EmblemHealth jobs in New York, NY - 113 jobs

* Support contract performance management of a large health system. * Review and analyze suspected underpaid and overpaid claims from hospital, ancillary, and provider groups based on contractual and industry guidelines. * Identify and analyze single issues and trends to determine root causes. * Provide recommendations for solutions to minimize errors and delays in systems and/or processes. * Monitor system output to ensure proper functioning. Roles & Responsibilities * Evaluate disputed claims for system configuration, claims processing, and/or contractual issues to facilitate claims review. * Maintain and organize detailed information on claims dispute files to ensure appropriate and comprehensive data is returned to the provider timely. * Track issues and monitor trends to support their resolution. * Identify potential/actual claims problems (single or recurring/trending) and document root cause analysis; present findings to management. * Improve quality, enhance workflow, and provide efficiencies within departments, identify opportunities for improvements; develop and present recommendations for changes. * Conduct regular meetings with the assigned provider groups for status of AR files and recycles * Support departmental goals for cycle time by organizing and tracking claims for review. * Monitor and provide timely responses for the designated provider group emails and AR files. * Perform other related tasks as directed or required. Qualifications * Bachelor's degree ; additional experience/specialized training may be considered in lieu of educational requirements required * 2 - 3 years' prior related work experience in professional/facility claims or benefits/billing environment required * Strong knowledge of claim processing policies and procedures required * Knowledge of medical terminology, ICD/CPT coding, per diem and DRG reimbursement and EDP testing procedures required * Proficiency with MS Office applications (word processing, database/spreadsheet, presentation) required * Ability to accurately interpret information from contractual and technical perspectives required * Must be conscientious and detail oriented; ability to recognize unusual patterns and troubleshoot for operational improvement and efficiencies required * Strong analytical and problem-solving skills required * Ability to effectively work on multiple projects/tasks with competing priority levels and deadlines required * Ability to effectively absorb and communicate information required * Strong Interpersonal and teamwork skills required Additional Information * Requisition ID: 1000002824 * Hiring Range: $48,600-$83,160

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 Strategic Account Executive manages ongoing client, broker and consultant relationships for an assigned book of business and is responsible for persistency goals and upselling new business expansion for both medical growth and ancillary within their book. They are responsible for representing their clients internally as advocate and coordinating with other functional areas within the company to implement client benefits, complete projects and address service needs. Will work closely with new business sales teams on prospective clients to support finalist meetings and manage implementation when cases are sold. Strategic Account Executive is responsible for the up-selling of appropriate services and ancillary products to clients, renewal of existing contracts and retention of membership and client satisfaction. The Strategic Account Executive is the owner of the client relationship. Must be self-sufficient, able to take direction and review training materials as provided timely, as well as be able to work in a less structured environment with minimal supervision. May be a resource, coach and teacher to others. Must be able to assess and interpret customer needs and requirements and identify solutions and company capabilities. Can translate concepts into practice. Able to work on complex problems and issues and provide innovative and effective solutions that support both the client and the company's goals and objectives. This is a highly incentivized role. This position follows a hybrid schedule with Three in-office days per week. Primary Responsibilities: Manage an assigned book of business with limited supervision, including in-person client and broker meetings Be responsible for achieving revenue growth targets based on book of business Meet annual renewal persistency goals to align with Incentive Plan to be provided Renew existing business and support upsell of new business expansion for all ancillary products Own/Lead Sales process and client engagement through the sale and onboarding for existing client Maintain ongoing relationships with clients and brokers Work in conjunction with Account Management Team on combined Medical/Ancillary clients Support new sales for finalist presentations Knowledge of UHC Value Story and ability to present externally Driver's License and access to a reliable transportation 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: Life and Health Licensed 5+ years of sales and/or Account Management experience Proven basic computer skills (Microsoft Office) Ability to develop and manage relationships to reach business goals Ability to travel as needed to meet/support clients/brokers - 25% Ability to work out of the One Penn Plaza office in New York 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 $60,000 to $130,000 annually based on full-time employment. This role is also eligible to receive bonuses based on sales performance. 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. #programmatic #programmatic

