMEs, business leadership) to identify applicable business needs to be addressed in training Develop training programs and deliver learning experiences that are high quality and engaging. Be creative! Demonstrate understanding and effectively communicate how upstream/downstream impacts of operational processes (e.g., first-call resolution, claims accuracy, timelines), impact customers/consumers/providers. Identify and leverage appropriate internal resources in order to address issues that may impact the learning process (e.g., systems access, facilities access). Identify, understand and prepare the appropriate training technology to ensure effective learning (e.g., WebEx, Knowledge Management Systems, ULearn, Knowlagent) Identify and adopt the facilitation approach that best meets the learning styles and needs of the audience, and achieves established learning objectives (e.g., audience analysis, audience engagement) Maintain and apply knowledge of facilitation best practices, and demonstrate appropriate teaching method, style and pace to optimize learning, adopting different delivery approaches/mechanisms as needed (e.g., technology usage, questioning techniques, story generation)

Details: You're looking for something bigger for your career. How about inventing the future of health care? Optum is offering an innovative new standard for care management. We're going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Our growth is fueling the need for highly qualified professionals to join our elite team. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Join us. Take this opportunity to start doing your life's best work.(sm) The UBH Medical Behavioral Health Integration Specialist (MBIS) is a direct clinical liaison between UBH, health plan customers, and the clinical network. This position 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. Primary Functions Identifies high-risk enrollees, monitors utilization, creates care plans to address problems while maintaining quality of care. (Information is collected from the patient, caregiver(s), health care providers and other relevant parties.) Utilizes advanced clinical skills to make effective decisions to meet the enrollee's health needs, using education, communication, and all available resources to promote quality, cost-effective outcomes. Screens, identifies and obtains approval on high-risk/cost, catastrophic, long term chronic cases which will benefit from care management services. Referrals for such cases may originate from various departments within the company. 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. For the Frail and Elderly, Functional Assessment and Treatment Plan Summary forms as completed by contracted network clinicians are used by UBH Care Advocates, in addition to the medical chart, to make utilization decisions regarding appropriate services. Collaborates with the UBH and health plan staff to ensure proper resource allocation and utilization to facilitate quality cost-effective patient outcomes. Collaborates with providers to determine acuity of mental health concerns and refer enrollees to appropriate community resources. Authorizes medically appropriate services for enrollees to facilitate quality cost-effective patient outcomes in a timely manner

Details: If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm) The Director of Health Information Management (HIM) Department is responsible for the managing the organizations, administrative, and financial performance of the HIM Department. Plans and organizes department goals and objectives, directly participates in budgetary planning, anticipates department and staff needs. Establishes and implements policies and procedures related to medical records in accordance with accreditation and regulatory requirements. Serves as the primary liaison between physicians, administrators, finance, and external agencies for medical record services. This position requires the full understanding and active participation in fulfilling the Mission of St. Bernardine Medical Center. It is expected that the employee will demonstrate behavior consistent with the Core Values. The employee shall support St. Bernardine Medical Center's strategic plan and the goals and direction of the quality improvement/process improvement activities. Primary Responsibilities: Manages operational and capital budgets within facility-specific guidelines. Prepares written justification for staffing, and software and hardware upgrades for the operations of the department, (i.e. Systems Upgrades for EMR) Plans and organizes services by establishing long and short term goals and objectives. Ability to make presentations to a variety of audiences utilizing PowerPoint software Interprets and implements requirements related to the management of health information by external accreditation and regulatory agencies, i.e. Department of Health, Joint Commission on the Accreditation of Hospitals and Medical Staff Rules and Regulations Implementing monitoring tools and achieving compliance at all times Develops and administers policies, procedures, and programs relative to human resource management (hiring, evaluating, discipline, orientation, training, etc.) in the Health Information Management Department. Consistency set policies and procedures, goals and objectives, including productivity monitoring and reports. Ability to resolve inter and intra department issues effectively Acts as a liaison between physicians, administrators, finance, and external agencies for the Health Information Management Department Provides leadership with resolving HIM issues. Plan future growth of the department as it relates to the implementation of new systems, i.e. EMR Provides resources in accordance with related business needs to ensure achievement of organizational goals and efficient service to all customers including medical staff, administration, and others as necessary Meets key performance indicators as identified by CHW expectations in the areas of: Discharge Processing; Assembly/Analysis; Transcription; Delinquent Medical Records; DNFB; Adjusted D/C days Plan, organizes, and evaluates medical record systems through coordination with other departments and services in order to provide optimum efficiency and accuracy Oversee performance of contracted services (coding, transcription, copy services, etc.) Develop and maintain statistical and other Informative reports for authorized requestors Acts as the organization HIPAA Privacy Officer, responsible for ensuring organizational compliance with HIPAA guidelines Attend Hospital Compliance Meetings. Participate and provide leadership in hospital wide Committees: Health Information Management/Forms Committee; Information Steering Committee; Performance Improvement Committee; JCAHO Team; Finance Operations Meeting; Corporate and Local CHW Compliance Committee

