Qureos Mentor

UnitedHealthcare

<div>At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Senior Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste, and abuse. The Senior Investigator will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. The Senior Investigator is responsible for conducting investigations which may include fieldwork to perform interviews and obtain records and/or other relevant documentation.
Office location: Warwick, RI
Hybrid role with expectation to work out of the Warwick, RI office approximately 3-4 times per week.
25-50% of expected travel within Rhode Island.
If you live near Warwick, RI, you will enjoy the flexibility of a hybrid-remote role as you take on some tough challenges.
Primary Responsibilities:<ul><li>
Assess complaints of alleged misconduct received within the Company</li><li>
Investigate medium to high complex cases of fraud, waste, and abuse</li><li>
Detect fraudulent activity by members, providers, employees, and other parties against the Company</li><li>
Develop and deploy the most effective and efficient investigative strategy for each investigation</li><li>
Maintain accurate, current, and thorough case information in the Special Investigations Unit's (SIU's) case tracking system</li><li>
Collect and secure documentation or evidence and prepare summaries of the findings</li><li>
Participate in settlement negotiations and/or produce investigative materials in support of the latter</li><li>
Collect, collate, analyze, and interpret data relating to fraud, waste, and abuse referrals</li><li>
Ensure compliance of applicable federal/state regulations or contractual obligations</li><li>
Report suspected fraud, waste, and abuse to appropriate federal or state government regulators</li><li>
Comply with goals, policies, procedures, and strategic plans as delegated by SIU leadership</li><li>
Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetings</li><li>
Communicate effectively, including written and verbal forms of communication</li><li>
Develop goals and objectives, track progress and adapt to changing priorities</li><li>
Must participate in legal proceedings, arbitration, and depositions at the direction of management</li></ul>
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:<ul><li>
Associate's degree</li><li>
2+ years of experience in fraud, waste and abuse (FWA) investigations/audit</li><li>
2+ years of experience with state/federal laws and regulations pertaining to healthcare FWA
</li><li>2+ years of experience in analyzing data to identify fraud, waste and abuse trends</li><li>
Demonstrated intermediate level of proficiency in Microsoft Excel and Word</li><li>
Ability to travel up to 50%</li><li>
Reside within a commutable distance to Warwick, RI</li><li>
Access to reliable transportation and valid US driver's license</li></ul>
Preferred Qualifications:<ul><li>
Specialized knowledge/training in healthcare FWA investigations</li><li>
Active affiliations with the National Health Care Anti-Fraud Association (NHCAA)</li><li>
Accredited Health Care Fraud Investigator (AHFI)</li><li>
Certified Fraud Examiner (CFE)</li><li>
Certified Professional Coder (CPC)</li><li>
Medical Laboratory Technician (MLT)<ul><li>
Statistical Analysis</li></ul></li><li>All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.</li></ul> 
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable. 
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. 
#RPO #YELLOW</div>

Senior Investigator - Rhode Island

<div>At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The RN Clinical Care Coordinator will be the primary care manager for a panel of members with complex medical/behavioral needs. Care coordination activities will focus on supporting members' medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care.
Expect to spend about 80% of your time in the field visiting our members in their homes or in long-term care facilities. You'll need to be flexible, adaptable and, above all, patient in all types of situations. Do you live or are you willing to travel to any of the following counties? Essex and surrounding counties, NJ
Primary Responsibilities:<ul><li>
Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs</li><li>
Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines</li><li>
Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan</li><li>
Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health</li><li>
Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission</li><li>
Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team</li></ul> 
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:<ul><li>
Current, unrestricted independent licensure as a Registered Nurse in New Jersey</li><li>
2+ years of clinical experience</li><li>
1+ years of experience with MS Office, including Word, Excel, and Outlook</li><li>
Access to reliable transportation and the ability to travel up to 80% of your time within assigned territory to meet with members and providers</li></ul> 
Preferred Qualifications:<ul><li>
BSN, Master's degree or higher in clinical field</li><li>
CCM certification</li><li>
1+ years of community case management experience coordinating care for individuals with complex needs</li><li>
Experience working in team-based care</li><li>
Background in managed care</li></ul> 
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $40.00 to $54.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.</div>

RN Clinical Coordinator - Field Based in Essex and Surrounding Counties - New Jersey