Manage the daily clinical operation and administration of a Medical Management Department or function to support improved utilization results across the spectrum of medical specialties. Provide clinical leadership both internally and externally. Serve as an essential liaison among Senior Management, Plan staff, contracted providers, vendors, and membership to promote and improve communication and operations areas of medicine including Internal Medicine, OB/GYN, Psychiatry, Ambulatory Medicine, Emergency Medicine and Radiology. Carry out assigned programs to ensure the delivery of quality medical care to the EmblemHealth membership and compliance with contractual obligations and standards; assist in the development and implementation of new policy and programs as needed. Maximize operational effectiveness and oversight of assigned functions, ensuring regulatory compliance and accreditation with Department of Health, Department of Insurance, CMS, NCQA, and URAC standards. Provide services per the NYCE contract. Principal Accountabilities * Manage use of medical resources for inpatient and outpatient services including Internal Medicine, OBGYN, Neurology, Surgery, Pediatrics, Emergency Medicine or Psychiatry. * Determine medical appropriateness through the application of clinical criteria; perform case management review; and participate in the clinical appeals process. * Sole authority and responsibility for issuing clinical adverse determinations based on medical necessity. * Conduct medical rounds, attend Medical Director meetings and participate in the inter-rater reliability process. * May also perform peer clinical reviews as needed. * Establish and maintain continuity in the planning, development and implementation of policies, operational processes, workflows required to execute organizational strategies and to assure consistency in process application throughout Care Management. * Validate and monitor adherence to implemented policies, procedures, workflows and processes: identify, recommend and implement improvement initiatives accordingly. * Generate methods to develop and improve the overall delivery and performance of the department. * Implement process improvements in a timely manner. * Deal effectively with and lead others throughout Company structure. * Support other areas in implementing cross-departmental changes. * Make sound decisions based on all available data. * Determine medical appropriateness through the application of clinical criteria and perform case management review. * Demonstrate familiarity with high-risk populations, community settings and care of medical patients. * Anticipate and identify key source information to analyze problems clearly and determines creative solutions. * Provide thought leadership to articulate and help build an effective and efficient medical delivery program. * Identify trends, problems and opportunities, conduct root cause analysis. * Implement action plans in an effective and efficient manner aimed at promoting goals/resolving barrier issues. * Strive to improve efficiencies of key operational areas. * Assist with contract negotiations as necessary. * Represent Care Management in interdepartmental committees designed to meet organizational goals. * Develop annual goals and oversight of assigned department/function. * Support Senior Medical Directors in communications with internal and external organizational goals; ensure a high level of customer satisfaction (members, vendors, providers, regulators, accreditation agencies, peers and employees). * Chair or participate on committees as requested. * Regular attendance is an essential function of the job. * Perform other duties as assigned or required. Qualifications * MD or DO degree. Board certification is required * Active New York or Connecticut license or certification to practice medicine without restriction required * 10+ years of relevant, professional work experience * 5+ years of clinical practice * Administrative experience on a hospital committee, in a medical group or for an insurer * Knowledge of clinical practice of medicine, health care delivery systems, utilization methods and treatment protocols * Knowledge and understanding of managed care principles, industry evolution, physician reimbursement, and human resource management * Experience conducting evidence-based treatments in group and individual modalities, especially for psychiatric treatment * Considerable independent decision making with physicians, members, subordinates, other departmental leaders and external vendors, regulatory and accreditation agencies * Excellent communication skills (verbal, written, presentation, interpersonal); tact and diplomacy sufficient to successfully carry out the above duties and responsibilities Additional Information * Requisition ID: 1000002696 * Hiring Range: $189,000-$361,800

Summary of Job Proactively lead a program and/or complex projects by setting strategic direction; identify gaps and recommend enhancements related to new and/or existing products, services and workflows based on broad view of the organization. Collaborate and partner with other functional managers, other business areas across/within the enterprise and/or other business areas to ensure all workflow processes and interdependencies are identified and addressed. Collaborate internally to identify and build external partnerships. Support existing and potential partnerships by collaborating to drive and deliver projects. Lead the work and deliverables of multiple, complex projects or programs, from the planning stage to implementation, that impact multiple processes, systems, functions, and products. Align and drive strategic business initiatives and goals. Conduct industry analysis and research to identify insights and recommend solutions that will support the enterprise