Organize and manage incoming claims Work through a queue with other team members to identify claim needs Identify billing discrepancies Determine member insurance coverage and eligibility status Ensure compliance with federal and state laws and regulations Sort and organize appeals to identify eligibility needs Communicate with legal teams on appeal status Make offers to

Supervise the daily operations of NMC staff Be available to assist staff with risk calls or calls requiring additional consultation Coach and train current staff, deliver information to NMC team regarding new and changed procedures, policies, etc. Monitor and manage individual and team performance; offer constructive and positive feedback to team members and coaching for

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

Telecommute Behavioral Health Advocate/Sign-On Bonus/Fortune 5 Organization!

Build an Elite Team of Field Account Managers As a Director of Account Management, you will be responsible for leading a team of Field Account Managers to support execution of the client's daily activities Execution of customer satisfaction and retention Work directly with Strategic Account Executives, Project Manager, and Operation team to ensure your team is executing o

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 Com

Facilitate, oversee and monitor on going business processes to support HEDIS data reporting Monitor compliance against relevant process requirements (e.g., turnaround time, accuracy) Evaluate processes and outcomes against benchmarks and metrics and identify potential business impacts of current state Ensure all business requirements are met Demonstrate understanding of r

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

Supervisory Position/Fortune 5 Organization/Excellent Compensation and Benefit Package!

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

Engage members 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, medication management and me

Serve as a supervisor overseeing CMA Case Management functions and associated staff. Assumes HSS Coordinator duties when necessary Respect confidentiality and maintain confidences as described in the UHG Employee Handbook and acknowledged through signature by all employees. The ability to maintain confidentiality is a critical and essential component of this position Cond

Engage members either face to face or over the phone to have a discussion about their health Review available member service records and relevant documentation (e.g., utilization history, functional level, stratification information, current plan of care) Conduct comprehensive member assessment that includes bio psychosocial, functional, and behavioral health needs Utiliz

Serves as the advocate for providers by demonstrating accountability and ownership to resolve issues Quickly and appropriately triage contacts from healthcare professionals (i.e. physician offices, clinics, billing offices) Seek to understand and identify the needs of the provider, answering questions and resolving issues (e.g. benefits and eligibility, billing and paymen

Are you a registered nurse looking for a unique opportunity focused on Home Health? We’re offering a six month paid residency with clinical training, mentorships, classroom training, and in field training for the role of Home Health Case Manager. There will be open positions throughout the year based on the needs of the agency. Primary Responsibilities Classroom tra