<div>At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste, and abuse. The Investigator will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. The Investigator is responsible for conducting investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.
Office location: Warwick, RI
Hybrid role with expectation to work out of the Warwick, RI office approximately 3-4 times per week.
25-50% of expected travel within Rhode Island.
If you reside in the state of Rhode Island, you will have the flexibility to hybrid-remote* as you take on some tough challenges.
Primary Responsibilities:<ul><li>
Assess complaints of alleged misconduct received within the Company</li><li>
Investigate low to medium complex cases of fraud, waste, and abuse</li><li>
Detect fraudulent activity by members, providers, employees, and other parties against the Company</li><li>
Develop and deploy the most effective and efficient investigative strategy for each investigation</li><li>
Maintain accurate, current, and thorough case information in the Special Investigations Unit's (SIU's) case tracking system</li><li>
Collect and secure documentation or evidence and prepare summaries of the findings</li><li>
Participate in settlement negotiations and/or produce investigative materials in support of the latter</li><li>
Collect, collate, analyze, and interpret data relating to fraud, waste, and abuse referrals</li><li>
Ensure compliance of applicable federal/state regulations or contractual obligations</li><li>
Report suspected fraud, waste, and abuse to appropriate federal or state government regulators</li><li>
Comply with goals, policies, procedures, and strategic plans as delegated by SIU leadership</li><li>
Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetings</li><li>
Communicate effectively, including written and verbal forms of communication</li><li>
Develop goals and objectives, track progress and adapt to changing priorities</li><li>
Must participate in legal proceedings, arbitration, and depositions at the direction of management</li></ul>
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:<ul><li>
Associate's degree or above</li><li>
Intermediate level of proficiency in Microsoft Excel and Word</li><li>
Reside within a commutable distance to Warwick, RI</li><li>
Ability to travel up to 50%, access to reliable transportation, and &amp; valid US driver's license</li></ul>
Preferred Qualifications:<ul><li>
Experience in health care fraud, waste and abuse (FWA) investigations/audit</li><li>
Experience with state/federal laws and regulations pertaining to healthcare FWA</li><li>
Experience in analyzing data to identify fraud, waste and abuse trends</li><li>
Knowledge/training in healthcare FWA investigations</li><li>
Active affiliations with the National Health Care Anti-Fraud Association (NHCAA)</li><li>
Accredited Health Care Fraud Investigator (AHFI)</li><li>
Certified Fraud Examiner (CFE)</li><li>
Certified Professional Coder (CPC)</li><li>
Medical Laboratory Technician (MLT)<ul><li>
Statistical Analysis</li></ul></li><li>All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.</li></ul> 
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $49,700 to $88,800 annually based on full-time employment. We comply with all minimum wage laws as applicable. 
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. 
#RPO #YELLOW</div>

Investigator

<div>At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
Like you, UnitedHealth Group is strong on innovation. And like you, we'll go the distance to deliver high-quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have a chance to make an impact.
Schedule: Monday through Friday from 8 am to 5pm Eastern Standard Time. Weekends (Saturday or Sunday) will be required on a rotating basis.
If you reside in the state of Virginia, you'll enjoy the flexibility to telecommute* from as you take on some tough challenges. Expectation to work from the office in Richmond VA approximately once per quarter.
Primary Responsibilities:<ul><li>
Manage administrative intake of members</li><li>
Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers</li><li>
Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles</li><li>
Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review</li><li>
Handle resolution/inquiries from members and/or providers</li></ul>
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:<ul><li>
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays</li><li>
Medical Plan options along with participation in a Health Spending Account or a Health Saving account</li><li>
Dental, Vision, Life&amp; AD&amp;D Insurance along with Short-term disability and Long-Term Disability coverage</li><li>
401(k) Savings Plan, Employee Stock Purchase Plan</li><li>
Education Reimbursement</li><li>
Employee Discounts</li><li>
Employee Assistance Program</li><li>
Employee Referral Bonus Program</li><li>
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)</li></ul>
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:<ul><li>
High School Diploma/GED OR 3 + years equivalent experience working within the health care industry or with health care insurance</li><li>
2+ years of customer service experience</li><li>
Intermediate level of proficiency with MS Word, Excel (create, edit, save documents) and Outlook (email and calendar management)</li><li>
Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)</li><li>
Reside in the state of Virginia</li><li>
Willing and able to commute to Richmond VA office approximately once per quarter</li></ul>
Preferred Qualifications:<ul><li>
Prior work at home experience</li><li>
Experience working within the health care Industry and with health care insurance</li><li>
Experience working in a hospital, physician's office or medical clinic setting</li><li>
A clerical or administrative support background</li><li>
Experience working in a call center</li></ul>
Soft Skills:<ul><li>
Strong oral and written communication skills - specifically telephone skills</li><li>
Demonstrated effective organizational skills and scheduling skills as observed in day-to-day work</li><li>
Excellent customer service skills</li><li>
Excellent interpersonal and problem-solving skills</li><li>
Attention to detail, as observed in day-to-day work</li><li>
Excellent time management and prioritization skills</li><li>
Must demonstrate flexibility, ability to follow through on all tasks in a timely fashion, good attention to detail and a willingness to learn</li><li>
Strong team player, initiative in achieving individual and team goals, and team building skills</li><li>
Able to handle sensitive issues with members and providers in a confidential manner</li><li>
Demonstrates initiative in achieving individual, team, and organizational goals and objectives</li><li>
Creative problem-solving skills with the ability to use community and network resources to meet members' needs</li><li>
Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment</li><li>All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.</li></ul> 
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $18 - $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. 
#RPO #GREEN</div>