Details: If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Financial discipline and accountability count more today than ever. Which is why your performance and innovation will find a reception here like nowhere else as you help people live healthier lives while doing your life's best work.(sm) Primary Responsibilities: Selling, General and Administrative Expenses (SG and A), management of reporting and analysis Participate and oversee month-end close Assist and drive SG and A efficiency initiatives Develop and enhance SG and A management reporting Identify and participate in cost cutting initiatives Assist in developing business level cost metrics to enable business leaders to make informed decisions around pricing and FTE management Participate and oversee month end capital closing process Assist in Capital project cost development and ongoing cost tracking Assist in identifying, measuring and tracking capital investment benefits Perform post implementation capital projects audits Maintain portfolio of Capital Projects Add and develop business cases for new capital projects and investments

Details: Position Description: If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work .(sm) Exceed goals and expectations; consistently recognized as top performer Methodical about information/data to present logical, systemic approaches to problem-solving Positions in this function include more traditional administrative/clerical support roles including: answering the telephone, typing/word processing of documents, maintaining calendars and setting up meetings, making travel arrangements, copying, faxing, greeting visitors, setting up files, tracking expenses, and coordinating building and equipment maintenance. At senior levels, function may include supervision of other clerical/administrative staff. Extensive work experience within own function. Work is frequently completed without established procedures. Works independently. May act as a resource for others. May coordinate others activities.

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) Primary Responsibilities: The Consultant Analyst is responsible for supporting assigned Practice clinical teams in implementing the United Accountable Care Communities program in the following key areas - Improve access to care; use practice level population data to analyze overall capacity/demand for appointments and visit patterns by clinic/overall and assist the Practice leadership to implement process improvements to reach mutual goals and improve patient access Reduce inappropriate ER use; use hospital ADT and daily ER data to analyze trends and work with all Community stakeholders to agree on and implement proactive strategies to address issues, and measure impact using a PDSA rapid cycle improvement approach Reduce avoidable admissions and readmissions; support practices in the effective use of the Accountable Care Population Registry to track and manage care transitions of all discharges and ensure follow up with PCP within 7 days, helping practice teams engage and coordinate with United clinical and hospital teams Measure and monitor success of outreach and develop strategies to simplify processes and ensure optimal care for patients Improve care of high risk patients; complete predictive modeling analyses of practice population risk and assist practices in identifying cohorts of high risk/health home patients for focused improvement initiatives Collaboratively establish with practice clinical leadership measurable goals for each cohort to increase access, address current care opportunities and reduce adverse events Analyze and report measurable progress against goals at monthly JOC meetings with practices and hospitals Collaborate with United teams including the practice Care Coordinator/s, quality management teams, hospital clinical teams, behavioral health teams to support integrated PCP driven care for our members in the Community Support practice in implementing process improvements to assist the practice in becoming an certified Medical Home, if desired by practice leaders Assist practices in creating work flows to optimize care delivery, introduce best practices improvements, and evaluate outcomes using rapid cycle improvements PDSA methods Meet with practice staff at least weekly, to facilitate progress and address barriers Prepare and present progress against goals monthly

