Engage directly with care providers, physicians, and office staff via phone calls and faxes Document provider feedback and consult with senior clinical pharmacists if there are questions about treatment, drug efficacy, or authorization status Shadow UHC pharmacists to gain a better understanding of the various roles they have within the UHCP team Collaborate with analytic

Serve as a coding resource and provide coding expertise and guidance for IFP Product and configuration partners Develop and maintain code sets used to define IFP medical and specialty benefits (hearing, vision, dental), seeking and promoting enterprise alignment when appropriate In partnership with Product and Clinical partners, ensure IFP sources of truth for benefit adm

Mainly handling inbound calling, NO knocking on doors Answer incoming phone calls from prospective members and identify the type of assistance and information the customer needs with the goal to convert the caller to a qualified lead and ultimately sale Ask appropriate questions and listen actively to identify specific questions or issues while documenting required inform

Lead the development, execution, and measurement of digital brand programs across UHC Paid digital media strategies, plans, demand analysis, forecasting and performance Oversee and direct growth activities for Google, Bing, Meta, Instagram, YouTube and future channels to drive brand engagement and affinity Partner with measurement leads and third party analytics platforms

Responsible for developing and preparing documentation for NCQA and other accreditation survey submissions Works closely with regional quality staff, health plan staff, and internal business partners to build and document compliance with accreditation standards Interpret complex data and draws conclusions Complete reports that provide analysis of data related to key quali

Facilitate, oversee and monitor on going business processes to support HEDIS data reporting Monitor compliance against relevant process requirements (e.g., turnaround time, accuracy) Evaluate processes and outcomes against benchmarks and metrics and identify potential business impacts of current state Ensure all business requirements are met Demonstrate understanding of r

Demonstrate understanding of relevant organizations' operations, products, applications, strategies and processes to effectively support Quality Reporting Operations using relevant tools and applications Submission of the NCQA Health Plan Roadmap General Information, Appendix and Attestation Submission of the NCQA Healthcare Organization Questionnaire (HOQ) Complete admin

In this dynamic position, you will Work with cross functional teams to align data science projects with business goals, ensuring impactful outcomes Lead advanced data analysis to improve business outcomes and efficiency using predictive modeling and machine learning Integrate data science techniques into operational processes, bolstering data driven decision making organi

Conduct confidential compliance investigations related to Agents/Brokers across all lines of business Document all relevant findings in written reports Utilize information from plan members (interviews), agents/brokers, sales operations, claims data, and internal systems Conduct and document interviews (on telephone and in person) for all parties involved in an investigat

Serve as a statistical expert on research projects that aim to evaluate Surest products, with a demonstrated ability to design research projects from end to end, including but not limited to data preparation, method selection, execution, and communication of results Use programming languages such as Python (PySpark, pandas), R, and SQL to build efficient data pipelines an

Set strategy for experience improvement that supports FP member NPS and retention goals Establish a culture focused on our people obsessed with continual improvements to our members' experience Present strategy to senior management and measure against the strategy Identify, develop, and support the implementation of operational process changes & innovative solutions that

Perform utilization review determinations for radiation oncology populations, and support case and disease management teams to achieve optimal clinical outcomes Speak with providers by phone. This will include discussion of evidence based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impact health care expense Enhance c

Support acquisition initiatives related to payroll and employee integration Serve as point person and resident in training to be expert regarding M&A system updates Responsible for the configuration of acquisition codes and new email extensions Responsible for the configuration, validation, and testing of new companies Responsible for the configuration of new vendor ident

Support acquisition initiatives related to payroll and employee integration Serve as point person and resident in training to be expert regarding M&A system updates Execute and validate test scenarios for area of expertise as needed Partner with project team and M&A Payroll team on trouble shooting and resolution of system issues Assist with testing for fixes, enhancement

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