Lead in the development and execution of IT internal audits including audit planning, detailing control procedures and the related testing and reporting in accordance with professional and departmental standards including financial (Sarbanes Oxley testing) and operational projects Prepare clear, accurate and complete workpapers in accordance with department quality standa

of Job To lead a team of case managers, while overseeing day to day clinical operations and participating in business development activities. The person in this position will manage a program or region, including performance management, process improvement, and standardized execution of clinical decision processes, case manager team management and implementation of new pro

Perform audit and risk surveillance activities in accordance with IIA audit standards and the Internal Audit & Advisory Services Charter Executes Internal Audit's segment specific strategies and framework for data enabled Key Risk Indicators (KRI) and Continuous Auditing (CA) by determining and documenting relevant management metrics and mitigating controls for top risk a

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 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

As an Enrollment Eligibility Representative your daily responsibilities would be researching errors by comparing enrollment error reports against system information along with CMS (Center for Medicare and Medicaid Services) records Sending correspondence to members or CMS (Center for Medicare and Medicaid Services) to gather information or provide updates for corrections.

Provide skilled nursing care for expectant mothers in the home care environment Travel to provide in home patient care and continuous education to patients and family members Continually assess the mothers' condition to ensure they are safe in the home environment Modify care plans as appropriate based on reassessment, change in prescriber orders, the patient's need for f

Provide skilled nursing care for expectant mothers in the home care environment Travel to provide in home patient care and continuous education to patients and family members Continually assess the mothers' condition to ensure they are safe in the home environment Modify care plans as appropriate based on reassessment, change in prescriber orders, the patient's need for f

Home health administrator responsibilities as assigned Special project management as assigned Additional responsibilities as assigned Primary Responsibilities Positively represent the Company to both internal and external customers; always maintain a professional and courteous manner Uphold the Optum core values in the conduct of work Adhere to Company privacy guidelines;

Locate and engage members within a 60 mile radius of a designated region Assess SDOH needs using a standardized screening tool and coordinate with ICT to identify and connect members to available community resources Engage with members post discharge from inpatient setting to facilitate connections with community based services and Peer Support Specialist as needed Provid

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

Answer incoming phone calls from prospective members, identify the type of assistance and information the customer needs with the goal to convert caller to a qualified lead and sale Follow up with members on questions or to review current or new products and services Navigate multiple computer systems to document member information while maintaining active listening and e

Building financial models, including but not limited to, projecting a target's future financial performance Deploying different valuation methodologies (DCF, precedent transactions, trading comparables and LBO) and performing various return metric calculations (EPS accretion / dilution analysis and IRR) Preparing executive level communication / summaries that help inform

Gaining exposure to building financial forecasts, including but not limited to, projecting a target's future financial performance Deploying different valuation methodologies (DCF, precedent transactions, trading comparables and LBO) and performing various return metric calculations (EPS accretion / dilution analysis and IRR) Supporting deal teams in financial due diligen

Investigate medium to highly complex cases of fraud, waste, and abuse Detect fraudulent activity by members, providers, employees and other parties against the Company Develop and deploy the most effective and efficient investigative strategy for each investigation Maintain accurate, current and thorough case information in the Special Investigations Unit's (SIU's) case t