Details: UnitedHealth Group is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) As a Lead Quality Assurance Analyst â€“ Data Warehouse / Informatica , you will work as a part of a dynamic team involved in testing for new systems and enhancements of existing Data Warehouse and ETL applications. This role will involve the use of both manual and automated testing tools, test script and test plan creation and maintenance, and defect tracking and reporting. The Lead Quality Assurance Analyst - Data Warehouse / Informatica will be responsible for both leading a team and in some cases performing hands on testing of Data Warehouse and ETL (Informatica) applications. Database technologies utilized may include a variety of Oracle, SQL Server or other enterprise relational databases. Testing of these applications will also involve performing Extract/Transform/Load of data to the Data Warehouse. Data files will be validated with UNIX and SAS. Primary Responsibilities: Work concurrently on several projects, each with specific instructions that may differ from project to project Ensure that quality processes are carried out through all phases of the Software Development Lifecycle Work with business partners, systems analyst, designers and programmers to create/analyze required project documents and ensures that quality assurance processes are incorporated Analyze and dissect system requirements and technical specifications to create and execute test cases for large business initiatives Product test and driving defect resolution Assist business users in defining User Acceptance Testing, test cases and plans Establish and maintain test cases and test data Create and maintain test cases in Quality Center/ALM and/or Test Director Actively participate in walkthrough, inspection, review and user group meetings for quality assurance Work with business users, system analysts, designers and programmers to create and analyze various required project documents Plan, document, evaluate and track testing results to ensure system applications are free from defects Communicate and interact with appropriate areas on problems, changes and enhancements that may impact data, workflow and /or functionality within Information Technology software Comply with standards of the software development life cycle and follow strategies, plans and procedures within information Technology software Comply with standards and strategies of the software development life cycle Apply solid understanding of the Software Development Life Cycle, Data Warehouse ETL and QA process Participate in Requirements and Design reviews, plan and estimate the QA effort Plan test strategies in accordance with project scope and develop schedules to meet delivery dates Design test plans, scenarios, scripts, or procedures Develop testing programs that address areas such as database impacts, software scenarios, regression testing, negative testing, error or defect retests, or usability Develop process for Data Analysis and testing Data flow Test system modifications to prepare for implementation Document defects, using a HP Quality Center, and report defects to Project teams Identify, analyze, and document problems with functionality, output files, tables or documentation Monitor defect resolution efforts and track successes Create metrics and status reports for projects Support QA management with information for issues escalation or concerns Identify and resolve issues and risks associated with the QA tasks and deliverable Responsible for providing work direction to offshore teams as needed

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) The Certified Medical Assistant performs a variety of patient care activities to assist physicians and nursing personnel, including administering injections, EKG's, phlebotomy, Quality screenings and various other procedures. Delivers quality customer service and maintains established quality control standards. This position will work directly with our Quality and Risk Adjustment market based teams and providers with both our employed and contracted providers in the respective market position is assigned.

Details: Are you ready to analyze data and deliver bold, business-savvy solutions to help millions live healthier lives? UnitedHealth Group is where some of the most innovative ideas in health care are created every day. When you join us, you will be joining the actuarial consulting leader in health care innovation. As the Associate Director of Actuarial Consulting, you will be responsible for providing Actuarial direction and strategy to balance growth and profitability goals for our internal and external clients. You will lead actuarial services in support of medical analysis, trend projections and rate negotiations for our broad range of clients. 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) Primary Responsibilities: Analyze financial and claims data to evaluate utilization and unit price trends Develop the organization's premium rate structure through the forecasting of financial/statistical data in a manner which is actuarially sound and competitive in the marketplace Design ad hoc health cost analyses Balance growth and profitability goals to maximum results Price products consistent with financial and business objectives Lead negotiations and presentations Manage projects for internal and external clients

