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395 💼 Jobs / Employment

Appeals and Grievances Medical Director - Virtual - New York
newabout 12 hours ago
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Work at home! The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include: - Perform individual case review for appeals and grievances for various healthplan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies. - Perform Department of Insurance/Department of Managed Healthcare, and CMS regulatory responses. - Communicate with UnitedHealthcare medical directors regarding appeals decision rationales, and benefit interpretations. - Communicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues. -Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results. - Provide clinical and strategic input when participating in organizational committees, projects, and task forces. What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. Qualifications: -MD or DO with an active, unrestricted license -Board Certified in an ABMS or AOBMS specialty -5+ years clinical practice experience -Intermediate or higher level of proficiency with managed care -2+ years Quality Management experience - Excellent telephonic communication skills; excellent interpersonal communication skills. - Excellent project management skills. - Data analysis and interpretation skills. - Excellent presentation skills for both clinical and non clinical audiences. Familiarity with current medical issues and practices. - Creative problem solving skills. - Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills. - Strong team player and team building skills. Transforming health care and millions of lives starts with the values you embrace and the passion you bring. Find out more and join us. It's an opportunity to do your life's best work.SMCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Market Chief Medical Officer (CMO) - Southern California - Cypress
newabout 12 hours ago
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The Market Chief Medical Officer (CMO) is the senior clinical executive for the designated market plans for the commercial business, Employer & Individual (E&I) and Medicare & Retirement (M&R). The CMO has accountability for driving excellent results for all clinical affordability, quality, population health, growth, Net Promoter Score (NPS), and external relationship initiatives for the designated market. The CMO is the leader of the market level Continuum of Care (COC) ensuring integration of all United Healthcare (UHC), United Clinical Services (UCS) and OPTUM clinical functions to drive incremental reduction in admissions/ readmissions, continuous improvement of HEDIS and STARs ratings, reduction of unnecessary ER visits, and mitigation of provider abrasion from prior authorization and inpatient management programs. The CMO collaborates with the market CEO, the market Senior Leadership (SLT) team, UCS staff, and matrix partners such as Network, Sales and other market and regional partners to implement and drive programs to support and meet UCS goals for commercial and Medicare lines of business. The CMO reports to the Regional Chief Medical Officer with dotted line accountability to the local market CEO. Major Responsibilities • Clinical Continuum – This CMO serves as the market lead of all clinical programs as they impact a member’s passage from enrollment thru end of life care and Hospice. The CMO will hold daily rounds with continuum clinical partners to identify road blocks, effect resolution, reduce internal and external cycle times, and integrate information flow with providers to reduce admissions/ readmissions. The CMO will produce and present weekly status reports, work plans, and results to the President of United Clinical Services on the performance of the market. • Quality and Affordability – The CMO has responsibilities for utilization management from a macro view: conducting hospital Joint Operations Committee meetings, contributing to--and implementing--regional Medical Cost Operating Team decisions, bed day action committee meetings with Inpatient Care Management (ICM), data sharing with physicians and physician groups on quality and efficiency improvement opportunities, and implementing local Health Care Affordability Initiatives. At a more micro level, the CMO will drive and manage Market ACO and delegated medical group performance and work with providers to close clinical quality gaps in care for STARs and HEDIS. This focus not only ensures affordability gains but also drives and reinforces the importance of the triple aim with strong emphasis on value realization at the market level which includes quality revenue, risk revenue and medical cost reduction. • Clinical Excellence – The CMO helps oversee the HEDIS data collection process, CAHPS improvement as the measure of member satisfaction and quality in its broadest definition (QoC, HEDIS, QIPs), and drive Health Plan accreditation activities as well as quality rating initiatives. The CMO acts as an improvement catalyst for all quality-related efforts including CMS Star initiatives. Additionally, the CMO communicates with providers on new focus and measure/process changes, and supports all Clinical Quality initiatives and peer review processes including Quality of Care and Quality of Service issues. • Relationship Equity— The CMO maintains a strong working knowledge of all government mandates and provisions, working across the enterprise to implement and maintain compliant clinical programs and procedures. S/he is engaged in regular, proactive dialogue with our external constituents) in order to continuously improve health care to enrollees and better products for our customers. • Innovation— This CMO leads the clinical interface with care providers and UHC network management colleagues in efforts to transform the health system, including, but not limited to, UHC’s Accountable Care Platform, value-based contracting, clinical practice transformation, patient-centered medical homes, transparency initiatives such as UnitedHealth Premium® Designation, creative care management programs, high-performance networks, consumer engagement, and value-based benefit designs. • Growth – This CMO delivers the clinical value proposition focused on quality, affordability and service, in support of the sales and growth activities of the Health Plan including conducting Broker/Client presentations and participating in customer consultations. The CMO reviews and edits communications materials as required, and represents the voice of the market-based customer in program design. S/he actively promotes positive relations with State/local regulatory authorities and Medical Societies. • Focused Improvement – The CMO is responsible for identifying opportunities through participation in regional and local Medical Cost Operating Teams or Market reviews. Additional responsibilities include the timely collection and entry of information into Online Engagement Survey tools and scorecards; developing action plans for sub-optimal results; and taking a leadership role in United Clinical Services and Quality Affordability Programs initiatives. Demonstrable Skills and Experiences: • Proven record of executive leadership/clinical management in a hospital system or large practice group. • Drive change and innovation though continually seeking and implementing innovative solutions; create a culture that thrives on continuous change; inspire people to stretch beyond their comfort zone; take well-reasoned risk; challenge "the way it has always been done"; change direction as required • Ability to build a team through influence that values organizational success over personal success; drive exceptional performance by provide ongoing coaching and feedback; identify and invest in high-potentials; actively manage underperformance. • Execute with discipline and urgency: Deliver value to the customer; closely monitor execution; drive operational excellence; get directly involved when needed; actively manage financial performance; balance speed with analysis; ensure accountability for results. • Model and demand integrity and compliance • Proven ability to execute and drive improvements against stated goals. • Ability to develop relationships with network and community physicians and other providers. • Visibility and involvement in medical community. • Ability to successfully function in a matrix organization. Qualifications: • Active and unrestricted medical license for the assigned market(s); Board Certified in an ABMS or AOBMS specialty • 5+ years clinical practice experience; strong knowledge of managed care industry • Familiarity with current medical issues and practices • Excellent interpersonal communication skills; ability to influence in executive settings • Superior presentation skills for both clinical and non-clinical audiences • Proven ability to develop relationships with network and community physicians and other providers • Solid data analysis and interpretation skills; ability to focus on key metrics • Strong team player and team building skills • Strategic thinking with proven ability to communicate a vision and drive results • Solid negotiation and conflict management skills • Creative problem solving skills. • Proficiency with Microsoft Office applications (Outlook, Word, Excel, PowerPoint) • Ability to travel within the assigned market • Advanced Business, Public Health, Medical Management degree is a plus Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Appeals and Grievances Medical Director - Virtual - Tampa
newabout 12 hours ago
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Work at home! The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include: - Perform individual case review for appeals and grievances for various healthplan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies. - Perform Department of Insurance/Department of Managed Healthcare, and CMS regulatory responses. - Communicate with UnitedHealthcare medical directors regarding appeals decision rationales, and benefit interpretations. - Communicate with UnitedHealthcare Regional and Plan medical directors and network management staff regarding access, availability, network, and quality issues. -Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results. - Provide clinical and strategic input when participating in organizational committees, projects, and task forces. What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. Qualifications: -MD or DO with an active, unrestricted license -Board Certified in an ABMS or AOBMS specialty -5+ years clinical practice experience -Intermediate or higher level of proficiency with managed care -2+ years Quality Management experience - Excellent telephonic communication skills; excellent interpersonal communication skills. - Excellent project management skills. - Data analysis and interpretation skills. - Excellent presentation skills for both clinical and non clinical audiences. Familiarity with current medical issues and practices. - Creative problem solving skills. - Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills. - Strong team player and team building skills. Transforming health care and millions of lives starts with the values you embrace and the passion you bring. Find out more and join us. It's an opportunity to do your life's best work.SMCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Clinical Coverage Review Medical Director - Virtual - Oncology, Genetics or associated experience required
newabout 12 hours ago
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Clinical Coverage Review Medical Director - Oncology and Genetics The Medical Director provides physician support to Clinical Coverage Review (CCR) operations, the organization responsible for the initial clinical review of service requests for UnitedHealth Care (UHC). The Medical Director collaborates with CCR leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other UnitedHealth Care departments. Specific responsibilities: Conduct coverage review based on individual member plan documents, and national and proprietary coverage review guidelines, render coverage determinations, and discuss with requesting providers as needed in peer-to-peer telephone calls. Use clinical knowledge in the application and interpretation of UHC medical policy and benefit document language in the process of clinical coverage review for UnitedHealth Care. Conduct daily clinical review and evaluation of all service requests collaboratively with Clinical Coverage Review staff. Provide support for CCR nurses and non clinical staff in multiple sites in a manner conducive to teamwork. Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants; educates providers on benefit plans and UHC medical policy. Communicate with and assist Medical Directors outside CCR regarding coverage and other pertinent issues. Communicate and collaborate with other departments such as the Inpatient Concurrent Review team regarding coverage and other issues. Is available and accessible to the CCR staff throughout the day to respond to inquiries. Serve as a clinical resource, coach and leader within CCR. Access clinical specialty panel to assist or obtain assistance in complex or difficult cases. Document clinical review findings, actions and outcomes in accordance with CCR policies, and regulatory and accreditation requirements. Actively participate as a key member of the CCR team in regular meetings and projects focused on communication, feedback, problem solving, process improvement, staff training and evaluation and sharing of program results. Actively participate in identifying and resolving problems and collaborates in process improvements that may be outside own team. Provide clinical and strategic leadership when participating on national committees and task forces focused on achieving Clinical Coverage Review goals. Other duties and goals assigned by the medical director's supervisor. Qualifications: Active, unrestricted physician license. Current board certification in Oncology or Genetics or associated experience in ABMS or AOA specialty. 5+ years of clinical practice experience after completing residency training. 5+ years hands-on experience in utilization and coverage review in a health plan with Commercial membership. Substantial experience in using electronic clinical systems in the payer setting. Sound knowledge of the managed care industry. Strong belief in EBM (Evidence Based Medicine), and familiarity with current medical issues and practices. Solid PC skills, specifically using MS Word, Outlook, and Excel. Experience in other MS programs a plus. Supervisory skills, including clinical mentoring and coaching expertise preferred Data analysis and interpretation experience and skills. Project management background a plus. Competencies: Excellent telephonic and interpersonal communication skills. Team player and strong teambuilding skills. Creative problem solving skills. Excellent presentation skills for both clinical and non-clinical audiences. Transforming health care and millions of lives starts with the values you embrace and the passion you bring. Find out more and join us. It's an opportunity to do your life's best work.SMCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Behavioral Medical Director (Psychiatrist) New Jersey - Telecommute - Woodbridge Township
newabout 12 hours ago
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The Behavioral Medical Director position is responsible for providing oversight to and direction of the Utilization Management Program and performing peer reviews as necessary. This individual will interact directly with Psychiatrists, Behavioral Health Providers, and other clinical professionals who consult on various processes and programs. The Behavioral Medical Director is part of a leadership team that manages development and implementation of evidence-based treatments and medical expense initiatives and will also advise leadership on health care system improvement opportunities. They are responsible for maintaining the clinical integrity of the program, including timely peer reviews, appeals and consultations with providers and other community based clinicians, including general practitioners and will work collaboratively with the Health Plan Medical Director, Clinical, Network and Quality staff. At Optum, our clinical vision drives the team to improve the quality of care our consumers receive. Primary Responsibilities: Ensuring delivery of cost effective quality care that incorporates recovery, resiliency and person-centered services Responsible for Level of Care guidelines and utilization management protocols Responsible for oversight and management, along with the Clinical Director and Clinical Program Director, utilization review, management and care coordination activities Provide clinical oversight to the clinical staff, oversee the management of services at all levels of care in the benefit plan. Keep current regarding Evidence Based Practices and treatment philosophies including those that address Recovery and Resilience. Required Qualifications: Doctor of Medicine or Osteopathy Current license to practice as a physician without restrictions Board certified in Psychiatry Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation and recovery Knowledge of post-acute care planning such as home care, discharge planning, case management, and disease management Computer and typing proficiency, data analysis and strong organizational skills necessary Must be able to travel on site to state, health plan and provider meetings weekly. Preferred Qualifications: Minimum of 3 years of experience as a practicing psychiatrist post residency strongly preferred Sub specialty in Child & Adolescent or Addiction Psychiatry a plus Prior Managed care experience a plus Experience in public sector delivery systems and experience in state specific public sector services Experience working with community based programs and resources designed to aid the State Medicaid population Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work,(sm) *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: psychiatry, post-acute care planning, clinical application, data analysis, telecommute

