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Found 212 Jobs
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Location : All Job Fields : Communications, Medical & Clinical Operations, Real Estate Services
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Clin Appeals RN (563806)
Full-time CA or Telecommute Considered
Job Posting: 10/20/2014
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Clin Appeals RN
Posted 10/20/2014
Region: North America Country: United States
State/Province: CA City:
Position Description:
Appeals experience preferredCandidates who also have one or more of the following will be preferred:-Appeals experience strong preferred-CPT and/or ICD9 experience is preferred-Managed care experience is strongly preferred-Utilization review and/or case management experience is preferred-Previous experience in a telephonic role

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Clinical Coverage Review Medical Director - Virtual - Board Certified in Oncology (568241)
Full-time NY or Telecommute Considered
Job Posting: 10/20/2014
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Region: North America Country: United States
State/Province: NY City:
Position Description:
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 b...

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Senior Clinical Quality Analyst - HEDIS - Las Vegas, NV (568095)
Full-time Las Vegas, NV
Job Posting: 10/20/2014
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Region: North America Country: United States
State/Province: NV City: Las Vegas
Position Description:
Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Senior Clinical Quality Analyst you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You'll act as a voice for our members, guiding the development of...

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Onsite Health Coach - San Antonio, TX (568480)
Full-time San Antonio, TX
Job Posting: 10/20/2014
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Region: North America Country: United States
State/Province: TX City: San Antonio
Position Description:
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to 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) Responsibilities for a Health Coach include: -Be able to assist clients in creating a health vision and goals for their Health & Wellness program-Participate in weekly meetings and monthly in-service trainings-Demonstrate an ability to deliver effective telephonic coaching in a manner that promotes behavior change-Appropriately adapt te...

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HEDIS Abstractor RN, NP or PA - U.S. Telecommute (568434)
Full-time Brentwood, TN or Telecommute Considered
Job Posting: 10/20/2014
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Region: North America Country: United States
State/Province: TN City: Brentwood
Position Description:
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to 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) The HEDIS Abstractor Nurse will measure the qualityof Preventative and Chronic Care services providedto our Health Plan members. Major responsibilities ofthis position include conducting HEDIS Medical Recordabstractions to identify whether the members received thenecessary services, per national Clinical guidelines withinthe appropriate...

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Quality Specialist - Telecommute (571719)
Full-time Centennial, CO or Telecommute Considered
Job Posting: 10/20/2014
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Region: North America Country: United States
State/Province: CO City: Centennial
Position Description:
Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Quality Specialist you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You'll act as a voice for our members, guiding the development of comprehensiv...

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Clinical Quality Analyst - Per Diem - Las Vegas, NV (570421)
Full-time Las Vegas, NV
Job Posting: 10/20/2014
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Region: North America Country: United States
State/Province: NV City: Las Vegas
Position Description:
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to 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) The Clinical Quality Analyst will manage quality improvement initiatives and projects that focus on improving the health care and services for health plan members and to manage compliance with NCQA accreditation and state and regulatory requirements.  Primary Responsibilities: Work with the Director/Manager of Clinical Quality to create...

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Senior Clinical Manager - Behavior Health - HARP - Latham NY (570391)
Full-time Latham, NY
Job Posting: 10/20/2014
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Region: North America Country: United States
State/Province: NY City: Latham
Position Description:
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to 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)  This position is on site in our Latham, NY office and manages a team of up to 15 in size working with Health Homes / HARP population, responsible for utilization review of treatment plans.  Team is responsible for utilization review of inpatient and outpatient Behavioral Health services and determining medical necessity.  This is a day...

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Clinical QI Specialist - Houston, TX (570755)
Full-time Houston, TX
Job Posting: 10/20/2014
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Region: North America Country: United States
State/Province: TX City: Houston
Position Description:
Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Delivering quality care starts with ensuring our processes and documentation standards are being met and kept at the highest level possible. This means working behind the scenes ensuring a member-centric approach to care. As a Clinical QI Specialist you will monitor and support health plan quality improvement initiatives with particular emphasis on compliance with state and federal regulatory and accreditation requirements. You'll act as a voice for our members, guiding the development of comprehe...

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Population Health Analytics Manager (564837)
Full-time MN
Job Posting: 10/20/2014
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Region: North America Country: United States
State/Province: MN City:
Position Description:
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to 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) Innovator: contributor to Provider Solutions clinical program design and successful program delivery to advance Optum as the leader in transforming the healthcare delivery and medical management landscapeChange agent: translates program objectives into actionable plans and drives enterprise adoption. Identifies and drives continuous imp...

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Risk Adjustment Quality Assurance Auditor – Telecommute! (572501)
Full-time Nashville, NC or Telecommute Considered
Job Posting: 10/18/2014
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Region: North America Country: United States
State/Province: NC City: Nashville
Position Description:
Talk about meaningful work.  Talk about an important role.  Let's talk about your next career move. Due to our expanding business, UnitedHealth Group is seeking Quality Assurance Auditor who share our passion for helping people live healthier lives to join our team.  It's an inspiring role and it can inspire your career.  For those who want to invent the future of health care, here's your opportunity.  Find out more about these opportunities to do your life's best work.(SM) The Quality Assurance Auditor  provides coding and coding auditing services . This includes the analysis and translation ...