Details: We're changing the way health care works for the better. That means consulting with our members, partnering with our physicians, and delivering drugs in the most efficient and effective way. Join us and start doing your life's best work.(sm) A Statistical Programmer in Optum Labs will play a critical role in making our partners' research projects successful. From the time our partners first join Optum Labs, the Statistical Programmer will develop a peer relationship to their researchers and coach and support them throughout the onboarding and learning process. The Statistical Programmer will then ensure success of the partners' research by teaching them how to navigate our data warehouse and how to be successful on our technology. In some circumstances, the Statistical Programmer will write codes on behalf of the researcher. The Statistical Programmer is the partner researcher's lifeline and should take pride in doing whatever it takes to make the partner successful, while operating either under a billable or non-billable model. The successful Statistical Programmer will bring a mix of hard skills and soft skills - he or she will be strong at coding and at quickly learning how to find applicable data in our data warehouse, and also strong at developing rapport with our partners and ultimately training them to be successful through strong communication skills. Above and beyond partner researcher support, the Statistical Programmer will create FAQs, data documentation, job aids and training materials to help promote the success of future partners. Optum Labs is an open collaborative research and innovation center, providing unique data and analytic resources that enable stakeholders from across the health care ecosystem to drive advances that will lead to improved patient care and patient value. Founded as a partnership between Optum and Mayo Clinic in early 2013, Optum Labs now has a diverse community of partners dedicated to conducting leading edge research that is linked to the clinical environment through prototyping and testing in actual care settings. Optum Labs strives to accelerate the creation of ground breaking research, translate clinical best practices across the health ecosystem, and develop innovative new tools and care pathways to improve the value of care and patient outcomes. Primary Responsibilities: Utilize statistical knowledge, programming techniques, and workflow management skills in data management and analysis Collaborate with partners and colleagues on decisions involving data collection methods and the application of appropriate statistical methods for an analysis Prepare the partners' research teams through proactive and reactive training, Q&A support, and issue resolution on Optum Labs processes, software, infrastructure, and data Monitor new data being incorporated into the Optum Labs Data Warehouse and learn how to use the new data for project development and analysis Proactively and reactively create data specifications, data sets, data dictionaries, verifications of data, FAQs, job aids and training materials Contribute to the development of other department tools and information systems Occasional travel (up to 10%) may be required

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) Primary Responsibilities: Making outbound calls to assess members' current health status Identifying gaps or barriers in treatment plans Providing patient education to assist with self management Interacting with Medical Directors on challenging cases Coordinating care for members Making referrals to outside sources Coordinating services as needed (home health, DME, etc) Educating members on disease processes Encouraging members to make healthy lifestyle changes Documenting and tracking findings Making post-discharge calls to ensure that discharged member receive the necessary services and resources

Details: North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. NAMM/PrimeCare California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform. The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets. The Medical Director provides physician support to Clinical Coverage Review (CCR) operations, the organization responsible for the initial clinical review of service requests for UnitedHealth Care (UHC). The Medical Director collaborates with CCR leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations. They will work to build and cement relationships and continuously educate on regulatory guidelines within managed care. Many of the Medical Director's activities will focus on the application of clinical knowledge in various utilization management activities and detail around pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other UnitedHealth Care departments. Primary Responsibilities: 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 UHC medical policy and benefit document language in the process of clinical coverage review for UnitedHealth Care Manage healthcare costs by actively overseeing daily inpatient and outpatient services by analyzing data and driving metric Conduct daily clinical review and evaluation of all service requests collaboratively with Clinical Coverage Review staff Provide support for CCR nurses and non clinical staff in multiple sites in a manner conducive to teamwork Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants; educates providers on benefit plans and UHC medical policy Communicate with and assist Medical Directors outside CCR regarding coverage and other pertinent issues Communicate and collaborate with other departments such as the Inpatient Concurrent -Review team regarding coverage and other issues Is available and accessible to the CCR staff throughout the day to respond to inquiries. Serve as a clinical resource, coach and leader within CCR Access clinical specialty panel to assist or obtain assistance in complex or difficult cases Document clinical review findings, actions and outcomes in accordance with CCR policies, and regulatory and accreditation requirements Actively participate as a key member of the CCR team in regular meetings and projects focused on communication, feedback, problem solving, process improvement, staff training and evaluation and sharing of program results Actively participate in identifying and resolving problems and collaborates in process improvements that may be outside own team Provide clinical and strategic leadership when participating on national committees and task forces focused on achieving Clinical Coverage Review goals

