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

Sales representative for the UHC Key Accounts responsible for broker and direct sales to customers in the 100 5000 employee range. The principle focus is the sale of new fully insured and self funded business with indirect responsibility for the retention of existing accounts New Business Sales Identifies potential healthcare business customers Accountable for prospect fr

Partner with UMR operations and Vendor partner, own the service experience of customers at the field level by working with the UMR Operations Team and other matrix partners as required to ensure issues are resolved promptly and accurately meeting the customers' expectations Develop and maintain solid relationship with internal partners in the UMR Service Team to manage cu

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

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

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Acts as primary CAHPS Manager Collaborating with leadership, develop and drive tactical plan that can be leveraged across the enterprise to achieve CAHPS goals Manages vendor relationships to support CAHPS program Analyzes key KPI's and data to derive progress and opportunities for improvement Establishes and reviews performance metrics on a regular basis to ensure effort

Telecommute Healthcare Advocate

Telecommute CDI Specialist (St. Louis, MO)

Intake/screening/referral, assessment/reassessment, development of support plans, on going case management, monitoring of the Member's health and welfare, documentation of contacts and case management activities in the Department prescribed system, resource development, and case closure Respect confidentiality and maintain confidences as described in the UHG Employee Hand

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

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

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

With guidance from audit management or audit lead, execute internal audits including audit planning, detailing control procedures, and the related testing and reporting in accordance with professional and departmental standards including financial (Sarbanes Oxley testing) and operational projects Prepare clear, accurate, and complete workpapers in accordance with departme

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