Clinical Administrative Coordinator - Remote in Virginia

<div>This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together
As a Life Claims Analyst you will be responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjudicating Life claims. Authorizes the appropriate payment or refers claims to Team Lead or Manager for validation of adverse or over limit approvals.
This position is full-time (40 hours/week). Employees are required to work our normal business hours of 7:00am - 6:00pm EST. Core hours business hours are 9:00 am - 4:00 pm EST. It may be necessary, given the business need, to work occasional overtime.
We offer 2 - 3 months of paid training. The hours during training will be aligned with their schedule. Training will be conducted virtually from your home. 
Primary Responsibilities:<ul><li>
Review and render determinations on Life claims</li><li>
Initiate and maintain appropriate level of communication within ERISA standards through the claim review and investigation process</li><li>
Respond to all inquiries generated relative to Life claims within established service timeframe</li><li>
Provide accurate claim decisions in accordance with Policy, State and Federal guidelines</li><li>
Adjudicate Life claims with current average volumes of 50 claims weekly</li></ul> 
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:<ul><li>
High School Diploma / GED OR equivalent work experience</li><li>
Must be 18 years of age OR Older</li><li>
2+ years of experience in Customer Service, including analyzing and problem-solving issues for policyholders, employers, for both internal and external customers</li><li>
2+ years of recent experience performing end to end life insurance claims processing, including claims review and benefit release</li><li>
Proficiency with computer and Windows personal computer applications, which includes the ability to navigate and learn new and complex computer system applications</li><li>
Ability to work full-time (40 hours/week). Employees are required to work our normal business hours of 7:00am - 6:00pm EST. Core hours business hours are 9:00 am - 4:00 pm EST. It may be necessary, given the business need, to work occasional overtime</li></ul> 
Preferred Qualifications:<ul><li>
OnBase claims processing system experience</li></ul> 
Telecommuting Requirements:<ul><li>
Ability to keep all company sensitive documents secure (if applicable)</li><li>
Required to have a dedicated work area established that is separated from other living areas and provides information privacy</li><li>
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service</li></ul> 
<ul><li>All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy</li></ul> 
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $49,700 - $88,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 
UnitedHealth is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 
UnitedHealth is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.</div>