strategic objectives. Conduct financial analysis and research to identify insights and recommend solutions that will support the enterprise strategic objectives and generate maximum return on investment(s). Provide research and financial analysis to support program improvement initiatives. Support transaction-related activities including due diligence, valuation modeling, and deal structuring in collaboration with internal and external stakeholders. Collaborate with Finance to develop and maintain the long-term planning and financial model (3+ years) for use in strategic planning. Track and report on risks and opportunities and how they may impact the financial results and projections by developing close ties to key financial and operational leadership. Support and consult with executive management on financial and operational initiatives and issues by being accountable for the development of cost benefit analyses in the form of business case analysis, as well as tracking and measuring initiatives over time against anticipated results. Responsibilities * Coordinate and implement a comprehensive process for obtaining, analyzing, synthesizing and publishing competitive intelligence. Conduct advanced analyses with immediate and future views; develop solutions to complex problems. * Interpret research findings to identify advancement opportunities and present these results in a concise way to leadership. Report on earnings calls for key competitors to highlight trends and develop a strategy team point of view. * Partner with leadership on the development, coordination, and administration of business initiatives in support of enterprise strategic objectives. * Utilize finance metrics to determine degree of success for projects; report on results to senior management. * Work with project owner(s) to develop, align and refine program management oversight to maximize chances for successful delivery of projects. * Communicate progress to Sr. Management via Management processes (i.e., Annual and Strategic Planning, Enterprise Strategy Team, and HCCI meetings). * Capture follow-ups and takeaways from these meetings. * Collaborate with external partners on project and program delivery internally. * Support corporate development efforts by working with internal teams and external parties on roadmap development and transaction processes. * Manage external partnerships by building relationships with key members of the team, understanding priorities, managing deliverables and timelines. * Clearly and proactively manage and communicate priorities to execute internally. * Build and manage internal stakeholder map to ensure engagement and delivery. * Manage the development, implementation, and ongoing maintenance of critical, enterprise projects. * Use data driven decision making to guide efforts; proactively lead projects by creating project timeline, identifying key milestones, and working cross-functionally for successful project completion. * Support corporate development and transaction execution efforts, including M&A, partnerships, and strategic investments. Coordinate with investment banks, legal counsel, and internal stakeholders to evaluate and execute deals. * Develop project proposal/scoping and/or ROI analyses in partnership with finance and business analysis areas. * Lead financial modeling and scenario planning to assess strategic options and investment opportunities. * Track progress and communicate project status on a regular basis to all impacted parties; work with the business, analytics and finance leads to ensure adherence to project timelines and budgets. Lead the business areas in working sessions to align with the enterprise strategy while providing coaching to the teams. Qualifications * Bachelor's Degree; MBA Preferred * Chartered Financial Analyst (CFA) Preferred. * Coursework or certification in corporate finance, financial planning, actuarial science, or data analytics Preferred. * 10 - 12+ years of related, professional work experience (Required) * 3 - 5+ years of healthcare experience, preferably in the health plan/payer/insurance space (Required) * Deep understanding of financial measures, KPIs, and ROI metrics (Required) * Strong experience in financial modeling, valuation, and transaction execution (Preference) * Experience supporting or leading M&A, joint ventures, or strategic partnerships (Preference) * Prior experience related to management and strategy consulting (Required) * Prior experience in investment banking, venture capital or private equity (Preference) * Ability to understand & interpret complex information and synthesize and communicate key information to all audiences (Required) * Proven large scale project management and/or process improvement leadership including development and management of multiple projects/program(s); setting and meeting project milestones; negotiating for resources and ensuring appropriate resource allocation; and successfully managing multiple tasks/projects with competing priorities and deadlines (Required). * Previous experience in a consulting environment (Preference) * Detail and solution oriented; ability to think independently and to identify and resolve issues and impediments to project success (Required) * Excellent communication skills - verbal, written, interpersonal, negotiation; ability to build rapport and relationships (Required) * Proficiency with MS Office - Word, Excel, PowerPoint, Outlook, Teams (Required) * Technical experience with data lakes, tableau and access (Preference) Additional Information * Requisition ID: 1000002557 * Hiring Range: $113,400-$210,600