Supervisor Tech Support - Overland Park, KS
newabout 12 hours ago
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Here, at Optum, you can showcase your passion and technical expertise among an elite team as you help to transform health care and change the way our businesses and consumers engage with technology. Sound exciting? Absolutely Our values are more than just words on inspirational posters; they are intrinsic to our culture, how we work together. Your performance will be measured not just in terms of technical achievements, but how you embody our values every day in your work with collaboration and communication skills. In this role you will be part of an OptumRx service team that supports the Dispensing operation at the Overland Park, KS facility. Although the Dispensing Operations are not 24/7, support is sometimes required outside of normal working hours, including weekends and holidays, depending on business needs. The dispensing application is named APS (Automated Pharmacy Service) which utilizes third-party software from vendors, e.g. QMSI (Quality Manufacturing Systems Inc.), Knapp, Creative Logistics Solutions. You will be expected to liaise with these vendors as needed. You will be leading a team of four people, and responsible for managing day to day support operations, liaising with the business, managing new projects and providing concise and accurate updates to leadership. The Overland Park facility is OptumRx's largest dispensing location, and critical to our members. Your primary responsibility will be to ensure that dispensing operations run as optimally as possible, preventing disruptions and outages. You will be expected to manage projects and upgrades prior to their implementation in production, while ensuring the business is not unnecessarily impacted or placed at risk. The IT team in Overland Park is currently sized at four people, and you would be responsible for managing day to day support operations, liaising with the business, vendors and other internal OptumRx teams, managing upgrade and patching projects and providing concise and accurate status updates to leadership. Primary Responsibilities: Assisting pharmacy technicians and systems operators with workstations, operating systems and infrastructure issues User applications and system configuration Hardware setup Troubleshooting issues Writing and maintaining SQL queries Working with the technical services support staff Serving as a key point of contact for the business and IT leadership Ensure that all SLAs are met, escalating any roadblocks to management as necessary Coordinate with other teams, e.g. facilities, workflow, to ensure no unplanned outages to the APS network or application Perform and review setup of monitoring software and for providing reporting parameters Review project status and make adjustments to meet expected timelines on all APS projects Organize and submit Change Requests, manage Incidents and Problem tickets and support projects / initiatives Manage the documentation of all APS processes Required Qualifications: High School Diploma or GED Experience of systems administration experience Experience with Windows systems, including Wintel and Windows Server Experience with PC troubleshooting Network knowledge Strong organizational and communication skills Preferred Qualifications: Helpdesk / IT support experience Team / Project leadership experience Experience writing SQL Disaster Recovery experience Altiris experience Technology Careers with Optum. Information and technology have amazing power to transform the health care industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life's best work.SM Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Title: Supervisor Tech Support - Overland Park, KS Shift: Day Job Travel: No Business: Optum Tech CIO Organization Family: Information Technology Telecommuter Position: No Job Level: Manager Overtime Status: Exempt Posted Date: 7/3/2018 City: Overland Park State: KS Country: United States Department: OptumRx IT - provided by Dice Automated, CIO, Disaster Recovery, Genetic, Hardware, Manager, Management, PC, Project, SQL, Supervisor, Windows

