Home health administrator responsibilities as assigned Special project management as assigned Additional responsibilities as assigned Primary Responsibilities Positively represent the Company to both internal and external customers; always maintain a professional and courteous manner Uphold the Optum core values in the conduct of work Adhere to Company privacy guidelines;

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

Building financial models, including but not limited to, projecting a target's future financial performance Deploying different valuation methodologies (DCF, precedent transactions, trading comparables and LBO) and performing various return metric calculations (EPS accretion / dilution analysis and IRR) Preparing executive level communication / summaries that help inform

Gaining exposure to building financial forecasts, including but not limited to, projecting a target's future financial performance Deploying different valuation methodologies (DCF, precedent transactions, trading comparables and LBO) and performing various return metric calculations (EPS accretion / dilution analysis and IRR) Supporting deal teams in financial due diligen

Investigate medium to highly complex cases of fraud, waste, and abuse Detect fraudulent activity by members, providers, employees and other parties against the Company Develop and deploy the most effective and efficient investigative strategy for each investigation Maintain accurate, current and thorough case information in the Special Investigations Unit's (SIU's) case t

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

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

Proficient in review of medical records and the ability to identify pertinent information on which to base appropriate clinical decisions. Document relevant chronology of case review and provide rational for determination Plan, prioritizes, organizes and completes work to meet established objectives. Excellent verbal and written communication skills with internal and exte

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

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least 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

Own the service experience of customers at the field level by working with the assigned team and other matrix partners as required to ensure issues are resolved promptly and accurately meeting the customer's expectations Develop and maintain strong relationships with internal partners throughout UHG to manage the customer service experience Fully accountable for supportin

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

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Utilize both company and community based resources to establish a safe and effective case management plan for members Collaborate with patient, family, and healthcare providers Identify and initiate referrals for social s

Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements Engage with requesting providers as needed in peer to peer discussions Be knowledgeable in