Multiple Openings * Present to, follow up and sell Individual Medicaid, Essential Plan, QHP and CHP products on a direct sales basis. Assist and enroll individuals by completing the appropriate application forms, obtain required documentation necessary for enrollment, and meeting necessary enrollment targets. * Conduct home visits and other appointments as needed to complete the application and obtain all required documentation. * Develop and maintain appropriate understanding of the health care products related to sales responsibility. Successfully complete periodic certification and testing to maintain knowledge level established by regulations. * Maintain appointments, develop community marketing sites, establish relationship with community based organizations, Participate in health related activities / special events including evening and weekend activity, create self-generated leads, and provide services to walk-ins. Obtains feedback from referral sources and prospective enrollees. * Stimulates word-of-mouth referrals from participants, prospects and their families. * Utilize automated tools to perform individual enrollment duties. * Refer all existing members up for recertification to Retention Specialist when applicable. * Perform recertification activities when necessary. * Function as a liaison between all EmblemHealth departments to help identify and capture prospect's problems or concerns. Work with Neighborhood care team to maintain and improve EmblemHealth's image as a High Quality and Affordable health plan in the community. * Assist members with selecting a Primary Care Physician (PCP) using the provider directory. * Present EmblemHealth insurance products and benefit plans to community groups, small businesses and other prospective subscribers. * Develop and execute sales plan which focuses on growth of the individual products in the assigned neighborhood. Maintain and grow book of enrollments. Enrollment activities include on-site coverage at hospitals, provider offices, City agencies, community business partners and Community Based Organizations (CBO's). All activity entered into Salesforce tool. * Performs other duties as assigned or required * Regular attendance is an essential function of the job. Qualifications: * High School Diploma or equivalent required * 4 years of relevant sales experience preferred * Driver's License and automobile with appropriate coverage is required for territories - Long Island, Staten Island, Westchester, etc. * Travel in the New York metropolitan area required * Must be able to work nights and weekends as required * Excellent interpersonal and presentation skills and the ability to work independently. * Excellent organizational and communication skills, both verbal and written * Ability to develop strong relationships and influences in the community * Ability to input and update data in database system * Works independently and produces Self-Generated leads * Ability to multi-task * Successful completion of annual product training and testing to maintain regulatory certification Additional Information * Requisition ID: 2502E * Hiring Range: $50,000 - $60,000

* Provide technical, administrative, and logistical support in executing community events for Marketplace Sales to facilitate the selling and engagement functions. * Assist with the management of EmblemHealth events, sponsorships, and community activations. * Responsible for the daily operation, maintenance, and organization of EmblemHealth's Community Outreach Vehicles (COVs), cargo vans, and RVs at assigned marketing locations. * Ensure the Sales Department staff have a professional and functional environment to engage with community members and support enrollment efforts. Principal Accountabilities Sales Operations Enablement: * Scout and secure approved parking/event locations within the assigned catchment area. * Identify safe and legal space to set up displays and working area. * Perform daily setup, breakdown, and transport of marketing equipment (tents, tables, banners, marketing material, supplies, A-Frames, etc.). * Support Sales Reps with administrative tasks (distribute flyers and other materials, assist with lead collection). * Engage with members of the public to generate or discern interest in speaking with our reps about health insurance. * Maintain communication with Fleet and Sales Management, report competitor activity or marketing obstacles. Vehicular: * Maintain an efficient, organized, and clean vehicle (interior & exterior). * Conduct daily vehicle inspections (complete daily inspection checklist): check and replace or replenish fluids as needed (gas, oil, transmission, windshield wiper, brake fluids, etc.). * Perform minor maintenance tasks: check tires, wiper blades, etc., and take necessary actions to ensure safety. * Communicate/escalate if more advanced or complex maintenance is required. * Responsible for transporting to repair shop (as needed) Transportation: * Pick up vehicle from assigned parking location and drive to assigned field location. * Lift, pack, and transport marketing equipment, materials, and supplies to field representatives. * Comply with DOT and local traffic regulations. * At the end of shift, pack up vehicle and return it back to assigned parking location. * Unload materials, equipment, and supplies as needed. Miscellaneous: * Conduct supply inventory checks and order replenishments as necessary. * Safeguard confidential documents and deliver them securely to appropriate staff within 24 hours. * Assist in onboarding/training new drivers. * Perform other related duties/tasks as directed, assigned, or required. Qualifications Education, Training, Licenses, Certifications * Bachelor's Degree. * Unrestricted NYS driver's License. Relevant Work Experience, Knowledge, Skills, and Abilities * 2 - 3+ years of relevant, professional work experience. * Extensive experience driving in various NY neighborhoods. * Additional experience/specialized training may be considered in lieu of degree requirement. * Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.). * Ability to perform minor vehicular maintenance tasks (e.g., checking and replacing wiper fluid, checking oil/fuel levels, checking tires, etc.). * Ability to lift and transport materials and equipment weighing up to 100 lbs. * Strong communication skills (verbal, written, interpersonal) with all types/levels of audiences. * Strong organizational skills; ability to manage and maintain inventories. * Prioritizing and problem-solving skills; ability to effectively manage logistical tasks. * Must be willing and able to work "off hours" such as evenings, weekends, holidays, etc. as needed. Additional Information * Requisition ID: 1000002760_01 * Hiring Range: $48,600-$60,000

