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

Perform telephonic member outreach and document telephonic interaction outcomes using appropriate note templates Follow standard operating procedures and utilize required scripting Deliver member outreach using a motivational interviewing style of communication Perform medication and disease state clinical discussions to improve health outcomes Use active and reflective l

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

Apply clinical knowledge to Case Managers behavioral health reviews to enrollee's identified as needing or receiving behavioral health services Conduct behavioral health consults with Case Managers, daily and maintain a quarterly schedule for identified members needing or receiving behavioral health services Serve as member advocate by addressing stigma, following Guiding

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

Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs) Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems Own problem t

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

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

Care Management allocation Care Management responsibilities 80% time allocation which includes case consultations with a case load of 45 50 Utilization of hotspotting tool and other internal resource tools that identify at risk AI members Community, relationship building, education 20% (Interventions and efforts to be logged and tracked, reviewed with Manager, including o

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