Details: What can YOU do with the right information? At OptumInsight, the possibilities and the impact are limitless. You'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever. It's always fresh. It's always exciting. As a Senior Consultant you'll provide consulting services to strengthen and improve health care operations that result in stronger financial returns and a healthier health care system. You'll use your strong strategic and business acumen to work closely with clients to define, develop and document business requirements to ensure needs are captured and critical deliveries are executed. This consulting career gives you the opportunity to travel and share in a mission that inspires. You'll see your ideas come to life and your achievements recognized. You won't find tougher challenges. And you won't find smarter people working together to solve them. Join us and start doing your life's best work.(sm) Primary Responsibilities: Collaborate with business and technology departments to define deliverables and develop solutions that are reusable across the organization Conduct research studies that may include collecting, analyzing, trending and presenting data and recommendations to management Perform project management duties including the creation of status reports, work plans, and presentations to client leadership Identify and document business process re-engineering opportunities including current and future state process flows Define, develop and document business requirements to ensure clients needs are captured and delivered Participate in quality assurance and user acceptance testing by writing test scripts, executing test cases and documenting defects Develop financial models and tools, including cost-benefit analysis, resource utilization models and performance reports Produce job aids, training material and instruction manuals for end-users

Details: Position Description: UnitedHealthGroup is working to create the Healthcare system oftomorrow and you can help. Already Fortune 17, we are totally focused oninnovation and change. We work a littleharder. We aim a little higher. We expect more from ourselves and each other.And at the end of the day, we're doing a lot of good. Through our family of businesses and a lot of inspired individuals, we'rebuilding a high-performance Healthcare system that works better for more peoplein more ways than ever. Now we're looking to reinforce our team with people whoare decisive, brilliant and built for speed. Join with us and start doing your life's best work .SM Managing a high volume PCP's and creating strong relationships to partnering with health plan initiatives and membership growth. Team lead for provider consultants in various service delivery areas in Texas. Position requires travel and abilty to provide guidance, teach and management day to day activities as well as projects. The lead will maintain a smaller amount of providers to managed and maintain the day to day concerns of the provider engagement. Manage the budget of trinkets. Manage provider events and scheduling. Mentor provider visits. Problem solving provider concerns. Coordinate meeting with provider advocates and CPC's. Lead engagement projects such; Provider advisory council, FQHC/RHC week, Optimization projects and Quality projects such as closing gaps in care such as wellness visits .

Details: No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. You'll help improve the health of millions. And you'll do your life's best work.(sm) Are you a Behavioral Psychiatrist who wants to be a part of something exciting? Then come join our team as we set out to improve access to a more comprehensive array of community-based services that are grounded in recovery principles and are sure to improve health outcomes and reduce health care costs. UnitedHealth Care Community Plan has requested to qualify as a managed behavioral health and HARP plan and will partner with the State of New York Office of Mental Hygiene and OASAS to transform the Behavioral Health system from an inpatient focused system to a recovery focused outpatient system of care. We are committed to focusing on integration, person-centered care, recovery-oriented care, and evidence-based practices as we integrate all Medicaid State Plan covered services for mental illness, substance use disorders (SUDs), and physical health (PH) conditions. Position Summary: Primary responsibility for ensuring delivery of cost effective quality care that incorporates recovery, resiliency and person-centered services. Responsible for Level of Care guidelines and utilization management protocols. Responsible for oversight and management with the Clinical Director and Clinical Program Director all utilization review, management and care coordination activities. The Medical Director will provide clinical oversight to the clinical staff, oversee the provision of both inpatient and outpatient services; and keep current regarding prevalent treatment protocols and philosophies including those that address consumer cultural preferences. Responsible for maintaining the clinical integrity of the program, including concurrent reviews of outpatient services; providing oversight to utilization management and quality staff; providing consultation to providers and other community based clinicians, including general practitioners. Will provide timely psychiatric services for the behavioral health operation including communication with the Health Plan Medical Director, clinical and quality staff, medical necessity review and recommendations, service denial reviews, grievance issues, medication reviews, and clinical best practices guideline development. Primary Responsibilities: Responsible for achieving appropriate utilization by performing reviews, denials, peer reviews and appeals; consulting with care management staff; using data to identify opportunities for improvement and implementing strong action plans for both Medicaid enrollees Responsible for implementing a recovery philosophy working closely with the Recovery & Resiliency staff by maintaining a knowledge base in rehabilitation and recovery principles and innovations; modeling principles of engagement, empowerment and learning with colleagues and employees, and training all staff in the practical implications of these principles with a particular emphasis on care management, alternative levels of care and network sufficiency Provide clinical leadership and supervision to other contracted medical staff that may perform behavioral health UM functions for Optum Provide periodic supervision/in-service training to both Optum clinical staff and other staff as needed focusing on medical necessity, reason(s) for continued services, state requirements, appropriate psychiatric practice and engagement, empowerment, recovery and rehabilitation Ensure systematic screening for behavioral health related disorders by using standardized and/or evidence-based approaches Provide peer to peer reviews and consultations Act as a liaison with Community & State and Optum service area facilities, physicians, and agencies as requested Chair the Quality Management Committee and Utilization Management Committee as required as well as participate in the NY Regional Planning Committee Complete all medical necessity reviews when Care Managers are unable to authorize continuation of services Provide sufficient electronic documentation in the consumer record when a denial is made for either adult or child/adolescent Establish criteria and procedures for the Medical Director Review of clinical cases Provide consultation to Optum management and staff regarding such issues as clinical standards, policies, procedures, recovery and resiliency and best practices Conduct clinical reviews of contracted provider clinical records as requested Minimal local travel required Are you a Behavioral Psychiatrist who wants to be a part of something exciting? Then come join our team as we set out to improve access to a more comprehensive array of community-based services that are grounded in recovery principles and are sure to improve health outcomes and reduce health care costs.

