Handle escalated calls, resolving more complex customer issues Demonstrate outstanding service to identify the source of the caller's issue and work to resolve the inquires in a timely and professional manner Help guide and educate customers about the fundamentals and benefits of consumer driven health care topics such as selecting the best benefit plan options, maximizin

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

The KA Field Account Manager is accountable for client and member education as well as escalated service issues of small to mid size, standard/non standard customers. In this position, the KA Field Account Manager is responsible for the following Coordinates, staffs, and conducts open enrollment meetings, wellness fairs and lunch and learns Acts as a strategic partner and

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

Full oversight of the specialty sale to achieve health plan market sales goals and maintain profitability Advocate for specialty voluntary products to support increase in enrollment and size of sale and negotiate based on broker/customer feedback with underwriting; leveraging rate bank, product discount programs and packaged savings to leverage the best value to the custo

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

Manages ongoing relationships and service delivery to clients for one or more accounts Acts as outward facing, dedicated resource for assigned accounts, typically with direct client contact (not call center) and large or complex accounts Works closely with Sales Leads on renewals and upselling, but incumbents do not have specific sales goal accountability or primary respo

Determine that the case is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial) Validate that cases/requests for services require additional research Identify and utilize appropriate resources to conduct non clinical research (e.g., benefit documents, evidence of coverage, state/federal mandates, online resources) Prioritize cases based on ap

Responsible for managing a team of Field Account Managers based throughout the State of Nevada Management and triage of customer related contacts, wellness integration and assistance in supporting UHG value proposition Training and development of employees, leading and developing a team of employees Managing employees up into other opportunities within the organization Ma

Interpret and analyze claims, capitation, membership data, and recommend best approaches in support of underwriting, actuarial and utilization analyses Lead projects to completion by contributing to database creation, statistical modeling and financial reports Performs complex data validation and conceptual analyses. Create and update automated processes within client dat

Develop, lead and execute category management strategies, conduct sourcing / RFX events, manage suppliers and conduct financial analysis Draft, Review, and lead negotiations of third party supplier contracts, including Master Services Agreements (MSAs), Statements of Work (SOWs), Non Disclosure Agreements (NDAs) and amendments in cooperation with legal, internal stakehold

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Evaluate and assess each request verifying eligibility and specific product Determine benefit level based on site of service Utilize written criteria to approve, pend or send the case to the medical director for review Send cases for pending process when appropriate Maintain at least 98% accuracy of clinical review case notes in Facets Maintain productivity standards and

Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff Work most often impacts a large business unit, or multiple markets/sites You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succe

Address any escalated issues sent to them, the SAE, or other field employee Work with the central team and their manager to coordinate resolution Meet with customers quarterly (or more often if requested) to review service related statistics including ideas for improving or enhancing the customer's total service Conduct training/education with customers on UHC eServices,