Bilingual Chinese / English Phone Advocate - New York, NY - UnitedHealth Group
newabout 13 hours ago
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Welcome to one of the most fulfilling ways to help people. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work. The purpose of this role is to interact with members regarding medical and pharmacy benefits, eligibility and claims issues and to assist with plan selection and enrollment in Medicaid and DSNP Service. This role is expected to identify opportunities to connect members to the best resources to meet their healthcare needs and provide support in order to resolve medical and benefits issues on behalf of a member. The Bilingual Chinese & English Phone Advocate builds trust with members across their health care lifecycle. Primary Responsibilities: Act as a customer advocate and provide in language phone service to Chinese and English speaking customersOwn problem through to resolution on behalf of the member in real time or through comprehensive and timely follow - up with the memberRespond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claimsProactively educate members on cover benefits, plan exclusions, and procedures to enhance total customer service experienceMaximize use of community services, support programs, and resources available to membersAssist and involve in member retention projectsPerform other related projects and duties as assignedMeet established performance standardsRequired Qualifications: High School Diploma / GED or higherBilingual fluency (verbal and written) in Chinese (Mandarin and Cantonese) and English2 + years in a Customer Service environment (proven customer service skills and experience working in retail, call centers, or any other professional business setting)1+ year moderate proficiency with Windows PC applications (MS Excel - navigation and creating spreadsheet, Word - navigation and creating documents)Ability to learn new and complex computer system applicationsUpon hire you must successfully complete the UnitedHealthcare Operations new hire training and demonstrated proficiencyAvailability to work from 9AM - 6:30PM Monday - Friday and work scheduled shifts within our hours of operation where lunches and breaks are scheduled, with the flexibility to adjust daily schedule Preferred Qualifications: Associate’s Degree or higherExperience in Health Care / Insurance environment, preferred (familiarity with medical terminology, health plan documents, or benefit plan design) Physical Requirements and Work Environment: Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computerService center environment with moderate noise level due to phone and walk - in conversation, printers, and floor activities Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in healthcare here. We serve the healthcare needs of low income adults and children with debilitating illnesses such as Cardiovascular Disease, Diabetes, HIV / AIDS and High - risk Pregnancy. Our holistic, outcomes - based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive Healthcare, Community, and Government partners to heal healthcare and create positive change for those who need it most. This is the place to do your life’s best work.SM Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: UHG, United Healthcare, Customer Service Advocate, Medicaid and DSNP service, Bilingual Mandarin / Cantonese / English 

Storefront Advocate4Me Representative - The Villages, FL - UnitedHealth Group
newabout 13 hours ago
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Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work. Even if you have no prior experience, we have training classes starting soon to help you build the successful career that you want - apply today!Turn on the news on any night of the week and you're likely to hear about the changes that are sweeping through our health care system. It's dramatic. It's positive. And it's being led by companies like UnitedHealth Group. Now, you can take advantage of some of the best training and tools in the world to help serve our existing and new customers. You'll take as many as 50 - 70 calls per day from customers who have questions about their health benefits. As their advocate, you'll use your personality and our tools to help them through the health care benefits available to them, including helping them enroll in a new plan. This is no small opportunity. As a Storefront Advocate4Me Representative, you'll compassionately deliver an exceptional experience to members between 20 to 25 callers per day and 15 - 20 walk - ins, always remembering that there is a real person on the other end of the phone who is looking for help, guidance, and support. You'll also provide support to your team members by serving as a resource or subject matter expert. Both of these are opportunities for you to identify and exceed our customer expectations by committing to and building strong relationships internally and externally. At the end, you’ll know you performed with integrity and delivered the best customer service experience making all your customers and team members feel better because they talked to you. This position is full - time (40 hours / week) with our site Hours of Operation from 8:30 AM to 5:00 PM Monday - Friday. We do require our employees to be flexible enough to work any shift, any day of the week during those hours.UnitedHealth Group is a team of more than 200,000 people who are building career success through commitment, compassion and a desire to make a difference. Join us. Learn more about how you can start doing your life's best work.SMPrimary Responsibilities:Serve as a resource or Subject Matter Expert (SME) for other team members or internal customersHandle escalated calls, resolving more complex customer issues in a one and done mannerAssist with member walk - ins at the store locationAnswer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systemsIntervene with care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when neededAssist customers in navigating UnitedHealth Group websites and encourage and reassure them to become self - sufficientOwn problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow - up with the memberResearch complex issues across multiple databases and work with support resources to resolve customer issues and / or partner with others to resolve escalated issuesProvide education and status on previously submitted pre - authorizations or pre - determination requestsMeet the performance goals established for the position in the areas of: efficiency, call quality, provider satisfaction, first call resolution and attendanceRequired Qualifications:High School Diploma / GED or higher 1+ years of Customer Service Representative (CSR) experience or 1+ years of experience in an office setting, call center setting, or phone support roleExperience with computer and Windows PC applicationsExperience working with MedicareAbility to work shift during the hours of operation Monday through Friday, 8:30 AM - 5:00 PM including the training period where lunches and breaks are scheduled, and work overtime and / or weekends as neededAbility to successfully complete the Customer Service training classes and demonstrate proficiency of the materialPreferred Qualifications:Associate's Degree (or higher) in HealthcareSoft Skills:Ability to show compassion and be empatheticAbility to learn new and complex computer system applicationsAbility to multi - task duties as well as the ability to understand multiple products and multiple levels of benefits within each productCareers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in healthcare. And we are the largest business in the nation dedicated to serving their unique health and well - being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our Healthcare system. Ready? It's time to do your life’s best work.SMDiversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.Keywords UHG, UnitedHealth Group, The Villages, FL, Advocate 

Workforce Management Representative - Columbia, MD - UnitedHealth Group
newabout 13 hours ago
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Energize your career with one of Healthcare’s fastest growing companies. You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader. Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance. Turn on the news on any night of the week and you're likely to hear about the changes that are sweeping through our health care system. It's dramatic. It's positive. And it's being led by companies like UnitedHealth Group. Here's where you come in. With the goal of ensuring the highest quality of operations and services, you'll be responsible for all scheduling, call volume monitoring and adjustments. You'll help determine and communicate work schedules and assign resources for various call queues and interface with site leaders to ensure adequate staff, contingency plans and workflow monitoring. This is no small opportunity. This role is equally challenging and rewarding. You'll need to ensure consistent methodologies are followed to maintain quality and support the preparation of ad hoc analysis that enables strong understanding of the business. You'll also create all production based reporting and ensure achievement of all metrics for telephone quality assurance. Positions in this function are responsible for all scheduling, call volume monitoring and adjusting. Responsible for determining and communicating work schedules, resources for various call queues. Works with site leaders to ensure adequate staff, contingency plans and workflow monitoring. Primary Responsibilities: Use workforce management software and call volume history to help manage daily staffing levels and to determine the most effective methods for staffing adjustmentsUtilize call center tools to observe agents' actual state compared to scheduled stateManage real - time inbound call traffic to help ensure that service levels are metGain an understanding of the technical and business solutions: optimized schedules, forecasts and other tools and present them to managementPrepare and maintain reports, dashboards and monthly packagesExtensive work experience within own functionWork is frequently completed without established procedures.Works independentlyMay act as a resource for othersMay coordinate others' activities Requirements: High School Diploma / GED (or higher) 2+ years' experience working in a call center and / or transaction siteIntermediate level of experience with Microsoft Excel (i.e. creating spreadsheets, v - lookups, pivot tables, etc.)Basic level of experience with Microsoft Word (ability to create, edit, save, and send documents)Ability to work a flexible schedule, including weekends Preferred Qualifications: 2+ years experience with workforce systems such as Avaya, CMS, IEX, eWFM, Genesis and / or Blue PumpkinBachelor's degree (or higher) in a related field of studyWorkforce management experience Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: Traffic, Workforce, Representative, Monitor, Customer Service 

Service Account Manager Associate - Lewisville, TX - UnitedHealth Group
newabout 13 hours ago
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It's a big step forward when you realize that you've earned the trust to lead a team. Now, let's determine just how big that step can be. Take on this role with UnitedHealth Group and you'll be part of a team that's reshaping how health care works for millions. Now, you can take advantage of some of the best resources and tools in the world to help serve our members. You'll play a lead role in a high volume, focused and performance driven call center where the goal is always to connect with members and enhance the customer experience. This is no small opportunity. This is where you can bring your compassion for others while building your career. This role is equally challenging and rewarding. Within a high volume environment, you'll need to model and act as an Ambassador for the company while solving complex health care inquires The Associate Service Account Manager acts as a customer advocate to resolve escalated and complex issues.Positions in this function are responsible for first - level response and resolution of escalated issues with external and internal customers. Responsible for the overall delivery of benefits and services by providing support and guidance to existing and potential customers to ensure continued membership. *Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.Primary Responsibilities:Provide expertise and customer service support to members, customers, and/or providers Serve as the liaison to a complex customer base to manage first level response and resolution of escalated issues with external and internal customersIdentify and resolve operational problems using defined processes, expertise and judgment Investigate claim and/or customer service issues as identified and communicate resolution to customersProvide feedback to team members regarding improvement opportunitiesExtensive work experience within own function.Work is frequently completed without established procedures.Works independently.May act as a resource for others. May coordinate others' activities.Required Qualifications:High School Diploma/GED (or higher) 3+ years of medical billing and/or medical insurance claimsExperience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, work within tables), and Microsoft Outlook (email and calendar management)Preferred Qualifications1+ years of customer service experience analyzing and solving customer problemsSoft Skills:Ability to multi-task including ability to understand multiple products and multiple levels of benefits within each product Ability to communicate across multiple departments Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.SMDiversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.Keywords: Collections, medical billing, healthcare, insurance, customer service  

