Assist with care management for high medical risks / needs members with comorbid behavioral health needs As a Care Coordinator Assess 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

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 prior to physician's/nurse practitioner's examination, serv

Key Agent/Agency Performance Agent Development Mentor, coach and engage key agents/agencies through ongoing business and strategy planning. This includes identifying sales opportunities, product positioning, UHC tools, UHC value proposition, compliance, and market education Onboarding Reach out to new agents identified by the PHD to share UHC learning, growth tools and va

Engage members either face to face or over the phone to have a discussion about their health Review available member service records and relevant documentation (e.g., utilization history, functional level, stratification information, current plan of care) Conduct comprehensive member assessment that includes bio psychosocial, functional, and behavioral health needs Utiliz

Forge relationships with key customers and consultants, and act as main contact for UnitedHealthcare and as "CEO" of their account Renew the customer year over year in the 100 3000 lives segment Clearly demonstrate the value propositions for specialty and ancillary business to improve customer growth and retention Develop and monitor client financial performance, includin

Analyze, review, forecast, and trend complex data Present analysis and interpretation for operational and business review and planning Support short and long term data warehousing activities through analysis Develop recommended business solutions through research and analysis of data and business process and implement when appropriate Skills with influencing others to get

Clinical Care Management Projects and acts as a Subject Matter Expert Understands and can discuss the Care Management application and implications of changes to clinical process, policies and procedures Healthcare software application configuration Assess, interpret, and analyze customer needs and requirements Provide analytical support and expertise needed to translate c

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

Development of new risk adjustment tools / analyses to expand UHC's ability to predict risk scores and revenue using emerging data Expand RAF program analytics to enhance valuations and potentially refine the operations of existing programs and/or introduction of new programs Consolidation of Medicare Advantage risk adjustment data received from the Centers for Medicare &

Assist with care management for high medical risks / needs members with comorbid behavioral health needs As a Care Coordinator Assess 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

Contribute to strategic projects, ETL design and architecture, performance tuning activities, etc Responsible for supporting the architecture and design of the data warehouse, data marts and BI reports which will support various data initiatives Development of ETL code with our current toolset, Informatica, PL/SQL, Snowflake Stored Procedures, Azure Data Factory Perform a

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

Make outbound calls, receive inbound calls, coordinate initial orders for home health nursing, enter authorizations, seek/review clinical records every 60 days and documentation The High Risk Nurse would interact with prescribers to offer recommendations to treatment plans, including cost effective alternatives, such as outpatient clinical supports, pharmacy supports or r

Analyze large data sets and identify trends and patterns Use statistical tools to interpret data sets, paying particular attention to trends and patterns that could be valuable for diagnostic and predictive analytics efforts Create data visualizations and reports to communicate findings to stakeholders Communicate and present findings, orally and visually in a way that ca

Key Agent/Agency Performance Agent Development Mentor, coach and engage key agents/agencies through ongoing business and strategy planning. This includes identifying sales opportunities, product positioning, UHC tools, UHC value proposition, compliance, and market education Onboarding Reach out to new agents identified by the PHD to share UHC learning, growth tools and va