Details: Position Description: Welcome to one of the toughest and most fulfilling ways to help people,including yourself. We offer the latest tools, most intensive training programin the industry and nearly limitless opportunities for advancement. Join us andstart doing your life's best work . Positions in this function are responsible for providing expertise and customerservice support to members, customers, and/ or providers. Direct phone-basedcustomer interaction to answer and resolve a wide variety of inquiries. Primary Responsibilities: Coordinates, supervises and is accountable for the daily/ weekly/ monthly activities of a team members Sets priorities for the team to ensure task completion and performance goals are met, such as Quality, Adherence, Service Level and AHT Coordinates work activities with other supervisors, managers, departments, etc. Identifies and resolves operational problems using defined processes, expertise and judgment Provides coaching and feedback to team members, including formal corrective action Conducts annual performance reviews for team members Provides expertise and customer service support to members, customers, and/ or providers Ability to navigate a computer while on the phone Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product Ability to remain focused and productive each day though tasks may be repetitive Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit. Impact of work is most often at the team level.

Details: Position Description: 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 providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims. Authorizes the appropriate payment or refers claims to investigators for further review. Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary. Primary Responsibilities: Provide expertise and/or general claims support to teams in reviewing, researching, negotiating, processing and adjusting claims Authorize appropriate payment or refer claims to investigators for further review Analyze and identify trends and provides reports as necessary Consistently meet established productivity, schedule adherence, and quality standards Respond to claims appeals Supervise, monitor, track and direct day to day operations to staff Consistently meet established productivity, schedule adherence, and quality standards Respond to claims appeals Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit. Impact of work is most often at the team level.

Details: Position Description: Great sales are the result of strong purpose, conviction and pride - pride in your ability and your product. UnitedHealth Group offers a portfolio of products that are greatly improving the life of others. Bring along your passion and do your life's best work.(sm) Responsible for the daily support of the sales function to minimize the administrative work of producers and act as a liaison to the Virtual Operations team. Works closely with sales and other functional leaders to develop and maintain the operational infrastructure supporting sales recruiting, goal setting, training and onboarding, troubleshooting order processing issues and producer requests, and sales-related information systems and procedures. Primary Responsibilities: Responsible for the daily support of new business sales teams, including ordering open enrollment materials and directories, assisting with the creation of open enrollment presentations, creating temporary ID cards, and assisting producers in meeting sales objectives. Works with Sales & Account Management in fulfilling a liaison role between the health plan and virtual operations teams and offering local sales support Analyzing and reporting sales data, communicating changes to sales plans, providing knowledge about customers and competitors, communicating pricing data, and managing the operational logistics of sales meetings and activities. Offer support related to major initiatives and miscellaneous projects in health plan Handle Broker walk-in/drop off cases Triage/route escalated issues Coordinate and track broker bonus programs Build and sustain positive relationships with brokers/consultants through direct and indirect communication