As part of a multi disciplinary care coordination team Addresses the total patient, inclusive of medical, psychosocial, behavioral, cultural, and spiritual needs Involves the individual patient and caregiver, as appropriate, in decision making Facilitates communication and coordination among members of the care team Provides patient care to include patient assessment prio

Extensive work experience within own function. Work is frequently completed without established procedures. Works independently. May act as a resource for others. May coordinate others' activities. Extensive work experience within own function. Applies knowledge/skills to a range of moderately complex activities. Demonstrates great depth of knowledge/skills in own functio

DEI Partnerships, Strategies and DEI Integration Operations Lead strategy and execution for strategic partnerships (conferences, memberships, brand recognition and ESG integration) Oversee strategic business initiatives from development through successful execution under the leadership of the Chief DEI Officer Collaborate cross functionally with business leaders to ideate

Answer incoming phone calls from prospective members, identify the type of assistance and information the customer needs with the goal to convert caller to a qualified lead and sale Follow up with members on questions or to review current or new products and services Navigate multiple computer systems to document member information while maintaining active listening and e

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

The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The

Provide an exceptional customer service experience when responding to and resolving customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence Research complex issues (such as Medical, Dental, Flex Spending, Pharmacy, etc.) across multiple da

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

The UnitedHealthcare Community Plan of DC proudly serves the Dual Eligible Special Needs (D SNP) population in the District of Columbia and is excited to recruit for our leader of clinical oversight. This individual contributor will report directly to the Executive Director and will support them on coordinating select priorities, as well as have accountability in two key

Confirm contract compliance specifics to meet the needs Turquoise Care contract network standards Work with cross functional teams within UnitedHealthcare to strengthen provider networks across multiple functions including but not limited to behavioral health, physical health, dental and vision Conduct advocacy activities with targeted providers to solicit participation W

Investigate medium to highly complex cases of fraud, waste and abuse Detect fraudulent activity by members, providers, employees and other parties against the Company Develop and deploy the most effective and efficient investigative strategy for each investigation Maintain accurate, current and thorough case information in the Special Investigations Unit's (SIU's) case tr

Partner with clinical care coordination team to manage complex members in the community Seek and find members in the community who have been labeled unable to reach Conduct assessments as needed, i.e., health risk assessment Perform targeted activities to complete care plan interventions and to support STAR gap closure Proactively engage the member to manage their care Pa

Manages a caseload by coordinating services and collaborating with other health care professionals in the provision of health care services for injured workers Determines the necessity and appropriateness of health care services for patients Evaluates and reports on outcomes Provides Health Education, coaching and treatment decision support for injured workers Meets with

Serves as primary care manager for members with primary high behavioral needs members Engage members through a variety of modalities (telephonically) to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, socioeconomic and SDOH needs Develops and implements individualized, person centered care plans inclusive of go

Business Growth by achieving assigned sales/membership growth targets in his/her territory/territories. Sales targets are achieved by building and managing agents and agencies within two sales channels 1) Direct Agents who are independent sales agents who contract directly with UnitedHealthcare to sell Individual and Family plans and 2) Field Marketing Organizations (FMO)