Support network pricing strategies and tactics, in collaboration with local network field leaders and network managers Analyze financial impact of provider contracts (e.g., facility; physician; ancillary). Analyze financial impact of corporate initiatives (e.g., policy changes; healthcare affordability) or external regulations (e.g., healthcare reform) Analyze payment app

Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered care plans inclusiv

Evaluates new and on going claims to determine compensability and liability, giving consideration to contract provisions, disability management duration contract guidelines, medical evidence and vocational evidence. Investigates questionable claims. Determines needs for additional medical information. Determine appropriate benefit calculations and payments. Performs revie

Interpret and analyze claims, capitation, membership data, and recommend best approaches in support of underwriting, actuarial and utilization analyses Lead projects to completion by contributing to database creation, statistical modeling and financial reports Performs complex data validation and conceptual analyses. Create and update automated processes within client dat

Make calls to qualified members to provide information and answer questions about health plan programs. Provide "best in class" customer service to enrollees Meet established productivity, schedule adherence, and quality standards while maintaining good attendance. Identify, qualify, and engage members into the most appropriate health and wellness programs to meet their n

Field inbound calls in a queue from members and providers for purpose of assessment and triage Focus on initial inpatient admission for psychiatric and chemical dependency patients Make patient assessments and determining appropriate levels of care Participate in member crisis calls Determine if additional clinical treatment sessions are needed Manage inpatient mental hea

Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered care plans inclusiv

Develop, lead and execute category management strategies, conduct sourcing / RFX events, manage suppliers and conduct financial analysis Draft, Review, and lead negotiations of third party supplier contracts, including Master Services Agreements (MSAs), Statements of Work (SOWs), Non Disclosure Agreements (NDAs) and amendments in cooperation with legal, internal stakehold

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease 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 Co

Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered care plans inclusiv

Maintain general ledger accounts and related activities for the production of financial statements and reports Reconcile, analyze and review general ledger accounts in preparation for month end close Prepare journal entries and review accounting classifications, in accordance with generally accepted accounting principles Prepare documentation in support of external and in

Provide a complete continuum of quality care through close communication with members via in person or on phone interaction Support members with condition education, medication reviews, and connections to resources such as Provider Services, Private Duty Nursing, DME, and supplies Assist members with the transition from a care facility back to their home This role involve

Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered care plans inclusiv

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 Co

of Job To effectively and promptly Perform the Administration, build, and troubleshooting for Anaplan models within UHC Workforce Planning & Management, including bugs and enhancements, both in the backend and on the front end (UX) Support multiple different Anaplan models and use cases Understand the differences and similarities between models and assist cross functional