Life Claims Analyst

<div>At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together 
As the Executive Director, Dual Special Needs Plan (DSNP ED), you will have the unique opportunity to manage a complex, innovative, and growing product line in collaboration with local Market Medicaid leadership and our nationally leading Medicaid team. The DSNP ED role will focus on delivering overall product results, including growth, medical expense and revenue management, quality and clinical outcomes, and integration and coordination of Medicaid and Medicare benefits. As the DSNP ED you will be accountable for developing deep state relationships to support the annual State Medicaid Agency Contracts (SMAC) Process as well as shaping state Medicaid strategy for integration and benefit coordination. In addition, this role will require deep knowledge of local community based supports and demonstrated relationships with local Community Based Organizations (CBO) and Medicaid service organizations such as Single Entry Point (SEP) and Area Agencies on Aging (AAA). This role will also serve as the accountable leader for collaboration with the Medicare Product Team for annual benefits and bid filing strategy. 
Dependent on market size and integration level, this role will allow for the DSNP ED to manage multiple markets. 
The successful candidate will have a deep understanding of both Medicaid and Medicare, understanding the manner in which these two programs work together to promote health and wellbeing for the most vulnerable, including those receiving long term services and supports (LTSS). The candidate will have a demonstrated ability to work in a matrixed environment, including collaborative goal setting with the local market CEO and national product team leaders. The DSNP ED will lead medical expense management strategies to address emerging trends, will collaborate with national Quality team members to drive continual STAR Rating performance, and will lead with a Person-First mindset to ensure our Medicaid and Medicare programs fully support our membership across all domains of care. 
The successful candidate will also be responsible for fostering close, mutually beneficial relationships with local community supports and providers, including but not limited to primary care medical homes, health systems, behavioral health providers, community leaders, community-based organizations, policymakers and consumer advocacy groups throughout the states. The Executive Director is a driver of solutions and partnerships that increase STARS rating of the health plans, close gaps in care and service delivery for members, and continuously improve access to care in the communities served. As a key leader among the health plans, the Executive Director assures that the health plans and their partners live up to service commitments for the communities served. 
If you are located in Missouri, Iowa, surrounding states or are willing to relocate, you will have the flexibility to work remotely* as you take on some tough challenges. 
Primary Responsibilities:<ul><li>
Functions as a member of the executive teams for the C&amp;S health plans being supported</li><li>
Direct oversight of the Dual Special Needs Plan (D-SNP) for multiple states</li><li>
Ensures compliance with applicable state and Federal laws and with contractual obligations to state Medicaid, providers and others</li><li>
Product P&amp;L ownership and matrixed and direct leadership across a complex organization</li><li>
End-to-end ownership of all related functions for assigned D-SNP markets including:<ul><li>
The development of market specific State Medicaid Agency Contract (SMAC) agreements and accountability for ensuring compliance with SMAC requirements</li><li>
Collaboration with Government Programs functional teams including but not limited to Product, Stars, Operations, Clinical, Sales and Marketing to ensure best in class delivery of Medicare Advantage programs</li><li>
Identification of market specific requirements and alignment with national vendor (clinical/non-clinical) options to support cost effective, proven solutions</li></ul></li><li>
Maintain awareness of and apply emerging state and federal policy requirements to market specific strategies</li><li>
In collaboration with clinical and Health Care Economics team, leads medical expense management strategies to manage trend and medical cost as well as promoting best outcomes</li><li>
Reporting and Analytics - in collaboration with national HCE, Finance, and Operations, develops and retains detailed reporting to enable effective management of the program, including but not limited to: trend drivers (DX and Provider type), member demographics, RAF/HCC reporting, detailed financials, integration status, etc.</li><li>
Develop and execute strategic priorities related to Highly Integrated Dual Eligible (HIDE) &amp; Fully Integrated Dual Eligible (FIDE) maturation, Accountable Care Organization (ACO) partnerships, community engagement, LTSS co-evolution including management of state relationship for DSNP integration (in collaboration with health plan CEO)</li><li>
Defines strategic priorities to support contract, SMAC, Risk Adjustment Factor (RAF), STARS and other quality standards</li><li>
Works closely with UHN partners to refine the DSNP network for optimal success including integration of providers, network adequacy and cost / quality / outcomes</li><li>
Ensures matrix partners provide excellent service to state customers, i.e., members and providers</li><li>
Works closely with Government Programs and M&amp;R CEOs to align on priorities when appropriate</li><li>
Assists in detecting service problems and coordinating solutions with the health plan, segments and corporate office</li><li>
Understands thoroughly and administers the contracts for the line of business within the applicable states</li><li>
Participates in formulating and administering company policies and developing long-range goals and objectives as they relate to the state health plans</li><li>
Represents the health plan professionally and effectively to customers such as state Medicaid and other important business relationships</li><li>
Establishes and maintains an excellent business reputation</li><li>
Monitors state activities, costs, operations, etc. to determine progress toward objectives and priorities</li><li>
Develop and maintain solid relationships within the key communities including providers, business partners, community alliances, etc.</li><li>
Continuously fosters innovation, improvement and positive differentiation in the assigned markets</li></ul> 
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:<ul><li>
4+ years of experience in Medicaid and/or Medicare programs environment, care delivery models, VBC/APMs</li><li>
Experience in quality improvement, strategic planning and development</li><li>
Experience designing and/or administering health programs and developing health care policy</li><li>
Experience managing high-profile community projects or large-scale contracts</li><li>
Consistent, progressive leadership experience in health care delivery and public programs</li><li>
In-depth knowledge of the dual Medicaid - Medicare eligible populations including Behavioral Health and LTSS</li><li>
People management, including direct supervisory experience and ability to indirectly influence those outside of direct supervision</li><li>
Resident of Missouri, Iowa, surrounding states or willing to relocate</li><li>
Ability to travel up to 75%</li><li>
Driver's License and access to reliable transportation</li></ul> 
Preferred Qualifications:<ul><li>
Knowledge of and experience with the Medicaid waiver process</li><li>
Knowledge of and experience with Medicaid and Human Services systems within the served states, licensure processes, quality and financial oversight processes, including applicable federal and state regulations</li></ul><div><ul><li> 
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy</li></ul></div> 
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $159,300 - $273,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. 
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.</div>

