With guidance from audit management or audit lead, execute 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 departme

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connect

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

Work Life Balance/$15,000 Sign-On Bonus/Fortune 5 Company/Excellent Benefit Package!

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

Assist with care management for high medical risks / needs members with comorbid behavioral health needs As a Care Coordinator Assess members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered

Functional role is responsible for utilization management of LTSS determinations, oversight on outpatient service requests from a reporting perspective and understanding the criteria for inpatient reviews, including concurrent inpatient reviews Leverage experience and understanding of disease pathology (e.g., conditions, normal course of care for a condition) to review ch

Addresses the total patient, inclusive of medical, psychosocial, behavioral, cultural, and spiritual needs Involves the individual patient and caregiver, as appropriate, in decision making Facilitates communication and coordination among members of the care team Provides patient care to include patient assessment prior to physician's/nurse practitioner's examination, serv

Work collaboratively with the interdisciplinary care team, specifically external entities such as OhioRise, Care Management Entities, and Provider Practices; to ensure an integrated team approach Engage members either face to face or over the phone to assist with closing gaps in care, linking to necessary services and providing education about their health Review availabl

Determine that the case is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial) Validate that cases/requests for services require additional research Identify and utilize appropriate resources to conduct non clinical research (e.g., benefit documents, evidence of coverage, state/federal mandates, online resources) Prioritize cases based on ap

Design, implement and maintain .NET applications within all phases of the Software Development Life Cycle (SDLC) Develop, test, implement and maintain application software working with established processes Communicate effectively with other developers and quality assurance analysts. Establish, refine and integrate development and test environment tools and software as ne

Perform telephonic customer outreach to improve health quality outcomes in collaboration with clinical pharmacists Provide additional telephonic engagement with providers and pharmacies Assess and interpret customer needs and requirements, triaging to a clinical pharmacist when appropriate Document and track member engagement You'll be rewarded and recognized for your per

Are you a registered nurse looking for a unique opportunity focused on Home Health? We’re offering a six month paid residency with clinical training, mentorships, classroom training, and in field training for the role of Home Health Case Manager. There will be open positions throughout the year based on the needs of the agency. Primary Responsibilities Classroom tra

Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered care plans inclusiv

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