Serves as primary care manager for members with primary high behavioral needs members Engage members through a variety of modalities (telephonically) to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, socioeconomic and SDOH needs Develops and implements individualized, person centered care plans inclusive of go

Answer incoming phone calls from prospective members, identify the type of assistance and information the customer needs with the goal to convert caller to a qualified lead and sale Follow up with members on questions or to review current or new products and services Navigate multiple computer systems to document member information while maintaining active listening and e

Answer incoming phone calls from prospective members, identify the type of assistance and information the customer needs with the goal to convert caller to a qualified lead and sale Follow up with members on questions or to review current or new products and services Navigate multiple computer systems to document member information while maintaining active listening and e

Evaluates new and on going claims to determine liability, giving consideration to contract provisions, disability management duration contract guidelines, medical evidence and vocational evidence. Investigates questionable claims. Determines need for additional medical information. Performs periodic follow ups to verify continued existence of a disabling condition. Respon

Answer incoming phone calls from prospective members, identify the type of assistance and information the customer needs with the goal to convert caller to a qualified lead and sale Follow up with members on questions or to review current or new products and services Navigate multiple computer systems to document member information while maintaining active listening and e

Program Administration Collaborates with key university departments (Registrar, Bursar, IT Services, University Communications and Marketing, Health Services. Student Life, etc.) to ensure processes pertaining to the SHIP are as smooth and seamless as possible throughout the insurance plan year. Regularly assesses and facilitates the implementation of the annual online st

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Co

Participates and assists in the preparation of quality committees, performance improvement projects, and other aspects of the Quality Assessment and Performance Improvement (QAPI) program as assigned Collect information based on applicable standards, state/federal or other regulations, internal requests, or project assignments Leverages available resources to improve qual

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Co

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Co

Collaborate with stakeholders, development teams, and subject matter experts to understand planned and emerging benefits, measure and monitor performance, and recommend solutions to enhance the value of ECS technology solutions and strategies Analyze data, summarize insights, produce executive status updates, triage requests, act as a point of contact for the benefit owne

Manage projects from inception to completion through QI science methodology documentation including Project charters, PDSA cycles, Key Driver Diagrams, GEMBAs, Run Charts and Paretos Complete data analysis for projects to determine progress and if SMART aims are achieved or root causes of performance Lead multidisciplinary teams to complete project tasks Recommend appropr

Manage provider complaints to resolution when initiated through regulators including, but not limited to DMS, DOI, or Legislators. Report status updates to DMS and providers, as needed. Implement solutions that educate network on how to resolve issues with UHC resources Proactively partner with providers to identify opportunities for improvement, opportunities for growth

Manage end to end conference/event related planning that drive a consistent attendee experience, providing on site support when needed Manage relationships with existing and potential vendors, ensuring mature utilization of existing tools and roadmap development Provide ongoing work direction to Attendee Managers regarding registration, reporting, attendee communications

Manage end to end conference/event related planning that drive a consistent attendee experience, providing on site support when needed Develop, streamline, and create best practices, processes, and reporting, keeping the business goals and policies in alignment Review and manage relationships with existing and potential vendors, ensuring mature utilization of existing too