DSNP Executive Director, Missouri and Iowa - Remote in MO, IA or surrounding area

<div>At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
As part of a care management team who will manage complex members, the Integrated Care Coordinator will be the primary care manager for a panel of older adult members with a variety of medical and/or behavioral health needs. Care coordination activities will focus on supporting members' medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care.
Work Schedule: Monday through Friday 8:00 am to 5:00 pm
Location: Wayne County, Indiana and surrounding areas
Local travel up to 75% and mileage is reimbursed at current government rate.
If you live within the state of Indiana and can travel to Wayne County, IN and surrounding counties, you will have the flexibility to telecommute* as you take on some tough challenges.
Primary Responsibilities:<ul><li>
Serve as primary care manager and service coordinator for high medical risks / needs members with comorbid behavioral health needs</li><li>
Engage members face-to-face and/or telephonically to complete comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural and socioeconomic (SDoH) needs</li><li>
Develop and implement individualized, person-centered care plans and service plans inclusive of goals, opportunities and interventions/services aligned with a person's readiness to change to support the best health and quality of life outcomes by meeting the members where they are</li><li>
Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan</li><li>
Provide referrals and linkage as appropriate and accepted by members (may include internal consulting opportunities such as Housing Navigator, Pharmacy Team, Peer Specialist, etc. or community-based provider referrals such as PCP, specialists, medication assisted therapy referrals, etc.)</li></ul>
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:<ul><li>
Must Possess One of the Following:<ul><li>
Master's Degree in Social Work</li><li>
Bachelor's Degree in Social Work, Psychology, Special Education, Counseling, or relevant degree with at least 1+ years of case management experience with older adults, individuals with disabilities or those with serious mental illness</li></ul></li><li>
2+ years of experience in long-term support services or working with older adults</li><li>
1+ years of experience with local behavioral health providers and community support organizations addressing SDoH (e.g., food banks, non-emergent transportation, utility assistance, housing/rapid re-housing assistance, etc.)</li><li>
1+ years of experience with MS Office, including Word, Excel and Outlook</li><li>
Ability to travel 75% of the time within assigned territory to meet with members and providers</li><li>
Reside in Indiana</li><li>
Access to reliable transportation &amp; valid US driver's license</li></ul>
Preferred Qualifications:<ul><li>
Demonstrated experience/additional training or certifications in Motivational Interviewing, Stages of Change, Trauma-Informed Care, Person-Centered Care</li><li>
Experience working in team-based care</li><li>
Experience in serving individuals with co-occurring disorders (both mental health and substance use disorders)</li><li>
Background in Managed Care</li><li>
Bilingual in Spanish or other language specific to market populations</li></ul>
Physical Requirements<ul><li>
Ability to transition from office to field locations multiple times per day</li><li>
Ability to navigate multiple locations/terrains to visit employees, members and/or providers</li><li>
Ability to remain stationary for long periods of time to complete computer or tablet work duties</li><li>All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.</li></ul> 
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $$29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. 
#RPO #RED</div>

Field Based Clinical Care Coordinator - Wayne County, IN

Join UnitedHealthcare and explore 16   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.