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

Perform initial and concurrent review of inpatient cases applying evidenced based criteria (i.e. MCG/Interqual criteria) Discuss cases with facility healthcare professionals to obtain plans of care Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management Participation in discussions with the Clinical Services team to impro

Lead a team of Event Planners with effective people leadership through effective coaching, feedback, and people management practices Manage end to end complex conference/event/incentive travel program planning coordination that drives a consistent attendee experience Develop, streamline, and create standards of excellence in designing and executing events while keeping th

Work with CICD frameworks to develop data solutions to support performing analysis, interpreting results, creating actionable insights, and presenting recommendations for use across the company Use business intelligence, data visualization, query, analytic and statistical software to build solutions, perform analysis and interpret data Partnering with stakeholders to unde

Partner with community providers of peer support to expand the network and ensure quality services are available for our members Educate by creating new curriculum specific to state need and facilitate community trainings Model the principles of recovery and provide member perspective to our CM, UM, Network, Product and Affordability partners Advocate for a recovery persp

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, c

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, c

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

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

Manage administrative tasks for the Complex CARE clinical team Handle outbound calls to members and providers Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers Check verification of eligibility for members as well as benefit information via various internal websites and applications Check discharge

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

Works to ensure that internal processes are executed, especially related to intersegment responsibilities, for fraud, waste, and abuse (FWA) vendors' instances of health care FWA by medical profession or insured member Acts as FWA subject matter expert for Federal and local FWA regulations and subsequent regulatory policy and process implementation Keeping apprised of cur

Provide an exceptional customer service experience when responding to and resolving customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence Research complex issues (such as Medical, Dental, Flex Spending, Pharmacy, etc.) across multiple da

Investigations Refine investigation protocols, documentation standards, and policy interpretation guidelines in partnership with Employment Law and ER Case Management leadership Conduct thorough, timely, objective, efficient and equitable investigations into employee complaints and allegations of misconduct, in line with agreed upon investigation framework and applicable