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

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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

Ensuring delivery of cost effective quality care that incorporates recovery, resiliency and person centered services Responsible for Level of Care guidelines and utilization management protocols Responsible for oversight and management, along with the Clinical Director and Clinical Program Director, utilization review, management, and care coordination activities Provide

Manage and monitor client assignments as well as train the account management staff, new hires and ongoing Set team strategy to achieve and surpass goals, and consistently develop and manage a team of Strategic Account Executives and Field Account Managers Relationship Building Build and maintain key client and producer relationships Develop and maintain key internal rela

Field inbound calls in a queue from members and providers for purpose of assessment and triage Focus on initial inpatient admission for psychiatric and chemical dependency patients Make patient assessments and determining appropriate levels of care Participate in member crisis calls Determine if additional clinical treatment sessions are needed Manage inpatient mental hea

Functional role is responsible for utilization management of LTSS determinations, oversight on outpatient service requests from a reporting perspective and understanding the criteria for inpatient reviews, including concurrent inpatient reviews Leverage experience and understanding of disease pathology (e.g., conditions, normal course of care for a condition) to review ch

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

Consult with users and technology specialists to define business processes and be the liaison between the two parties Perform Business Analysis Ability to define project objective, scope, write business and technical requirements Business Liaison to refine business requirements Communicate and validate requirements with stakeholders Validate solution meets business needs

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

Responsible for handling inbound calls, from providers and members in a call center environment Conduct initial clinical assessments and determine appropriate levels of care, based on medical necessity Explain and administer benefits according to plan descriptions for all levels of care (OP, IOP,PHP,RTC,IP) Ability to quickly assess and meet time sensitive deadlines withi

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

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

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

Work closely with Finance, Actuarial, and Affordability partners to develop financial projections and forecasts of expected savings from key affordability programs. Also, build comparisons of actual to expected results and develop explanations of variances Provide management with unbiased advice regarding medical cost strategy, including review of affordability programs s