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** The overall purpose of the Behavioral Health Care Advocate is to improve the enrollee's ability to remain stable in the community and out of the hospital. Care Advocates engage people in the treatment process and assist them to access the appropriate community services so they can pursue their treatment goals in the community and avoid institutionalization. This position is also designed to be a direct clinical liaison between health plan staff and the clinical network. The program fosters a collegial and mutually beneficial relationship between the providers and payers of medical and behavioral health services. This is a field-based position working with adults enrolled in the Medicaid program. You will spend 80% of the time meeting with enrollees at hospitals, clinical facilities, community sites, and in their homes. The remaining 20% is spent working remotely at home. The schedule is Monday - Friday, 8 am to 5 pm, with no weekends, evenings, or holidays. Due to business needs, current residency in or near Yonkers or Central / Southeast Bronx is required. **Primary Responsibilities:** + Identify and provide community service linkage + Assist enrollees with aftercare appointments + Provide subsequent member follow-up as determined by individual member needs + Work with enrollees to identify gaps in care or obstacles to care and problem solve for successful connection to needed services + Review IP Census each day to determine which enrollees on the census are re-admits within the last 12 months + Go to facility meetings with treatment team to develop a successful aftercare plan + Manage the aftercare follow-up of identified high risk enrollees (manage follow-up calls/outreach and documentation) + Meet with community providers/facilities as company liaison to foster good rapport and relationships and to identify new programs As part of your employment with Optum, you'll enjoy a robust total rewards package that includes: + Competitive salaries + Comprehensive benefits, including health insurance, 401(k) matching, and a wide range of life and wellness resources to support your overall well-being + Paid time off and paid company holidays + Continuing education support, including CEU and licensure reimbursement + Mileage reimbursement for work-related travel + Opportunities to make a meaningful impact by supporting your local community and partnering with area resources We're committed to creating a supportive and rewarding environment where you can thrive both personally and professionally. 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:** + Master's degree in Psychology, Social Work, Counseling, or Marriage and Family Counseling; OR Licensed Ph.D.; OR Registered Nurse with 5+ years of Behavioral Health experience + Active, unrestricted, independent license the State of New York: + Licensed Mental Health Counselor (LMHC) + Licensed Marriage & Family Therapist (LMFT) + Licensed Clinical Social Worker (LCSW) + Licensed Psychologist (LP) + Registered Nurse (RN) + 2+ years of experience in a related mental health environment + Demonstrated proficiency with computers and solid working knowledge of Excel spreadsheets + Dedicated, distraction-free home office / workspace with access to install secure, high-speed internet at home + Access to reliable transportation that will allow daily travel throughout an assigned territory to meet with enrollees + Reside in or near Yonkers or Central / Southeast Bronx **Preferred Qualifications:** + Medical/Behavioral setting experience (i.e., hospital, managed care organization, or joint medical/behavioral outpatient practice) + Dual diagnosis experience with mental health and substance abuse + Case Management experience + Community health experience + Field based experience + Experience working with low-income populations + Experience working with the aged, blind, or disabled + Working knowledge of city and state agencies and practices including APS, ACS, AOT, ACT, Health Home, Forensic and others All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. 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 $58,800 to $105,000 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._