Billing Supervisor -West Hills, CA
newabout 13 hours ago
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We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. Yes, we share a mission that inspires. We need your organizational talents and business discipline to help fuel ours. It's the opportunity to do your life's best work.(sm) Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.This role will involve supervising remote employees performing automation tasks and researching account receivables. The ideal candidate is able to manipulate, analyze, and interpret data using Access, Excel, SQL and VBA and be able to provide answers to business questions and billing issues found through analyzing data. Primary Responsibilities: Manipulate, analyze, and interpret large amounts of data using Access, Excel, SQL and VBA Automate processes and reports Recognize inefficiencies in processes (operational or technical) Design solutions to address billing issues Pull Adhoc reports from various billing systems Perform Data validation of data to ensure accuracy and quality. Data mining for advanced analysis of data presented in reports for management. Analyze insurance medical billing denials to identify trends Recommend solutions to decrease Bad Debt and increase cash for receivables from laboratory tests Assist Billing department in the resolution of billing issues Provide feedback to Senior Management regarding contractual issues impacting Revenue Services Collaborate with other business units and departments on analysis projectsRequirements: Bachelor's Degree or higher 6+ months of experience as a team lead, coach, mentor or supervisor 1+ years of work experience in Healthcare or Revenue Cycle management / Billing / Accounts Receivable 1+ years of working in Microsoft Excel functions such as v - look ups, pivot tables, filtering, sorting and analyzing data on reports Ability to work Monday - Friday (8 hours) 7:00 am to 3:30 pm plus a rotating 3 hour shift on a weekend day every 6 weekends Preferred Qualifications: BS / BA Degree (or higher) in Mathematics, Statistics, Finance, Economics, or Computer Science 1+ years of business analysis experience Previous experience implementing cross - functional initiatives Advanced Excel (create, sort, and edit column data in spreadsheets) and Access (create and utilize desktop database) skills with programming knowledge using VBA and SQL Experience with Insurance Health Plans or HMOs Soft Skills: Ability to work to consistent high standard under pressure Ability to work under fast paced environment and adapt to ever changing priorities High degree of accuracy and attention to detail required Demonstrate problem - solving and strong analytical skills Able to multitask on multiple small to complex projects / tasks and meet deadlines Willingness to undertake additional responsibilities as required Self - motivated, able to work in a team and demonstrates the ability to work independently Demonstrated ability to clearly communicate complex issues to all levels of management Excellent organizational, interpersonal and communication (written and verbal) skills Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.SM Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: Analyst, Analysis, Analytical, Accounting, Finance, Mathematics, Statistics, Engineering, Computer Science, VBA, Visual Basic for Applications, programming, Billing, Revenue Services, Data, Excel, Access, SQL, vlookup, Revenue, Business, Greenbelt, Green belt, Automation, Process Improvement, Healthcare, HMO, IPA, Insurance, Project Management 

Bilingual (English / Spanish) Customer Service Scheduling Representative - Sandy, UT - UnitedHealth Group
newabout 13 hours ago
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Are you ready for a job that could lead to new career opportunities? If you have basic work skills - from an office, retail or hospitality environment, UnitedHealth Group provides the support to help you advance. Apply today as our training classes start every week. You like working with people. Even more so, you like helping them. This is your chance to join a team dedicated to helping our members every day. As a member of our Customer Service Scheduling team, you’ll be responsible for receiving inbound calls and scheduling non-emergency medical transportation. This is where you can bring your compassion for others while doing your life’s best work. SMThis Bilingual Customer Service Scheduling Representative position is full-time (40 hours/week) Monday-Friday. Our shift schedules are 8 hours with starting times from 6:00 am to 11:30 am. It may be necessary, given the business need, to work occasional overtime or weekends. Competitive pay of $15.00/hour. Our office is located at 280 W. 10200 S, Suite 210, Sandy, UT. Employees in this position have the potential to telecommute after 3 months of employment, depending on meeting performance metrics and UnitedHealth Group telecommuter guidelines.What are the reasons to consider working for UnitedHealth Group? With offices throughout the country and even globally, the career options are endless. Put it all together competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success.Some of our offerings includes: 18 days of Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays Medical Plan options along with participation in a Health Spending Account or a Health Saving account Dental, Vision, Life& AD&D Insurance along with Short term disability and Long-Term Disability coverage 401(k) Savings Plan, Employee Stock Purchase Plan Education Reimbursement up to $5,250 per calendar year for job related coursework Adoption Assistance Plan Employee Discounts Employee Assistance Program Employee Referral Bonus Program Business Casual Dress Code Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) More information can be downloaded at: http://uhg.hr/uhgbenefitsPrimary Responsibilities Respond to incoming calls from members and assists them with scheduling non-emergency medical transportation (i.e. doctor appointments, physical therapy appointment or radiology appointment) with their preferred providers at their preferred location. Ensures communication completed in a timely manner with members/patients, home health aides, physicians and medical facilities Supports the member and others by answering their questions and concerns to include cancelling or rescheduling appointments based on members requests Observes at all times the required HIPAA standards to protect private information Enters into computer system the required documentation on members, the scheduling arranged and the communication provided. Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, call resolution and attendanceRequired Qualifications Demonstrated proficiency in English and Spanish An education level of at least a high school diploma or GED or 10 years equivalent experience Prior experience in an office setting, call center setting, or phone support role is a plus Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs Ability to remain focused and productive each day though tasks may be repetitiveUnitedHealth Group is working to create the health care system of tomorrow. Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.Keywords: customer service representative, customer service, CSR, UnitedHealth Group, call center, UnitedHealthcare, health care, office, phone support, training class, admin, clerk, cashier, retail, entry level, retail sales, hostess, waitress/waiter, appointment setter, appointment scheduler, NMT, National Med Trans, medical transportation, Spanish, Bilingual 

Licensed EAP Counselor (Eventual Telecommute) - San Francisco, CA - UnitedHealth Group
newabout 13 hours ago
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For those who want to invent the future of health care, here's your opportunity. We're going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work. (sm) Licensed EAP Counselors conduct telephonic and on-line (chat) with individual members. EAP Counselors use clinical expertise to conduct a thorough assessment of risk to self or others, clinical screening for substance abuse and medical co-morbidities for member calls. Solution Focused Consultation, Motivational Interviewing and short term problem resolution are the clinical modalities used to develop an individualized action plan. Within the context of the consultation, the EAP Counselors guide individuals to appropriate benefits and resources provided by employer, community, and other cross-carrier vendors. EAP Counselors coordinate and facilitate the response to high risk situations through consultation with licensed staff. In addition, EAP Counselors are the National Point of Contact (NPOC) for non-licensed EAP Specialists. Licensed Counselors provide clinical consultation and mentorship to non-licensed EAP Specialists. ***This position has a required schedule of Monday-Friday, 1:45pm - 10:15pm (after applicable training). The position starts out office-based, and will eventually allow for telecommute depending on performance and business needs*** Primary Responsibilities: Conduct telephonic and on-line (chat) consultations with individual members Engage individually with members to clinically and holistically assess the reason for call and presenting needs including issues impacting the individual’s personal wellbeing, emotional and physical health, and personal safety Independently conduct thorough assessment of risk of harm to self, or others; assist with safety planning and coordinating services with emergency personnel and hospital staff in order to access appropriate level of care and ongoing support. Coordinate follow-up care and services to individuals and organizations, as appropriate Develop next steps and identify meaningful goals and resources utilizing Solution Focused Consultation model Provide appropriate type of service based on member’s presentation, clinical history and needs and accurately differentiate between EAP and BH services Formulate short term problem resolution plan of action, and provide full Benefit Exploration reviewing the appropriate tools and resources to support the plan, and offer and refer clients to additional benefits including access to Health Coaches, Health Advisors, and community resources as appropriate Authorize additional services including behavioral health, and/or contracted EAP and behavioral health network providers Formulate and document accurate description of member’s clinical presentation in their individual clinical records and maintaining appropriate records, case notes, forms and reports as well as database entries Provide resources, consultation, coaching and guidance to non-licensed EAP Specialists as designated National Point of Contact Provide consultation and disposition on ‘risk’ calls with non-licensed EAP Specialists Maintain appropriate confidentiality Participate in staff meetings, case consultations, and training opportunities Consult as required with licensed peers and supervisors Required Qualifications: A Master’s degree in psychology, social work or related mental health field Active, unrestricted independent mental health license in the state of California, such as Licensed Psychologist (L.P.), LMFT, LPC, or LCSW, etc. 3+ years of post-graduate experience in a behavioral health setting Strong written, verbal and interpersonal skills are required. Must be able to use various computer applications and move through computer screens while talking with members Must live within a commutable distance of our San Francisco office location Preferred Qualifications: Previous EAP experience CEAP (Certified Employee Assistance Professional) Experience working in a call center environment Experience working with domestic abuse victims Experience working in a crisis center/hotline Ability to work with a culturally and geographically diverse population Able to address a variety of problems and issues as presented by callers Ability to work flexibly and creatively with other professional team members Demonstrate the ability to build rapport, assess and address risk, and develop goals with members in a telephonic, and/or online Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: EAP Counselor, EAP Consultant, Crisis Calls, Social Worker, Therapist, Counselor, Marriage and Family Therapist, Psychologist, Licensed Professional Counselor, LPC, LCSW, LMFT, Employee Assistance Program, San Francisco, CA, California 

