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

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

Collaborates effectively with interdisciplinary team (IDT) to assist in establishing an individualized plan of care for members, goals including both short and long term. May participates in IDT meetings Works with the Utilization Management (UM) RNs, Social Worker (LMSWs) Case Managers and other internal and external providers to facilitate smooth care transitions Strati

Care Management allocation Care Management responsibilities 80% time allocation which includes case consultations with a case load of 45 50 Utilization of hotspotting tool and other internal resource tools that identify at risk AI members Community, relationship building, education 20% (Interventions and efforts to be logged and tracked, reviewed with Manager, including o

Perform initial and concurrent review of inpatient cases applying evidenced based criteria (InterQual criteria) Discuss cases with facility healthcare professionals to obtain plans of care Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management Participation in discussions with the Clinical Services team to improve the pr

Perform initial and concurrent review of inpatient cases applying evidenced based criteria (InterQual criteria) Discuss cases with facility healthcare professionals to obtain plans of care Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management Participation in discussions with the Clinical Services team to improve the pr

Perform initial and concurrent review of inpatient cases applying evidenced based criteria (InterQual criteria) Discuss cases with facility healthcare professionals to obtain plans of care Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management Participation in discussions with the Clinical Services team to improve the pr

Perform initial and concurrent review of inpatient cases applying evidenced based criteria (InterQual criteria) Discuss cases with facility healthcare professionals to obtain plans of care Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management Participation in discussions with the Clinical Services team to improve the pr

Develop Others into a successful team aimed at increasing growth and market permeation by Continually building and nurturing agents through educational support on product information, selling skills, systems, and processes at United Healthcare Actively engage in the management and coaching of agent performance by implementing successful start strategy and guiding agents t

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

Conduct confidential compliance investigations related to Agents/Brokers across all lines of business Document all relevant findings in written reports Utilize information from plan members (interviews), agents/brokers, sales operations, claims data, and internal systems Conduct and document interviews (on telephone and in person) for all parties involved in an investigat

Provide monthly financial reporting of key business initiatives Provide ongoing financial analysis of development and operational results against the budget and forecasts Work side by side with the Business Team and/or Finance personnel across UnitedHealth Group, to fully understand the business and support the financial goals and objectives Develop and implement controls

Program Administration Collaborates with key university departments (Registrar, Bursar, IT Services, University Communications and Marketing, Health Services. Student Life, etc.) to ensure processes pertaining to the SHIP are as smooth and seamless as possible throughout the insurance plan year. Regularly assesses and facilitates the implementation of the annual online st

Financial management of Lease accounting prepare, document and record lease transactions, including transactions that require technical accounting Fixed asset accounting and asset management close out projects, create assets, maintain appropriate useful life of asset, manage depreciation schedules, evaluate capitalization versus expense A suite of real estate based balanc

Recruits, hires, and manages performance of staff (2 3 employees) providing ongoing feedback, conducting regularly scheduled 1 1s and facilitating the performance management process in a timely manner Leads team pipeline generation, using a curated set of UHG sales tools and prospecting persistence to identify and validate opportunities Guides team members to attain month