Summary of Job Oversee and actively participate in quality improvement projects. Contribute to the overall success of Quality Programs by promoting /advancing the department mission of effectively managing members and improving health outcomes. Serve as the Quality Management liaison for internal and external partners for projects and improvement initiatives. Subject matter knowledge expert with regards to quality improvement & reporting. Responsibilities * Work directly with business partners to plan, implement, and oversee ongoing operational execution of quality improvement projects and action plans (HEDIS, CAPHS, and HOS) to meet corporate business goals for Medicare, Medicaid, QHP, and Commercial product lines. * Support the execution of centrally developed and data-driven strategic plans. * Assist in leading cross-functional teams for collaboration on HEDIS, CAHPS, HOS, Pharmacy, and Enterprise metrics. * Serve as a point of contact for quality vendors: develop and share target lists; provide support in monitoring performance against established Service Level Agreements; provide a communication bridge between the company/line(s) of business and the vendors. * Manage ongoing quality programs including Member Rewards & Incentives, Provider Quality Incentives, and addressing Health Disparity initiatives. * Provide subject matter expertise and support on all quality metrics to key stakeholders. * Support NCQA/CMS/HEDIS/CAHPS/HOS and other regulatory requirements that apply to quality programs. * Work with the data team to conduct analysis and reporting as needed on initiatives designed to impact quality performance to provide insight to future projects. * Develop annual performance improvement projects; analyze project data; and ensure completion of the finished product(s) including the development of year-end report(s). * Develop methodologies for quality program assessment (ROI and proof points of program outcomes, etc.) Qualifications * Bachelor's Degree; Master's Degree strongly preferred. * Project Management/Vendor Management certification preferred. * 5 - 8 years of relevant, professional work experience (Required) * 3 - 5 years of Quality and/or program management experience in a managed care organization (Required) * Additional years of experience/specialized training/certifications may be considered in lieu of educational requirements (Required) * Experience in researching, developing, implementing, and assessing results of metrics and analytics (Required) * Understanding of contractual or compliance related SLAs (Required) * Ability to successfully manage multiple projects/tasks with competing priority levels and deadlines (Required) * Experience and knowledge with HEDIS/QARR, CAHPS, CMS Star Ratings, and Accreditation (Required) * Proficient in MS Office - Word, PowerPoint, Excel, Outlook (Required) * Excellent communication skills - verbal, written, presentation, interpersonal, active listening (Required) * Working knowledge of MS Access (Preferred) Additional Information * Requisition ID: 1000002751 * Hiring Range: $77,760-$149,040

**Opportunities with Optum in the Tri-State region** (formerly CareMount Medical, ProHEALTH New York and Riverside Medical Group). Come make a difference in the lives of people who turn to us for care at one of our hundreds of locations across New York, New Jersey and Connecticut. Work with state-of-the-art technology and brilliant co-workers who share your passion for helping people feel their best. Join a dynamic health care organization and discover the meaning behind **Caring. Connecting. Growing together.** The **Phlebotomist** performs venipuncture and capillary puncture on adults, neonates, and pediatric patients; collects urine specimens; participates in the instruction of new personnel; works with computer; communicates in a manner that promotes Laboratory professionalism as well as a comfortable phlebotomy. **Schedule:** This is a 37.5 **-** hour work week, Monday through Friday between the hours of 7:30 am to 6:00 pm. Rotating Saturdays from 7:30 am to 12:00 pm. The schedule will be determined by the hiring manager upon hire. **Location:** 1 Dakota Drive, Lake Success, NY, 2 Ohio Drive Lake Success, NY, 4045 Hempstead Turnpike, Bethpage, NY, and 575 Underhill Blvd. Syosset, NY **Primary Responsibilities:** + Perform routine phlebotomy procedures + Ability to distinguish sample types and draw requirements with order of draw for lab testing + Navigate laboratory computer system with minimal to no errors + Perform pediatric and adult phlebotomy + Obtain finger stick collection + Verify patient demographics accurately with two patient identifiers + Adhere to safety and scientifically accepted infection control practices and standards + Blood collection: from adult and pediatric patients using vacutainer, syringe and butterfly techniques; capillary puncture using heel and fingerstick techniques + Identifies and labels specimens appropriately + Instruct patients regarding urine and stool collection procedures + Enters accessing data into the computer + Prepares specimens for sending out testing + Inventories supply and prepare phlebotomy stations to effectively collect blood + Attends required meetings + Function as an effective team member. Work cooperatively alongside physicians, nurses and other ancillary staff + Display effective communication + Maintain pace of over 4-6 patients per hour + Travel to all other draw stations and perform all tasks + Troubleshoot problems within LIS and partner with LIS team to resolve outstanding issues. + Performs other duties as assigned + Including but not limited to: + Follow handwashing protocols + Practice aseptic techniques + Utilize protective barriers + Utilize personal protective equipment, e.g. gloves, lab coats + Maintain proper disposal of hazardous materials + Demonstrate knowledge of role in emergency disaster + Maintain pace of over 4-6 patients per hour + Travel to all other draw stations and perform all tasks **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:** + Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays + Medical Plan options along with participation in a Health Spending Account or a Health Saving account + Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage + 401(k) Savings Plan, Employee Stock Purchase Plan + Education Reimbursement + Employee Discounts + Employee Assistance Program + Employee Referral Bonus Program + Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) + More