Associate Employer Installation Specialist - US Telecommute - Phoenix
newabout 13 hours ago
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Energize your career with one of Healthcare’s fastest growing companies. You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader.Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation and Performance.Working in Operations at UnitedHealth Group is one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SMPosition in this function are responsible for the installation of assigned accounts, including, but not limited to: structure building and billing set up, structure revisions, researching & resolving structure issues, database loading, and preparation of plan materials such as administrative documents and customer education materials. Positions are responsible for overall employer contract loading using various databases and / or source documents. May research installation issues & develop customer specific resolutions. May include auditing contract loads for adherence to quality measures and reporting standards.Primary Responsibilities:Audit contract load for adherence to quality measures and reporting standardsResearch errors by comparing Account Management documentation against multiple internal systemsAnalyze and Research techniques to trend or quantify projects Prepare, process, and maintain new group installation and renewalsRespond to member eligibility or group questions and verify enrollment statusReconcile reports and group set up discrepancies, as well as analyzing transactional data and submitting retroactive eligibility changesResearch and respond to all claims processing inquiries from Client Management, Clinical, and other internal departments.Perform claim testing to ensure accurate claim adjudicationConduct installation of assigned accounts, including, but not limited to: structure building and billing set up, structure revisions, researching and resolving structure issues, database loading, and preparation of plan materials such as administrative documents and customer education materialOverall employer contract loading using various databases and / or source documents. May research installation issues & develop customer specific resolutions which may include auditing contract loads for adherence to quality measures and reporting standardsPerform other duties as assignedBasic, structured, standard approach to workKey Work and Accountabilities (Guidelines)Develop decision trees (DTs) in RxAuth & Pega RXAUTH & PAS using plan specific clinical guideline criteriaDocument testing of changes to or creation of DTsManage DT life cycle to ensure completion in accordance with deployment scheduleWork with RxAuth & RXAUTH & PAS IT support to overcome environmental challengesReview client PA survey and ensure all key attributes exist for successful installMaintain Pega RXAUTH & PAS decision & data tables for appropriate case processingTriage RXAUTH & PAS Change Request, identify enhancement vs. biz rule updateCollaborate with RXAUTH & PAS dev team to provide solutions where possibleWork with RXAUTH & PAS IT support to overcome environmental challengesKey Competencies / Capabilities needed to perform this roleUtilize and understand Pega RXAUTH & PAS business rule functionality to provide "business configurable" solutionsAble to identify system vs. user errorListen to, understand, and anticipate solutionCritical thought process and analytical skillsBasic proficiency with MS Excel & WordAbility to drive task to completion despite significant challenges (collaborate, communicate)Required Qualifications:High School Diploma / GED or higher1+ years of experience in a healthcare insurance environment using the telephone and computer as the primary instruments to perform job duties1+ year of experience in a PBM environment performing a benefit related function. Proficiency with Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications Intermediate level of Microsoft Excel, must be able to navigate, create, open, a save a spreadsheet. Must have the ability to sort, filter, and search spreadsheets as well as create formulas. Data Entry experience (45+ WPM)Must be available to work a scheduled 8 hours shift within the hours of 8:00 - 5:00pm, Monday through Friday with the possibility of working overtime either before, after, or on a day other than your scheduled day.1+ years of AS400 and RX Claim ExperiencePreferred Qualifications: Ability to be flexible and work independently with minimal supervision as well as in a team setting within a constantly changing environmentUndergraduate degree or higher - pharmacy or healthcare fieldsPharmacy Technician and / or CPHT LicenseQuality assurance experienceProficiency with MS Word, Access and PowerPoint 5+ years of experience in a healthcare insurance environment using the telephone and computer as the primary instruments to perform job duties2+ year of experience in a PBM environment performin a benefit related functionSelf-directed and the ability to prioritize caseloads based on business and customer needsSoft Skills:Ability to be flexible and work independently with minimal supervision as well as in a team setting within a constantly changing environmentSelf - directed and the ability to prioritize caseloads based on business and customer needsPhysical Requirements and Work Environment: Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, and long periods working at a computerService center environment with moderate noise level due to Representatives talking, computers, printers and floor activityOptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do. If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life’s best work.SMDiversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: Prior auth, prior authorization, PBM, Pharmacy, pharmacy technician, RXAUTH, PAS, RXClaim, Sharepoint, Business Rules, PresPlus Share, NewLeaf, Optum, OptumRx, UnitedHealthcare, UnitedHealthcare Group 

Service Account Manager - Irving, TX
newabout 13 hours ago
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Turn on the news on any night of the week and you're likely to hear about the changes that are sweeping through our health care system. It's dramatic. It's positive. And it's being led by companies like UnitedHealth Group. Now, you can take advantage of some of the best resources and tools in the world to help serve our members. You'll play a leadership role in a high volume, focused and performance driven call center where the goal is always to connect with members and enhance the customer experience. This is no small opportunity.This role is equally challenging and rewarding. Within a high volume environment, you'll need to model and act as an Ambassador for the company while solving complex health care inquires The Service Account Manager acts as a customer advocate to resolve escalated and complex issues.Positions in this function are responsible for first-level response and resolution of escalated issues with external and internal customers. Responsible for the overall delivery of benefits and services by providing support and guidance to existing and potential customers to ensure continued membership. Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.Primary Responsibilities:Provide expertise and customer service support to members, customers and / or providersServe as the liaison to a complex customer base to manage first level response and resolution of escalated issues with external and internal customerIdentify and resolve operational problems using defined processes, expertise and judgment Investigate claim and / or customer service issues as identified and communicate resolution to customersProvide feedback to team members regarding improvement opportunitiesExtensive work experience, possibly in multiple functions. Work does not usually require established proceduresWorks independently.Mentors others.Acts as a resource for others.Coordinates others' activities.Required Qualifications: High School Diploma / GED (or higher)2+ years of customer service experience analyzing and solving customer problemsProficiency with Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications Ability to multi - task including the ability to understand multiple products and multiple levels of benefits within each product Preferred Qualifications:2 + years of call center / or account management experience UnitedHealth Group is a team of more than 260,000 people who are building career success through commitment, compassion and a desire to make a difference. Join us. Learn more about how you can start doing your life's best work.SMCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.Keywords: Account Manager, Service Manager, Client Manager, Customer Service Manager, Client Account Manager 

