Develop, lead and execute category management strategies, conduct sourcing / RFX events, manage suppliers and conduct financial analysis Draft, Review, and lead negotiations of third party supplier contracts, including Master Services Agreements (MSAs), Statements of Work (SOWs), Non Disclosure Agreements (NDAs) and amendments in cooperation with legal, internal stakehold

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, 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

Perform clinical assessment of healthcare services provided to our members for appropriateness Understand relevant state and federal grievance and peer review requirements and accreditation standards applicable for processes supported Receives cases from the QIS non clinical team and reviews them against required clinical information, assessing for appropriateness and con

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

Leverage technical skillset to support the design, development, testing, and implementation of analytics, insights, and reporting for the business Leverage analytical skillset to review and analyze data compared to industry trends Support reporting needs and requirements and help identify possible automated data solutions to non standard requests Solve moderately complex

Develop innovative analytic solutions, create actionable insights and drive better decisions and performance to help the business achieve its business objectives Support operational analytics, machine learning and process improvement data deep dive, identify and execute on new opportunities for increases in efficiencies and performance Support data governance and stewards

Key Agent/Agency Performance Agent Development Mentor, coach and engage key agents/agencies through ongoing business and strategy planning. This includes identifying sales opportunities, product positioning, UHC tools, UHC value proposition, compliance, and market education Onboarding Reach out to new agents identified by the PHD to share UHC learning, growth tools and va

Sort and file patient demographic forms (may include lifting up to 30 lbs.) Locate and retrieve patient demographic forms when requested. Cross train and work in all processes when needed Other duties as assigned Repetitive movements including sit, stand, kneel, reach You'll be rewarded and recognized for your performance in an environment that will challenge you and give

Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence Educate customers about the fundamentals and benefits of consumer driven health care, guiding them on topics such as selecting the best benef

Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence Educate customers about the fundamentals and benefits of consumer driven health care, guiding them on topics such as selecting the best benef

Act as internal counsel on the No Surprises Act and its rulemaking Act as internal counsel on state law regarding out of network reimbursement Act as internal counsel on preemption issues associated with the No Surprise Act and out of network reimbursement Provide internal counsel across the organization on out of network reimbursement Provide internal counsel on the reso

Assess, plan, and implement care strategies that are individualized by the member 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 socia

Manage end to end conference/event related planning that drive a consistent attendee experience, providing on site support when needed Review and 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 comm

Educate members on health education and condition management (formal and informal), as well as plan specifics and member resources, in collaboration with OptumHealth Referral of employees to available clinical programs including premium designated physicians Create, manage and implement employer specific programs based on employer needs Monitors and analyzes customer spec