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Coding Quality Analyst CPC Phoenix AZ (561406)
Full-time Phoenix, AZ
Job Posting: 10/17/2014
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Region: North America Country: United States
State/Province: AZ City: Phoenix
Position Description:
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. Fo...

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Physician Advisor - Psychiatry - Temporary (563913)
Full-time Malvern, PA or Telecommute Considered
Job Posting: 10/17/2014
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Region: North America Country: United States
State/Province: PA City: Malvern
Position Description:
Basic Function  The Physician Advisor represents contracted hospitals in matters involving concurrent denials.  These services are performed telephonically with medical directors who have denied inpatient stays.  In addition, the Physician Advisor in Commercial Appeals serves as an advocate and an appeal expert for the hospitals by conducting thorough reviews of the hospital medical records for claims denied by the commercial payers, summarizing the services provided during the hospital stay, and providing appeal arguments based on clinical judgment and evidence based medicine.  With EHR's pro...

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Senior Clinical Appeals RN, Sacramento, CA OR Phoenix, AZ (559013)
Full-time Sacramento, CA
Job Posting: 10/17/2014
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Region: North America Country: United States
State/Province: CA City: Sacramento
Position Description:
Health care isn't just changing.  It's growing more complex every day.  ICD10 replaces ICD9.  Affordable Care adds new challenges and financial constraints.  Where does it all lead?   Hospitals and health care organizations continue to adapt, and we are vital part of their evolution.  And that's what fueled these exciting new opportunities.    Who are we?  Optum360.  We're a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise.  As part of the growing family of UnitedHealth Group, we'll leverage our compassion, our talent, our resources and experience to b...

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Senior Clinical Data Analyst, Minnetonka, MN (preferred) or Telecommute in the U.S. (559474)
Full-time Minnetonka, MN
Job Posting: 10/17/2014
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Region: North America Country: United States
State/Province: MN City: Minnetonka
Position Description:
For those who want to invent the future of health care, here's your opportunity.  We're going beyond basic care to 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)This position is in our Patient Centered Care Model (PCCM) team. PCCM is an innovative approach to changing the care delivery model in primary care. PCCM is one of several Population Health Management programs, such as Accountable Care Organization (ACO), Patient Centered Medical Home (PCMH) etc., that we offer. The PCCM team is part of...

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Clinical Administrative Coordinator - Nashville, TN & Knoxville, TN (569627)
Full-time Nashville, TN or Telecommute Considered
Job Posting: 10/17/2014
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Region: North America Country: United States
State/Province: TN City: Nashville
Position Description:
Position Description:Energize your career with one of Healthcare's fastest growingcompanies.   You dream of a great career with a great company – where you canmake an impact and help people.  We dream of giving you the opportunity todo just this.  And with the incredible growth of our business, it's adream that definitely can come true. Already one of the world's leadingHealthcare companies, UnitedHealth Group is restlessly pursuing new ways tooperate our Service Centers, improve our Service levels and help people leadhealthier lives. We live for the opportunity to make a difference and righ...

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Clinical Program Consultant - Cypress, CA (569467)
Full-time Cypress, CA or Telecommute Considered
Job Posting: 10/17/2014
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Region: North America Country: United States
State/Province: CA City: Cypress
Position Description:
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to 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) In this new and exciting role, supporting our UHC line of business, you will be identifying best practices and implementing the standardization of lean principles.  As the chosen candidate, you will be responsible for tracking and monitoring multiple projects and RFPs (i.e. system migrations) and developing monitoring tools for segment ...

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Social Worker Field Care Coordinator - Miami/Dade (569406)
Full-time Miami, FL or Telecommute Considered
Job Posting: 10/17/2014
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Region: North America Country: United States
State/Province: FL City: Miami
Position Description:
The Social Worker Field Care Coordinator is responsible for facilitating, promoting and advocating for the enrollees' ongoing self-sufficiency and independence. This position is responsible for assessment and planning for an identified group of patients. Additionally, the care coordinator is responsible for assessing the availability of natural supports such as the enrollee's representative or family members to ensure the ongoing mental and physical health of those natural supports. The Care Coordinator collaborates with the Interdisciplinary Team to coordinate the delivery of comprehensive, e...

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Quality Consultant, Pharmacy - Telecommute (568625)
Full-time Houston, MO
Job Posting: 10/17/2014
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Region: North America Country: United States
State/Province: MO City: Houston
Position Description:
Bring us your experience, your head for strategy, your strength with relationships and your eye for opportunity. In return we offer an unmatched place to grow and develop your career among a richly diverse group of businesses driven by the power and stability of a leading health care organization. Come help us heal and strengthen the health care system as you do your life's best work. (sm) The Quality Consultant will be responsible for monitoring changes with laws and regulations to ensure compliance with Pharmacy Contractual, State and Federal guidelines for Medicaid. This individual will be ...

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Senior Clinical Administrative Coordinator - Southfield, MI (572007)
Full-time Southfield, MI
Job Posting: 10/17/2014
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Region: North America Country: United States
State/Province: MI City: Southfield
Position Description:
Position Description:For those who want to invent the future of Healthcare, here's your opportunity. We're going beyond basic care to 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) In this position, you will be utilizing the Med Measure reports to see which Members' care is outstanding with specific Providers assigned to you. Once these members are identified, you will reach out to them to close the gaps in care. You will also reach out to the Providers to see what the next steps are in the pro...

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