Recovery / Resolutions Analyst - Eden Prairie, MN - UnitedHealth Group
newabout 13 hours ago
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The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. As part of our Recovery and Resolutions team, you'll help understand and overcome errors in claims processing. You'll have all the tools and backing you need to help manage subrogation files, negotiate settlements and ensure adherence to compliance policies. All the while, you'll be building your career with a leader and reaching for the highest levels of performance as you do your life's best work.SM The Recovery / Resolution Analyst handles information about patient services and how the services are paid by investigating and pursuing recoveries through contact with various parties. Primary Responsibilities: Perform investigation on tips / allegations to identify potential Fraud, Waste, Abuse, or Error (i.e. internet research, review claims history on various platforms and FWAE databases), based on applicable Job Aids Perform member and provider interviews, and review medical documentation as needed Document in a professional manner the investigation activities that were performed on tips and allegations Adjust claims as needed based on investigation performed Refer tip / allegation to the appropriate internal team Communicate with clients and business partners as needed Submit CMS reporting as required Ensure adherence to state and federal compliance policies and reimbursement policies Adhere to turn around time standards Meet and maintain minimum quality and productivity Required Qualifications: High School Diploma / GED (or higher) 1+ years of insurance or fraud investigation experience 2+ years of insurance experience with one or more of the following: Claim Processing, Provider Demographic Information or Insurance Billing Practices Proficiency within Microsoft Excel (ability to create pivot tables, and use spreadsheet for tracking) Must be available to work 7:00am - 3:30pm, Monday - Friday Preferred Qualifications: 2+ years of experience in criminal justice, legal or fraud investigation Experience in working with claims platforms Professional Certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar Familiar with CPT code terminology Physical and Work Environment: Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So, when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: recovery/resolutions analyst, claims platforms, claims processing, insurance billing practices, Eden Prairie, MN 

Behavioral Medical Director (Psychiatrist) Philadelphia, PA - Telecommute
newabout 13 hours ago
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The Behavioral Medical Director position is responsible for providing oversight to and direction of the Utilization Management Program and performing peer reviews as necessary. This individual will interact directly with Psychiatrists, Behavioral Health Providers, and other clinical professionals who consult on various processes and programs. The Behavioral Medical Director is part of a leadership team that manages development and implementation of evidence-based treatments and medical expense initiatives and will also advise leadership on health care system improvement opportunities. They are responsible for maintaining the clinical integrity of the program, including timely peer reviews, appeals and consultations with providers and other community based clinicians, including general practitioners and will work collaboratively with the Health Plan Medical Director, Clinical, Network and Quality staff. At Optum, our clinical vision drives the team to improve the quality of care our consumers receive. Primary Responsibilities: Ensuring delivery of cost effective quality care that incorporates recovery, resiliency and person-centered services Responsible for Level of Care guidelines and utilization management protocols Responsible for oversight and management, along with the Clinical Director and Clinical Program Director, utilization review, management and care coordination activities Provide clinical oversight to the clinical staff, oversee the management of services at all levels of care in the benefit plan Keep current regarding Evidence Based Practices and treatment philosophies including those that address Recovery and ResilienceRequired Qualifications: Doctor of Medicine or Osteopathy Current license to practice as a physician without restrictions Board certified in Psychiatry Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation and recovery Knowledge of post-acute care planning such as home care, discharge planning, case management, and disease management Computer and typing proficiency, data analysis and strong organizational skills necessary Must be able to travel to Philadelphia, PA for client audits and Care Advocacy team meetings Preferred Qualifications: Minimum of 3 years of experience as a practicing psychiatrist post residency Sub specialty in Child & Adolescent Psychiatry Prior Managed care experience Experience in public sector delivery systems and experience in state specific public sector services Experience working with community based programs and resources designed to aid the State Medicaid population Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: Psychiatrist, Behavioral, Clinical, Telecommute, Utilization, Work From Home

Clinical Coverage Review Medical Director - Virtual - Hawaii Preferred
newabout 13 hours ago
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Clinical Coverage Review Medical Director The Medical Director provides physician support to Clinical Coverage Review (CCR) operations, the organization responsible for the initial clinical review of service requests for UnitedHealth Care (UHC). The Medical Director collaborates with CCR leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other UnitedHealth Care departments. Specific responsibilities: Conduct coverage review based on individual member plan documents, and national and proprietary coverage review guidelines, render coverage determinations, and discuss with requesting providers as needed in peer-to-peer telephone calls. Use clinical knowledge in the application and interpretation of UHC medical policy and benefit document language in the process of clinical coverage review for UnitedHealth Care. Conduct daily clinical review and evaluation of all service requests collaboratively with Clinical Coverage Review staff. Provide support for CCR nurses and non clinical staff in multiple sites in a manner conducive to teamwork. Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants; educates providers on benefit plans and UHC medical policy. Communicate with and assist Medical Directors outside CCR regarding coverage and other pertinent issues. Communicate and collaborate with other departments such as the Inpatient Concurrent Review team regarding coverage and other issues. Is available and accessible to the CCR staff throughout the day to respond to inquiries. Serve as a clinical resource, coach and leader within CCR. Access clinical specialty panel to assist or obtain assistance in complex or difficult cases. Document clinical review findings, actions and outcomes in accordance with CCR policies, and regulatory and accreditation requirements. Actively participate as a key member of the CCR team in regular meetings and projects focused on communication, feedback, problem solving, process improvement, staff training and evaluation and sharing of program results. Actively participate in identifying and resolving problems and collaborates in process improvements that may be outside own team. Provide clinical and strategic leadership when participating on national committees and task forces focused on achieving Clinical Coverage Review goals. Other duties and goals assigned by the medical director's supervisor. Qualifications: Active, unrestricted physician license. Current board certification in ABMS or AOA specialty. 5+ years of clinical practice experience after completing residency training. 5+ years hands-on experience in utilization and coverage review in a health plan with Commercial membership. Substantial experience in using electronic clinical systems in the payer setting. Sound knowledge of the managed care industry. Strong belief in EBM (Evidence Based Medicine), and familiarity with current medical issues and practices. Solid PC skills, specifically using MS Word, Outlook, and Excel. Experience in other MS programs a plus. Supervisory skills, including clinical mentoring and coaching expertise preferred Data analysis and interpretation experience and skills. Project management background a plus. Competencies: Excellent telephonic and interpersonal communication skills. Team player and strong teambuilding skills. Creative problem solving skills. Excellent presentation skills for both clinical and non-clinical audiences. Transforming health care and millions of lives starts with the values you embrace and the passion you bring. Find out more and join us. It's an opportunity to do your life's best work.SMCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Behavioral Medical Director NYC area
newabout 13 hours ago
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For those who want to invent the future of health care, here's your opportunity. We're going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) We have a unique opportunity to become part of United HealthGroup/ Optum Behavioral Health, one of the largest behavioral networks nationally with more than 130,000 clinicians and facilities. For us, what matters most is making the health care system work better for members and providers, partnering with them to achieve the best possible outcomes. The Behavioral Medical Director position is a fully administrative role based in the Greater NYC area and has a leadership team overseeing the largest community plan in the country with nearly 240,000 covered lives. We take a unique, focused and dedicated approach to managed care, centered on the member and grounded in collaboration both within our organization and with our community providers. We’re looking for a Psychiatrist who shares our vision dedicated to health care that integrates the medical, behavioral and social needs of our members. In addition, the Behavioral Medical Director is responsible for providing oversight to and direction of the Utilization Management Program and performing peer reviews as necessary. This individual will interact directly with Psychiatrists, Behavioral Health Providers, and other clinical professionals who consult on various processes and programs. The Behavioral Medical Director is part of a leadership team that manages development and implementation of evidence-based treatments and medical expense initiatives and will also advise leadership on health care system improvement opportunities. They are responsible for maintaining the clinical integrity of the program, including timely peer reviews, appeals and consultations with providers and other community based clinicians, including general practitioners and will work collaboratively with the Health Plan Medical Director, Clinical, Network and Quality staff. At Optum, our clinical vision drives the team to improve the quality of care our consumers receive. Primary Responsibilities: Ensuring delivery of cost effective quality care that incorporates recovery, resiliency and person-centered services Responsible for Level of Care guidelines and utilization management protocols Responsible for oversight and management, along with the Clinical Director and Clinical Program Director, utilization review, management and care coordination activities Provide clinical oversight to the clinical staff, oversee the management of services at all levels of care in the benefit plan Keep current regarding Evidence Based Practices and treatment philosophies including those that address Recovery and ResilienceRequired Qualifications: Doctor of Medicine or Osteopathy Current license to practice as a physician without restrictions in the state of NY Board certified in Child & Adolescent Psychiatry Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation and recovery Knowledge of post-acute care planning such as home care, discharge planning, case management, and disease management Computer and typing proficiency, data analysis and strong organizational skills necessary Preferred Qualifications: Minimum of 3 years of experience as a practicing psychiatrist post residency Prior Managed care experience Experience in public sector delivery systems and experience in state specific public sector services Experience working with community based programs and resources designed to aid the State Medicaid population Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: Psychiatrist, Behavioral, Clinical, Physician, New York, Children

