Meet with business operations stakeholders to understand their requirements and objectives Develop reporting and dashboard solutions to communicate insights, measure business performance; identifies / quantifies drivers, risks and opportunities and defines solutions to mitigate risks and leverage opportunities Automate processes and reporting, including email alerts for k

Serves as subject matter expert for Critical Incident Reporting to the state. Uses interpersonal and collaboration skills to foster relationships and maintain communication with multiple internal and external disciplines (e.g., internal Clinical teams, EOHHS, CMS) Consult and collaborate with UHC matrix partners to identify organizational and structural challenges hinderi

Partner with clinical care coordination team to manage complex members in the community Seek and find members in the community who have been labeled unable to reach Conduct assessments as needed, i.e. health risk assessment Perform targeted activities to complete care plan interventions and to support STAR gap closure Proactively engage the member to manage their care Par

Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods of working at a computer. Call center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity. During direct phone based Customer interaction encourage members to use their benefits

Engage members telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and me

Manages and is accountable for clinical behavioral health professional employees and non clinical staff Sets team direction, resolves problems and provides guidance to members of own team Adapts departmental plans and priorities to address business and operational challenges Influences or provides input to forecasting and planning activities Ability to prepare and present

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

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

Discharge Planning Works with facility Case Manager or Social Worker to coordinate DC process and transition needs based on patient's diagnoses and status Care Coordination and Patient Support Collaboration with the entire clinic team to proactively manage high risk patients by ensuring appropriate Telephonic Post Hospital Discharge Calls Medication Management to include

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

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

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 Co

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 tr

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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