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

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

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

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

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 Co

Mainly handling inbound calling, NO knocking on doors Answer incoming phone calls from prospective members and identify the type of assistance and information the customer needs with the goal to convert the caller to a qualified lead and ultimately sale Ask appropriate questions and listen actively to identify specific questions or issues while documenting required inform

Full oversight of the specialty sale at the direction of the AE/SAE to achieve health plan market sales goals and maintain profitability Advocate for specialty voluntary products to support increase in enrollment and size of sale and negotiate based on broker/customer feedback with underwriting; leveraging rate bank, product discount programs and packaged savings to lever

Make Extra Money/Fortune 5 Company/Friendly Work Environment!

Oversee performance of end to end provider servicing Resolve complex problems and provide guidance to members of own team Drive the design and implementation of programs that build / nurture positive relationships between the health plan, providers, and practice managers Ensure implementation of training and education programs for external providers Identify gaps in netwo

Utilize advanced clinical skills to engage and motivate Consumers via a recovery, health and wellness oriented approach Assist consumers and their families/caregivers with connections to appropriate psychiatric, medical, and psychosocial referrals and services Identify and remove barriers to procurement, delivery, participation in and success of services Provide supportiv

Participate in telephonic outreach for collaboration with treating providers. This will include discussion of evidence based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expenses Responsible to collaborate with operational and business partners on clinical and quality initiatives at the site and cust

Primary Responsibilities Conducts clinical evaluation of members per regulated timelines, determining who may qualify for complex case management based on clinical judgment, changes in member's health, social determinants, and gaps in care Creates and implements a case management plan in collaboration with the member, caregiver(s), provider(s), and/or other appropriat

Work collaboratively with the interdisciplinary care team, specifically external entities such as OhioRise, Care Management Entities, and Provider Practices; to ensure an integrated team approach Engage members either face to face or over the phone to assist with closing gaps in care, linking to necessary services and providing education about their health Review availabl

Solid understanding of self funded marketplace and pricing disciplines Establish and maintain "solid and appropriate" level relationships with customers and consultants; ensure UHG senior management has customer specific "board level" contacts Develop and monitor client financial performance including renewal planning, negotiation and profitability levels Detailed underst

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