Medicare Sales Rep, Community Plan - Phoenix, AZ - UnitedHealth Group
newabout 13 hours ago
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You want to do work that really matters. We want to bring more health resources and better solutions to the most vulnerable and least served members in our communities. This sounds like the perfect match. In this role you can work with state and federal government agencies, physicians and other providers, to bring greater care to more than three million people. Make a difference in the lives of those in your own community and a career with UnitedHealthcare Community Plan will allow you to do just that! Your performance will be rewarded! **** This is an outside/ field sales position **** If you are located in the state of Arizona, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: Interact with senior population aged 65+ and conduct presentations at their group/centers, churches, homes, etc. to sell and promote Medicare product Travel throughout an assigned territory and work directly with community-based organizations, providers, and other sources to obtain referrals Manage your travel and territory efficiently to produce maximum results Meet with eligible participants with the goal of enrollment and presenting product information Generate own leads - some sales leads are company provided Execute excellent communication, interpersonal, time management and organizational skills Apply strong sales acumen skills in generating and closing leadsRequired Qualifications: Undergraduate degree or equivalent years of experience Active health insurance license 1+ years of managed care, outside sales or territory management experience Ability to travel up to 100% of the time within assigned NY sales territory Live within a commutable distance of the assigned NY sales territory Proficiency in MS Office (Outlook, Word, Excel and Power Point) Preferred Qualifications: Bilingual Prior experience selling Medicare Advantage or Dual Eligible Special Needs Plan (D-SNP) Established professional contacts or active within the community (i.e. non - profits, health providers, community or faith based organizations, etc.) Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV / AIDS and high - risk pregnancy. Our holistic, outcomes - based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm) *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: health license, D - SNP, Dual Eligible Special Needs Plan, Medicare, Medicare Advantage, Sales Enrollment Representative, Sales, Healthcare, Bilingual, Medicare Sales, Sales Agent, Phoenix, AZ, Arizona, managed care, Affordable Care Act, ACA 

Service Account Manager - Wauwatosa, WI and US Telecommute - Horsham
newabout 13 hours ago
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yourlife's best work.SMThe purpose of Service Account Manager is to delight ourcustomers by resolving their issues through fast and accurate problemidentification, routing to the appropriate department or Account Manager whenapplicable with resolution or status of issues requiring additional research.Primary Responsibilities: auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Serve as the liaison to a complex customer base to manage first level response and resolution of escalated issues with external and internal customers auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Quickly and accurately identify and assess customer issues and resolve the issues real - time auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Identify and resolve operational problems using defined processes, expertise and judgment auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Investigate claim and / or customer service issues as identified and communicate resolution to customers auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Provide feedback to team members regarding improvement opportunities auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Provide expertise and customer service support to members, customers, and / or providers auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Quickly establish rapport relating to the customer in a polite, positive and courteous manner auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Project patience, empathy, caring, and sincerity in voice tone and words auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Express thoughts and information clearly and succinctly auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Handle irate callers in a manner that defuses their emotion auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Achieve quality and efficiency objectives auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Maintain proficiency in all technical applications (technical skills and system knowledge) auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Comply with all current policies, procedures and workflows auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Manage response and resolution of escalated issues with external and internal customers auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Investigate claim and / or customer service issues and communicate resolution to customers auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Case completion within established turnaround times to meet service level targets auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Make calls on complex and sensitive cases auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Communicate effectively with others to ensure prompt and accurate resolution of issues auto;line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Work independently to prioritize and organize workload line-height:normal;mso-list:l0 level1 lfo1;tab-stops:list .5in">Provide expertise and customer service support to members, customers, and / or providersnormal">normal">Required Qualifications: auto;line-height:normal;mso-list:l1 level1 lfo1;tab-stops:list .5in">High School Diploma / GED (or higher) auto;line-height:normal;mso-list:l1 level1 lfo1;tab-stops:list .5in">Experience with the AARP Medicare Supplement products and systems auto;line-height:normal;mso-list:l1 level1 lfo1;tab-stops:list .5in">Ability to work under time constraints and compose professional business letters auto;line-height:normal;mso-list:l1 level1 lfo1;tab-stops:list .5in">Ability to work 8 hours shift between the hours of operation (6am - 10pm) and is flexiblenormal">PreferredQualifications: auto;line-height:normal;mso-list:l2 level1 lfo2;tab-stops:list .5in">Experience with UCPS and / or COMPAS processing systemsnormal">Soft Skills: auto;line-height:normal;mso-list:l0 level1 lfo3;tab-stops:list .5in">Ability to handle escalate complaint calls auto;line-height:normal;mso-list:l0 level1 lfo3;tab-stops:list .5in">Strong communication skills both written and verbal auto;line-height:normal;mso-list:l0 level1 lfo3;tab-stops:list .5in">Ability to work independently and prioritize workload auto;line-height:normal;mso-list:l0 level1 lfo3;tab-stops:list .5in">Strong organizational skillsnormal">Careers atUnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growingmarket segment in health care. And we are the largest business in the nationdedicated to serving their unique health and well-being needs. Up for thechallenge of a lifetime? Join a team of the best and the brightest to find boldnew ways to proactively improve the health and quality of life of these 9million customers. You'll find a wealth of dynamic opportunities to grow anddevelop as we work together to heal and strengthen our health care system.Ready? It's time to do your life's best work.SMnormal">Diversity creates a healthier atmosphere: UnitedHealth Group isan Equal Employment Opportunity/Affirmative Action employer and all qualifiedapplicants will receive consideration for employment without regard to race,color, religion, sex, age, national origin, protected veteran status,disability status, sexual orientation, gender identity or expression, maritalstatus, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates arerequired to pass a drug test before beginning employment.normal"> normal">Keywords: Customer service, claims, healthcarebenefits, escalation, escalated, resolution, United Healthcare 

Bilingual Pharmacy Technician Supervisor, Prior Authorization - San Juan, PR - UnitedHealth Group
newabout 13 hours ago
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Join Us for Our Job FairThursday- February 28, 2019/ 9:00 am -6:00 pmHyatt Place580 Fernandez Juncos AvenueSan Juan, Puerto Rico 00907*** We strongly encourage you to apply in advance of the event if you are interested in this opening. *** As one of the largest pharmacy benefits managers in the United States, UnitedHealth Group provides a professional culture where you're empowered and encouraged to exceed the expectations of our members, with better schedules than retail and more reach than any hospital. When you work in Operations at UnitedHealth Group, you can help improve the efficiency and usability of a system that's going to change the face of health care. Join us and start doing your life's best work.(sm) This Pharmacy Technician Supervisor, Prior Authorization opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader. As a Pharmacy Technician Supervisor, Prior Authorization you will lead a team in a corporate environment. You will be responsible for coordinating, supervising and maintaining performance oversight of daily activities of pharmacy technicians involved in prior authorization business support, the telephonic production team. Primary Responsibilities: Supervise a team of Pharmacy Technicians Ensure that the team meets productivity and quality goals Follow HIPAA, Healthcare/Process Regulations, and Company Policies Lead by example in all aspects of the business Reports directly to Manager for daily team performance and other projects assigned Coach and mentor technicians and develop them continuously Motivate technicians through rewards and team building activities Support technicians in their day to day transactions Drive innovation and process improvements Analyze team performance and formulate action plans to address opportunities Actively participate in project’s regular townhall and other activities May be assigned to work on special projects and business initiativesRequired Qualifications: Pharmacy Technician Certification and active, unrestricted Pharmacy Technician License to practice in Puerto Rico 1+ year of supervisory experience 1+ years’ experience in a pharmacy, clinical or healthcare setting Willingness to work overtime as necessary Ability work any shift during operating hours of Monday - Friday, 8 am - 9 pm AST Proficient in with Microsoft Word, Excel, PowerPoint and Outlook Bilingual Spanish/English capability. Please note that an English proficiency assessment will be required for this position Preferred Qualifications: Excellent written and verbal communication Skills Call Center experience Strong focus on customer service Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: Pharmacy Supervisor, Prior Authorization, Pharmacy, Pharmacist, Clinical, Leadership, Supervisor, Puerto Rico, PR, San Juan 

