Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community Be knowledgeable on and apply all necessary regulatory requirements for assigned re

Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community Be knowledgeable on and apply all necessary regulatory requirements for assigned re

Raise the bar on excellence in execution in terms of quality, timeliness, and scalability Take accountability for key engineering metrics of the platform specifically availability, reliability, and security Develop and evolve engineering and product roadmap of UAIS Collaborate across various lines of businesses as well as global locations to ensure smooth execution of cri

Deploy machine learning models and establish automated data pipelines between cloud and on premise environments Design and implement integration and unit tests to ensure system reliability and performance Continuous integration and continuous delivery of production code Develop code and system level documentation Work with the broader technical team to scope engineering m

Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community Be knowledgeable on and apply all necessary regulatory requirements for assigned re

Collaborate cross organizationally in the development, proposing and prioritization of customer solutions to reduce trend (programs, processes, benefit design, network, etc.) Works with business partners to ensure are aligned with successfully achieving savings targets Development and execution of cross functional strategies, projects and tactics which result in increment

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, c

Facilitate onboarding, upskilling, continuing education, and performance improvement training in a virtual environment Provide feedback to operations managers regarding class progress, areas of strength, and areas of improvement Develop training materials using appropriate mediums (virtual facilitation, blended learning, job support, elearning, etc.) Maintain a high degre

Design and develop onboarding, upskilling, continuing education, and performance improvement training using appropriate mediums (e learning, virtual facilitation, blended learning, job support, etc.) Maintain a high degree of accuracy and attention to detail Follow industry standard design and delivery process model(s) for assigned projects Meet deadlines and effectively

Serves as the clinical liaison with clinical performance and administrative staff as well as providing expertise solving member issues Makes outbound calls to assess members' current health status, as well as take inbound calls to resolve inquiries and assist members as needed. Warm transfer to other departments or services as needed Assesses patient needs using establish

Record monthly journal entries for asset, liability, revenue, and expense transactions Perform monthly account reconciliations for asset and liability accounts Support general ledger close processes including consolidating, maintaining, and reconciling accounts Prepare monthly customer invoices Produce clear, well formed documentation to communicate results and conclusion

Familiarity with SMF/RMF record structures Ability to work with SAS programming and statistical data Utilize knowledge of large scale operational and system concepts Develop and maintain system performance reporting using MXG, SAS, and Splunk Monitor daily system health for areas of improvement and exceptions Deliver recommendations for enhancing performance Perform probl

Prepare or review monthly journal entries for asset, liability, revenue, and expense transactions Perform or review monthly account reconciliations for asset and liability accounts Support general ledger close processes including consolidating, maintaining, and reconciling accounts Produce clear, well formed documentation to communicate results and conclusions Validate fi

Strategic Planning In partnership with key stakeholders across marketing, oversees the strategic planning, budget and execution of industry programs and trade shows Trade show SME Support team and partner across marketing and sales stakeholders by being the subject matter expert on trade shows, enabling capabilities, proactively meeting their needs, communicating effectiv

Lead engineering teams for conceptualizing, designing, developing, and maintaining vital elements of UAIS Platform Raise the bar on excellence in execution in terms of quality, timeliness, and scalability Take accountability for Key Engineering Metrics of the platform namely Availability, response time metrics, Time to Value and Time to build Develop and Evolve Engineerin