Conduct coverage review based on individual member plan documents, and national and proprietary coverage review guidelines, render coverage determinations, and discuss with requesting providers as needed in peer to peer telephone calls Use clinical knowledge in the application and interpretation of medical policy and benefit document language in the process of clinical co

Develop and execute Internal Audit department operations, methodology, technologies and tools, and continuous improvement efforts in alignment with direction provided by the OSCaR Leader, IAAS leadership, IIA audit standards, the Internal / External Audit Policy and the Charter of the UHG Board of Directors Audit Committee Ensure policies, procedures, and other core depar

The preparation of quarterly and annual income tax provisions The timely and accurate preparation of federal and state income tax returns and quarterly estimates Assist with the IRS examination Assisting Tax leadership with M & A and other related projects Providing research support for the analysis of proposed and existing tax laws, regulations, and rulings Prepare and r

Support network pricing strategies and tactics, in collaboration with local network field leaders and network managers Analyze financial impact of provider contracts (e.g., facility; physician; ancillary) Analyze payment appendices to provide options for various contracting approaches and methodologies Communicate results of financial impact and analysis to appropriate st

Advise UnitedHealthcare's Medicare Part D business Counsel on Part D product, clinical (Pharmaceutical & Therapeutic Committee, formulary development), marketing, and regulatory requirements Provide strategic counsel to the business on the Pharmacy Benefit Management (PBM) Agreements, benefit implementation and management, and compliance oversight and monitoring Provide c

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

Test Data Provision & Masking Operation Test data need & masking analysis ( Data structure, SQL queries) Working with Informatica tool to configure & invoke Data Copy and Masking jobs and maintain Gold Copy Maintenance of TDM Portal using UNIX scripting, Java Spring boot and Angular You'll be rewarded and recognized for your performance in an environment that will challen

Assess, plan and implement care strategies that are individualized and directed toward the most appropriate level of care for Medicare and Medicaid members while proactively engaging the member to manage their own health and healthcare Utilize strong skill sets of managing multiple tasks at a time, being self motivated, driven toward quality results, managing time well, b

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

Seeking process improvement through efficiency or technology advancements in all areas of work Assisting with UHG's quarterly international tax provision and effective tax rate projections, including coordination with non US business lines Preparing US international tax compliance and reporting forms (including Forms 5471, 8858, 8865, 1118, etc.) Preparing responses to in

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

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

Partners with business leaders to scope, create and execute business analytics using the appropriate data aggregation and visualization tools Creates backlog and prioritization methodology for analytics requests Evaluates existing tools and processes to create a long term strategy for sustainable analytics in a scaled business, offering ease and efficiency of data visuali

The UnitedHealthcare Community Plan of DC proudly serves the Dual Eligible Special Needs (D SNP) population in the District of Columbia and is excited to recruit for our leader of clinical oversight. This individual contributor will report directly to the Executive Director and will support them on coordinating select priorities, as well as have accountability in two key

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