Proficient in review of medical records and the ability to identify pertinent information on which to base appropriate clinical decisions. Document relevant chronology of case review and provide rational for determination Plan, prioritizes, organizes and completes work to meet established objectives. Excellent verbal and written communication skills with internal and exte

Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements Engage with requesting providers as needed in peer to peer discussions Be knowledgeable in

Perform audit and risk surveillance activities in accordance with IIA audit standards and the Internal Audit & Advisory Services Charter Executes Internal Audit's segment specific strategies and framework for data enabled Key Risk Indicators (KRI) and Continuous Auditing (CA) by determining and documenting relevant management metrics and mitigating controls for top risk a

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Conne

Build and maintain solid relationships with key brokers and others as necessary within the assigned territory Develops action plans and strategies to optimize Medicare sales Partner with peers and the Sales Director (SD) to identify and develop relationships with individuals and organizations that influence the buying behavior of our target consumer (e.g., Providers, Regu

Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medicati

Building financial models, including but not limited to, projecting a target's future financial performance Deploying different valuation methodologies (DCF, precedent transactions, trading comparables and LBO) and performing various return metric calculations (EPS accretion / dilution analysis and IRR) Preparing executive level communication / summaries that help inform

Assess complaints of alleged misconduct received within the Company Investigate low to medium complex cases of fraud, waste and abuse Detect fraudulent activity by members, providers, employees and other parties against the Company Develop and deploy the most effective and efficient investigative strategy for each investigation Maintain accurate, current and thorough case

Gaining exposure to building financial forecasts, including but not limited to, projecting a target's future financial performance Deploying different valuation methodologies (DCF, precedent transactions, trading comparables and LBO) and performing various return metric calculations (EPS accretion / dilution analysis and IRR) Supporting deal teams in financial due diligen

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Com

Assess, plan, and implement care strategies that are individualized by member and directed toward the most appropriate care Utilize both company and community based resources to establish a safe and effective case management plan for members Collaborate with member, family, and healthcare providers Identify and initiate referrals for social service programs, including fin

Accountable for customer (employer) loyalty and satisfaction, as measured by survey results and persistency Establish, cultivate and manage the customer relationship at multiple levels, serving as a healthcare consultant and trusted business advisor to these customers Establish, cultivate and manage relationships with consultants and brokers, recognizing the value they br

Provide office and community based resource coordination and member education to help improve member wellness and quality of life Provide Housing Supports and Services as defined in state contract to eligible members experiencing housing insecurity Collaborate with internal teams and community organizations to support members through housing related needs Assist members i

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us and start doing

Develop key internal and external relationships to facilitate results. Understand and create a strategy based on analysis and reporting of sales and market trends, including sales plan execution, competitive intelligence and new product requirements Drive the development of market sales strategies and value proposition formulation Lead as an expert in our national account