Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies Perform Department of Insurance/Department of

Sales representative for the UHC Key Accounts responsible for broker and direct sales to customers in the 100 5000 employee range. The principle focus is the sale of new fully insured and self funded business with indirect responsibility for the retention of existing accounts New Business Sales Identifies potential healthcare business customers Accountable for prospect fr

Field inbound calls in a queue from members and providers for purpose of assessment and triage Focus on initial inpatient admission for psychiatric and chemical dependency patients Make patient assessments and determining appropriate levels of care Participate in member crisis calls Determine if additional clinical treatment sessions are needed Manage inpatient mental hea

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

Responsible for handling inbound calls, from providers and members in a call center environment Conduct initial clinical assessments and determine appropriate levels of care, based on medical necessity Explain and administer benefits according to plan descriptions for all levels of care (OP, IOP,PHP,RTC,IP) Ability to quickly assess and meet time sensitive deadlines withi

Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies Perform Department of Insurance/Department of

Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies Perform Department of Insurance/Department of

Accountable for customer (employer) loyalty and satisfaction, as measured by survey results and persistency Establish, cultivate, and manage the customer relationship at multiple levels, serving as a healthcare consultant and trusted business advisor to these customers Establish, cultivate, and manage relationships with consultants and brokers, recognizing the value they

Oversee initial inpatient admission requests for psychiatric and chemical dependency patients Make patient assessments and determine appropriate levels of care Administer benefits, review treatment plans, and coordinate transitions between various areas of care Obtain information from providers on outpatient requests for treatment Provide utilization management concurrent

Assess, plan, implement, coordinate, monitor, and evaluate case management activities for offenders being released from state and local prison and for those currently residing at the Community Transition Center, across the continuum of care, within the scope of the case manager's license Coordination and service delivery, Physical and psychological factors, Case managemen

The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The

Identify potential health care business customers Develop business relationships with agents and/or brokers to increase sales Promote sales of health care and ancillary products to Mid Market Employers (2 99 EE) through brokers. This includes educating and keeping brokers up to date on products and pricing, evaluating, and discussing with brokers, developing recommendatio

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

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