Preparing and assessing financial, qualitative and valuation analyses Lead special initiatives for corporate senior executives Key liaison to business segment senior leadership, transaction advisors and acquisition targets Developing and coaching junior team members (training, coaching, and mentoring) Defining and negotiating transaction terms Leading and conducting due d

Perform utilization management, utilization review, or concurrent review of behavioral health and substance abuse admissions and continued stays Ensure that behavioral health care services provided are medically necessary per standard guidelines Ensure that behavioral health care services are provided in the most appropriate setting Integrate a collaborative process which

Provide support and strategic counsel on a wide variety of matters including, regulatory compliance and oversight, contracts, STARs, the Inflation Reduction Act, and finance Collaborate with colleagues across the legal, compliance, and regulatory affairs departments You'll be rewarded and recognized for your performance in an environment that will challenge you and give y

Engage directly with care providers, physicians, and office staff via phone calls and faxes Document provider feedback and consult with senior clinical pharmacists if there are questions about treatment, drug efficacy, or authorization status Shadow UHC pharmacists to gain a better understanding of the various roles they have within the UHCP team Collaborate with analytic

Develops and executes strategies for a function or discipline that span a large business unit or multiple markets/sites Research and develop applicable business rules that support product reimbursement methodologies and policies for existing and new business opportunities (e.g., Medicare; Medicaid; commercial) Support ongoing maintenance of pay as state pay facility prici

Promote Excelsior's product portfolio to benefits brokers and help them increase their enrollment and average case size with all product lines Ability to negotiate and close sales Conduct in depth market presentations for brokers and employers Create and drive strategies for top producing agencies and Brokers Collaborate with Sales Management regarding pipeline, persisten

Reviews surgical and other professional claims for correct coding using clinical record Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews Composes, if

Maintenance and enhancement of existing EDI solution built on EDI Fabric in C# Troubleshoot and resolve EDI technical issues, including diagnosis and root cause analysis Troubleshoot claim workflow issues from EDI intake through EDI export Develop and maintain monitoring tools to ensure EDI connectivity meets service level agreements Analysis and design of systems and con

Analyze and report on financials Assist in the development of program forecasts, budgets, and plans Research economic progressions to assist with the organization's financial planning Create annual budget templates Prepare spreadsheets to effectively show financial results and financial forecasts You'll be rewarded and recognized for your performance in an environment tha

Review applications, gather data, determine eligibility and compliance Process broker and agent licensing, appointment and contracting credentials for Medicare Supplement Products Ensure that all paperwork, credentials and other necessary documents are in good order Perform analysis of submitted material for completeness and accuracy, analyzing, credentials and documentat

Lead the development, execution, and measurement of digital brand programs across UHC Paid digital media strategies, plans, demand analysis, forecasting and performance Oversee and direct growth activities for Google, Bing, Meta, Instagram, YouTube and future channels to drive brand engagement and affinity Partner with measurement leads and third party analytics platforms

Responsible for developing and preparing documentation for NCQA and other accreditation survey submissions Works closely with regional quality staff, health plan staff, and internal business partners to build and document compliance with accreditation standards Interpret complex data and draws conclusions Complete reports that provide analysis of data related to key quali

Facilitate, oversee and monitor on going business processes to support HEDIS data reporting Monitor compliance against relevant process requirements (e.g., turnaround time, accuracy) Evaluate processes and outcomes against benchmarks and metrics and identify potential business impacts of current state Ensure all business requirements are met Demonstrate understanding of r

In this dynamic position, you will Work with cross functional teams to align data science projects with business goals, ensuring impactful outcomes Lead advanced data analysis to improve business outcomes and efficiency using predictive modeling and machine learning Integrate data science techniques into operational processes, bolstering data driven decision making organi

Set strategy for experience improvement that supports FP member NPS and retention goals Establish a culture focused on our people obsessed with continual improvements to our members' experience Present strategy to senior management and measure against the strategy Identify, develop, and support the implementation of operational process changes & innovative solutions that