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

Oversee initial inpatient admission requests for psychiatric and chemical dependency patients Make patient assessments and determine appropriate levels of care Administer benefits, review treatment plans, and coordinate transitions between various areas of care Obtain information from providers on outpatient requests for treatment Provide utilization management concurrent

Receive appeal or grievance documentation and determine relevant details (e.g., what member is requesting) Enter appeals and grievances details within the system and audit against provided documentation. Determine where appeal or grievance should be reviewed / handled or route to other departments as appropriate Contact and work with other internal resources to obtain and

Positions in this function will be responsible for researching and investigating key business problems through quantitative analyses of utilization and healthcare costs data. Develop and improve quantitative data analytics and set performance targets. The main responsibilities will include Interpret and analyze clinical data from various sources and recommend best approac

Assess, plan, implement, coordinate, monitor, and evaluate case management activities for offenders being released from state and local prison and for those currently residing at the Community Transition Center, across the continuum of care, within the scope of the case manager's license Coordination and service delivery, Physical and psychological factors, Case managemen

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

Identify potential health care business customers Develop business relationships with agents and/or brokers to increase sales Promote sales of health care and ancillary products to Mid Market Employers (2 99 EE) through brokers. This includes educating and keeping brokers up to date on products and pricing, evaluating, and discussing with brokers, developing recommendatio

Supervisory Position/Fortune 5 Organization/Excellent Compensation and Benefit Package!

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

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