of Job To lead a team of case managers, while overseeing day to day clinical operations and participating in business development activities. The person in this position will manage a program or region, including performance management, process improvement, and standardized execution of clinical decision processes, case manager team management and implementation of new pro

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

Manage and monitor client assignments Training of account management staff, new hire and ongoing Maintain an acceptable level of persistency in teams book of business Recruit, hire and monitor account management staff Personnel development and management Set account management strategy to achieve goals Direct and manage service plans Build and maintain key client and prod

Focusing on initial and concurrent reviews for psychiatric and chemical dependency patients for Intensive Outpatient (IOP) level of care Identifying ways to add value to treatment plans and recommending modifications to ensure best practices Communicating best practice guidelines through clinical discussion with providers Making patient assessments and determining most ap

Plan Conduct training needs analysis by engaging business/process and system key stakeholders and SMEs Identify training goals, dependencies, audience and timelines Collaborate with business/process and system SMEs/stakeholders to gather training content, information Identify the appropriate delivery approaches, media and methodologies Apply principles of adult learning a

Positions in this function will be responsible for researching and investigating key business problems through quantitative analyses of utilization and healthcare costs data. Develop and improve quantitative data analytics and set performance targets. The main responsibilities will include Assesses and interprets customer needs and requirements Identifies solutions to non

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

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

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

Partner with community providers of peer support to expand the network and ensure quality services are available for our members Educate by creating new curriculum specific to state need and facilitate community trainings Model the principles of recovery and provide member perspective to our CM, UM, Network, Product and Affordability partners Advocate for a recovery persp

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

Receive assigned provider inquiries and perform a code review on both professional and facility claims Make determinations on cases after a coding review is complete Review various edits on cases and complete audit of medical records received to ensure proper editing is applied Review medical charts electronically Abstract and code diagnosis and procedures from the medica

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

Oversee initial inpatient admission requests for psychiatric and chemical dependency patients Make patient assessments and determine appropriate levels of care Administer benefits, review treatment plans, and coordinate transitions between various areas of care Obtain information from providers on outpatient requests for treatment Provide utilization management concurrent

Managing and administering inpatient and residential behavioral health benefits Reviewing clinical assessments and determining appropriate levels of care Determining if additional clinical services are needed Coordinating benefits and transitions between various levels of care Identifying ways to add value to treatment plans and consulting with facility staff on those ide