Evaluates new and on going claims to determine liability, giving consideration to contract provisions, disability management duration contract guidelines, medical evidence and vocational evidence. Investigates questionable claims. Determines need for additional medical information. Performs periodic follow ups to verify continued existence of a disabling condition. Respon

Promotes wellness and good health habits in the employee population in all activities and interactions while coordinating with Quad/QuadMed and UMR teams With the help of predictive modeling and other tools, identifies high risk and emerging risk members to engage with them for stabilization through ongoing one on one interactions Identifies gaps in care and collaborates

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

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

Work with a wide range of internal clients and internal/external attorneys to address inquiries, assess development projects, and provide guidance on patentability Mentor and advise inventors on patentability and invention disclosures Assist in the management of a growing docket of patent filings Perform analytics on patent portfolio and create reporting Assist in the dev

Seeking an Accounts Payable Sr. Accounts Payable Processor for an immediate opening This position is within the Corporate Accounts Payable team and reports directly to the Payment Services Accounts Payable Associate Director Responsibilities include, but are not limited to Verifies accuracy on documents electronically submitted for payment, confirms all appropriate suppor

Evaluates, investigates and negotiates settlements on new and pending claims to determine liability, as applicable to all State and Federal statutes and client contract provisions. Documents claim files, assesses potential legal liability exposure, set appropriate claim reserves and negotiate appropriate claim settlements based on thorough investigation and all supporting

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

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

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

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

Perform clinical documentation review of inpatient and outpatient care delivered to adults and children with Medicaid, Medicare health care benefits through Arizona United Health Care Community Plans for peer review and internal investigations of Quality of Care concerns Create professionally written case investigation summaries for Peer Review, present case summaries at

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

Assess, plan and implement care management interventions that are individualized for each member and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals for both healthcare and community based services; including but not limited to financial, psychosocial, community and state supportive services Develop and implement care

Strive to add value in any task you're assigned with a customer first mindset Ingest assets from on location or studio and prepare for post production team Categorize and tag metadata to footage DAM / MAM platforms Organize, prepare and record all physical media as required Assist developing new media management policies, procedures and workflows Coordinate intake and del