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

Assess, plan, and implement care strategies that are individualized by member and directed toward the most appropriate, lease restrictive level of care. Identify and initiate referrals for member transition to community request and provide assist with social service programs, including financial, psychosocial, community and state supportive services. Manage the care plan

Take ownership and responsibility for the design and development of all aspects of manual and automated test approach and strategy. Author and execute the Test Suite of manual and automated test scenarios with traceability to requirements to validate the application. Collaborate with business team members to review and clarify requirements and acceptance criteria for all

Manage all facility based admissions for mental health and substance abuse through the continuum of care Effectively collaborate with treating providers and facilities to ensure consumers are receiving treatment in line with best practice and level of care guidelines Effectively communicate with consumers about their benefit coverage and provide appropriate resources and

Provide guidance and education to individual members and families via phone and email correspondence for the following topics (not all inclusive) Disability issues related to private insurance Characteristics of disability and relationship to ADL, current and future impact on family, social success and referrals to partnering programs Community and state resources, Specia

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

Managing and administering inpatient and residential behavioral health benefits Reviewing clinical assessments and determining appropriate levels of care Determining if additional clinical services are needed Coordinating benefits and transitions between various levels of care Identifying ways to add value to treatment plans and consulting with facility staff on those ide

Provide support and strategic counsel on a wide variety of matters including, regulatory compliance and oversight, contracts, STARs, the Inflation Reduction Act, and finance Collaborate with colleagues across the legal, compliance, and regulatory affairs departments You'll be rewarded and recognized for your performance in an environment that will challenge you and give y

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

Acts as primary CAHPS Manager Collaborating with leadership, develop and drive tactical plan that can be leveraged across the enterprise to achieve CAHPS goals Manages vendor relationships to support CAHPS program Analyzes key KPI's and data to derive progress and opportunities for improvement Establishes and reviews performance metrics on a regular basis to ensure effort

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

Confirm contract compliance requirements to meet the needs of Turquoise Care contract network standards Possess knowledge of Managed Care Organization (MCO) contracting/credentialing process Experience working with providers/facilities in order to conduct advocacy initiatives with targeted providers to solicit participation Work with cross functional teams within UnitedHe

Build multi channel automated and batched campaigns in Salesforce Marketing Cloud Journeys that deliver on campaign objectives Manager campaign production schedule in Asana, and ensure launch deadlines are met and communicated internally Conduct routine reporting on assigned email campaigns to ensure optimal performance Design marketing experiments and employ A/B testing

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

Secure, track and review records via multiple media Identify program specific documents within member's records Submit coverage checks and claims to Allstate on members behalf Use clinical judgement to prepare records for external review Use clinical judgement to triage patients for program candidacy Make appropriate referrals into various programs in a timely manner Act