Address
Form of work
Salary- Create a positive experience and relationship with the member
- Help member set goals and develop a care plan to achieve those goals
- Proactively engage the member to manage their own health and healthcare
- Support the member to improve their wellbeing by staying out of the hospital, and attend regular visits to their primary physician
- As needed, help the member engage with mental health and substance use treatment
- Support the member to ensure pick-up of their prescriptions
- Provide member education on community resources and benefits
- Conduct post discharge activities from hospital facility and support connection to social services
- Support member to engage in work or volunteer activities, if desired, and develop stronger social supports through deeper connections with friends, family, and their community
- Partner with care team (community, providers, internal staff)
- Knowledge and continued learning of community cultures and values
- Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
- Manage the care plan throughout the continuum of care as a single point of contact
- Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
- Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
- Answer incoming phone calls from health care providers (i.e. physician offices, clinics) and identify the type of assistance the provider needs (EG. benefit and eligibility, billing and payments, authorizations for treatment, explanation of benefits)
- Focus on resolving issues on the first call, navigating through complex computer systems to identify the status of the issue and provide appropriate response to caller
- Deliver information and answer questions in a positive manner to facilitate strong relationships with providers and their staff
- Complete the documentation necessary to track provider issues and facilitate the reporting of overall trends
- Extensive work experience with Medicaid community. Monitor timely receipt, accuracy and compliance of State assessments
- Maintain 100% adherence to State contract, CMS requirements, and UnitedHealthcare Community Plan Performance and Quality metrics around Conversion Goals. 100% adherence to submission timelines of scheduled department reports, assigned metrics and state deliverables.100% adherence to submission deadlines on complaints
- Meet State Partner and Internal expectation on timeliness & quality of interactions with members and providers
- Demonstrate compliance in the urgency of all Star+Plus State & internal deadlines
- Act as an advocate for membership and establish effective working relationships with our providers to service our members, ensuring all federal, state and company regulations, policies, and expectations are followed
- Be responsive to our members (retention & referrals) and providers (contracting retention)
- Manage administrative intake of members
- Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and/or providers
- Manage the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
- Receive care coordination notification cases for non-clinical assessment/intervention and provide appropriate triage
- Review requests for adverse determination, approval notification and processing notification requirements
- Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- High school diploma/GED or higher
- 3+ years of experience working within the community health setting in a health care role
- Familiarity with Microsoft Office, including Word, Excel, and Outlook
- Reliable transportation and the ability to travel in this ‘assigned area’ to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, nursing facilities or providers' offices if field based
- High speed internet in residence
Preferred Qualifications:
- Bachelor's degree in social work, licensed practical nurse (LPN), or CNA/HHA
- Ability to create, edit, save and send documents, spreadsheets and emails
- Reside within commutable distance of assigned duties.
- Makes member touchpoints
- All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.
#RPO, #RED
