Compile and/or integrate information needed to complete reports and documents Prepare and/or format office documentation (e.g., letters; spreadsheets; reports) needed for various audiences (e.g.,clients; executives; internal business partners) Review prepared documents to ensure accuracy and quality, and revise as needed Post relevant documentation (e.g., meeting notes; P

Synthesize and forecast industry trends, customer needs, competitive threats, survey insights, member experience best practices and internal and competitive performance to design industry leading customer service and health plan improvement strategies Serve as a subject matter expert in CAHPS measure specifications, member pain points, survey strategy and business operati

Analyze, review, forecast and trend complex data Present analysis and recommendations for operational and business review/planning Support short and long term operational/strategic business activities through analysis Develop, recommend and implement business solutions through research and analysis of data and business processes This is a complex, fast paced, matrixed env

Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community Be knowledgeable on and apply all necessary regulatory requirements for assigned re

Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community Be knowledgeable on and apply all necessary regulatory requirements for assigned re

Proficient in review of medical records and the ability to identify pertinent information on which to base appropriate clinical decisions. Document relevant chronology of case review and provide rational for determination Plan, prioritizes, organizes and completes work to meet established objectives. Excellent verbal and written communication skills with internal and exte

Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community Be knowledgeable on and apply all necessary regulatory requirements for assigned re

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

Own the service experience of customers at the field level by working with the assigned team and other matrix partners as required to ensure issues are resolved promptly and accurately meeting the customer's expectations Develop and maintain strong relationships with internal partners throughout UHG to manage the customer service experience Fully accountable for supportin

Collaborate cross organizationally in the development, proposing and prioritization of customer solutions to reduce trend (programs, processes, benefit design, network, etc.) Works with business partners to ensure are aligned with successfully achieving savings targets Development and execution of cross functional strategies, projects and tactics which result in increment

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Utilize both company and community based resources to establish a safe and effective case management plan for members Collaborate with patient, family, and healthcare providers Identify and initiate referrals for social s

Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements Engage with requesting providers as needed in peer to peer discussions Be knowledgeable in

The KA Field Account Manager is accountable for the field based service of small to mid size, standard/non standard customers under 1,000 members. In this position, the KA Field Account Manager is responsible for the following Acts as a strategic partner and consultative resource to the customer, responsible for the customer's total service experience Meets with customers

Compiles financial statements for various Management and Labor customers in prescribed formats by collecting financial data from Peoplesoft General Ledger and other finance data repositories while ensuring accuracy and consistency Prepares standard daily and month end journal entries pertaining to revenues and expense, reclassification entries and month end reconciliation

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at 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