Bilingual (Spanish / English) Customer Service Advocate - San Antonio - TX - UnitedHealth Group
newabout 13 hours ago
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Cuando se trata de salir adelante y tienes la voluntad de ganar, vamos a llamarlo gran potencial de carrera! Imagine being able to get answers to your health plan questions from someone who speaks the same language as you do. Or, the opposite, not being able to get the answers. At UnitedHealth Group, we want our customers to get those answers by speaking to one of our Bilingual Representatives. If you're fluent in English and Spanish, we can show you how to put all of your skills, your passions and your energy to work in a fast growing environment. Turn on the news on any night of the week and you’re likely to hear about the changes that are sweeping through our health care system. It’s dramatic. It’s positive. And it’s being led by companies like UnitedHealth Group. Now, you can take advantage of some of the best training and tools in the world to help serve our existing and new customers. You’ll take as many as 50-70 calls per day from customers who have questions about their health benefits. As their advocate, you’ll use your personality and our tools to help them through the health care benefits available to them, including helping them enroll in a new plan. This is no small opportunity. This position is full-time (40 hours/week) Monday- Friday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of (7:00am to 11:00pm). It may be necessary, given the business need, to work occasional overtime. Our office is located at 6200 Northwest Pkwy, San Antonio, TX 78249.There are several steps in our hiring process. Please make sure that you have filled out all required sections of your employment application. Once you submit your completed application, you will receive an e-mail with information regarding next steps including any pre-employment assessment(s) that are required. Both your application and any required assessment(s) need to be completed before we can consider you for employment so the sooner you complete these two steps, the sooner you will hear from us. To learn more, go to: http://uhg.hr/OurApplicationProcessPrimary ResponsibilitiesRespond to and resolve, on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondenceHelp guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to select the best benefit plan options, maximize the value of their health plan benefits and choose a quality care providerContact care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistanceAssist customers in navigating myuhc.com and other UnitedHealth Group websites and encourage and reassure them to become self-sufficientThis role is equally challenging and rewarding. You’ll be called on to research complex issues pertaining to the caller’s health, status and potential plan options. To do this, you’ll need to navigate across multiple databases which requires fluency in computer navigation and toggling while confidently and compassionately engaging with the caller. Required QualificationsSpanish Bilingual RequiredHigh school diploma, GED or equivalent work experienceFamiliarity with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applicationsDemonstrated ability to listen skillfully, collect relevant information, build rapport and respond to customers in a compassionate manner Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can understand and act uponProficient conflict management skills to resolve issues in a stressful situation Preferred Qualifications1+ years of customer service experiencePrior health care experienceUnitedHealth Group is a team of more than 200,000 people who are building career success through commitment, compassion and a desire to make a difference. Join us. Learn more about how you can start doing your life's best work.SMCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SMDiversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.Key words: customer service representative, customer service, CSR, UnitedHealth Group, call center, UnitedHealthcare, health care, office, phone support, training class 

Bilingual Korean Service Account Manager Associate - Koreatown, CA - Los Angeles
newabout 13 hours ago
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UnitedHealth Group is working to create the Healthcare system of tomorrow and you can help. Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.Through our family of businesses and a lot of inspired individuals, we're building a high - performance Healthcare system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant and built for speed. Join with us and start doing your life’s best work.SMThe purpose of this role is to interact with members regarding medical and pharmacy benefits, eligibility & claims issues and to assist with plan selection and enrollment. This role is expected to identify opportunities to connect members to the best resources to meet their healthcare needs and provide support in order to resolve medical and benefits issues on behalf of a member. The Service Account Manager Associate builds trust with members across their health care lifecycle. Primary Responsibilities:Provide in language service to Korean and English speaking customers over the phoneOwn problem through to resolution on behalf of the member in real time or through comprehensive and timely follow - up with the member Effectively refers and enrolls members to appropriate internal specialists and programs, based on member’s needs and eligibility Respond to and resolve on the first walk - in, customer service inquires and issues by identifying the topic and type of assistance the customer needs such as benefits, eligibility and claims, financial spending accounts and correspondence. Resolve member service inquiries related to: - Terminology and plan design - Financial spending accounts - Pharmacy benefits, eligibility and claims - Correspondence requests and Medical benefits, eligibility and claimsEducate members about the fundamentals of health care benefits including: - Managing health and well being - Maximizing the value of their health plan benefits - Selecting the best health plan to meet their health needs - Choosing a quality care provider and appointment scheduling - Premium provider education and steerage - Pre - authorization and pre - determination requests and status Assist members in appointment scheduling to proactively address gaps in care Intervene with care on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when needed Research complex issues across multiple databases and work with support resources to own the resolution of all customer issues and anticipate their future healthcare needs or potential opportunities to improve the experienceOvercome objections and persuade members to take action / change behavior Use analytical thought process to dissect complex claim issue, and complete appropriate steps to resolve identified issues / or partner with others to resolve escalated issues. Provide education and status on previously submitted pre - authorizations or pre - determination requests Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance Maximizes use of social services, support programs, and resources available to members by outreaching to CBO’s Make outbound calls for various events organized by the team for higher event participation, successful member onboardingRequired Qualifications: High school diploma / GED (or higher)Bilingual fluency (verbal and written) in Korean and English required1+ year in a Customer Service environment. Proven customer service skills and experience working in retail, call centers, or any other professional settingAbility to successfully complete UnitedHealthcare Operations CCP new hire training and demonstrated proficiency and successfullycomplete UnitedHealthcare Operations Customer Service Advocate training classes upon hireCalifornia Health License required or the ability to obtain license within 30 days of employmentMust be able to navigate a computerAbility to navigate through multiple programs including Microsoft Excel (create spreadsheets) and Microsoft Word (update documents) Access (store information for reference, reporting)Access to reliable transportation that will enable you to travel to other sites Preferred Qualifications: Bachelor’s degree Experience in Health Care / Insurance environment (Familiarity with medical terminology, health plan documents, or benefit plan design) Previous experience in translating healthcare - related jargon and complex processes into simple, step - by - step instructions customers can understand and act upon Soft Skills:Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manner and delivering on commitments) Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the member Ability to overcome objections and persuade members to take action / change behavior Ability to utilize multiple systems / platforms while on a call with a member – strong computer skills and technical aptitude Proficient problem solving approach to quickly assess current state and formulate recommendations Flexibility to customize approach to meet all types of member communication styles and personalities Excellent conflict management skills including: Professionally and adeptly resolve issues while under stress Diffuse conflict and member distress Demonstrate personal resilience Strong verbal and written communication skills. Solid time management skills Strong attention to detail Physical Requirements and Work Environment: Able to lift 30 lb boxesHelping create positive customer experiences for our members can drive your sense of impact and purpose. Join us as we improve the lives of millions. Learn more about how you can start doing your life's best work.SMCareers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.SMDiversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.Keywords: UnitedHealth Group, UnitedHealth Care, Health Care, Sales, Medicaid, Retirement, Bilingual, Korean,, Language, customer service, California Health License 

Quality Review Specialist - Roanoke, VA - UnitedHealth Group
newabout 13 hours ago
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Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM Turn on the news on any night of the week and you're likely to hear about the changes that are sweeping through our health care system. It's dramatic. It's positive. And it's being led by companies like UnitedHealth Group. Now, you can take advantage of some of the best resources and tools in the world to help serve our members by ensuring the quality of our customer service operations and the customer experience. This is no small opportunity. The Quality Review Specialist is responsible for monitoring adherance to HIPAA and CMS Guidelines through Quality Monitoring on internal and external Telesales Agents and Sales Support Representatives. Primary Responsibilities: Monitor agents and representatives for compliance with established processes, policies and guidelines Provide feedback and coaching to agents and representatives based on evaluation results Analyze information and utilize to build recommendations to reduce errors and improve process performance Create, maintain and track reports in relation to performance Serve as subject matter resource to team members, supervisors and management staff Applies knowledge / skills to a range of moderately complex activities Demonstrates great depth of knowledge / skills in own function Sometimes act as a technical resource to others in own function Proactively identifies solutions to non-standard requests Solves moderately complex problems on own Works with team to solve complex problems Plans, prioritizes, organizes and completes work to meet established objectives Required Qualifications: High School Diploma / GED (or higher) 2+ years of experience in a Customer Service or telesales role within a call center Previous experience working with Microsoft Office including Outlook, Word, and Excel (ability to create, edit, send and save) Ability to work 8:00 am - 4:30 pm or 9:00 am - 5:30 pm Monday through Friday Preferred Qualifications: Associate's Degree (or higher) Previous Medicare/Medicaid experience Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.SM Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: UHG, Healthcare, UnitedHealth, Clinical, Administrative, Telesales, Call Center, Roanoke 

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