information can be downloaded at: ************************* 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:** + High School Diploma/GED (or higher) + 1+ years of computer proficiency experience in Microsoft Office and demonstrates solid computer skills + 1+ years of phlebotomy experience (Additional appropriate education may be substituted for the minimum experience requirement) + Available to work rotating Saturdays + Ability to have reliable transportation and travel to other draw stations (Beth Page, Lake Success, Syosset) **Preferred Qualifications:** + Phlebotomy certified + Previous laboratory experience + Pediatrics Phlebotomy experience **Soft Skills:** + Ability to work independently and as a team, and maintain good judgment and accountability + Demonstrated ability to work well with health care providers + Strong organizational and time management skills + Ability to multi-task and prioritize tasks to meet all deadlines + Ability to work well under pressure in a fast-paced environment + Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others 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 $16.00 to $27.69 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

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. This position highly prefers RN Licensure. **Position Purpose:** Serve as a liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams + Implement and manage procedures for tracking, identifying and problem-solving operational issues. + Interpret and present program results and develop data-driven analysis and metrics used to measure effectiveness and ROI of all current and new products. + Act as the clinical representative in various meetings. + Collaborate with staff to identify internal and external opportunities and initiate process changes to increase quality and improve staff, provider and member satisfaction. + Serve as a resource and liaison on utilization, quality improvement, and case management activities. + Partner with various staff, along with internal and external departments on provider education and outreach. + Partner with regional leadership for providers requiring a clinical interpretation of results related to health plan reporting, data, and quality incentive payments. + Support community and member initiatives with a focus on at risk targets. + Performs other duties as assigned + Complies with all policies and standards **Education/Experience:** LPN or LVN license. RN license preferred. 4+ years of clinical nursing experience, preferably in a large primary care office or clinic setting working with Medicaid or the uninsured. Experience in conflict management or data reporting and evaluation. Experience working in managed care, utilization management, case management, or quality improvement preferred. Pay Range: $33.71 - $60.67 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

* Responsible for receiving, researching and resolving provider inquiries received from UMR or internal departments and business partners (i.e., account management, client retention, access to care, G&A, etc.) regarding claim outcomes. * Perform root cause analysis and take appropriate steps to have corrected, working directly with support areas (Provider Network Management, Provider File Ops, CCT) as needed. * Review and analyze suspected underpaid and overpaid claims from hospital, ancillary, and provider groups based on the provider contract language * Recommend changes in procedures, desk level procedures (DLPs) and workflow to improve quality and efficiency as needed. * Ensure impacted claims are adjusted. Roles and Responsibilities * Serve as subject matter expert (SME) for resolution of issues related to claims adjudication outcomes for medical and hospital claims for NYCE as requested by UMR. * Work across multiple groups/departments to ensure that issues are clearly understood and defined, and that they are either resolved or escalated as appropriate. * Perform root cause analysis and take appropriate actions to ensure root cause is remediated. * Research and resolve claim issues as requested and make determination of appropriateness of claim adjudication outcome and/or adjustment request. * Remediation may include configuration updates, recommendation of changes to processing procedures, UMR or Facets workflows, and processing documentation tools. * Collaborate with EmblemHealth business partners as needed via email or virtual meetings to validate accuracy of NetworX rate sheets, provider participation status, and provider file impacting the claim(s) adjudication outcome. * Support NYCE SLA agreements by providing timely turnaround of cases to ensure alignment with specified parameters of completion, timeliness, and accuracy. * Perform follow up as needed to ensure the issue has been resolved; provide documentation with appropriate level of detail in "speak human" terms so that all information is communicated and understood clearly, including claim adjustment detail(s) and/or explanation for payment correctness to the requestor. * Perform other related tasks and responsibilities as directed, assigned, or required. Qualifications * Bachelor's degree, preferably in Business Management required * 3 - 5+ years of relevant, professional work experience required * 2 - 3+ years in claims processing with working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding, coordination of benefits required * Experience managing in a BPASS model preferred * Experience within a health care and/or claims environment required * Additional years of experience may be used in lieu of educational requirements required * Strong knowledge of claims processing, procedures and systems, State, Federal and Medicare Regulations and Coordination of Benefits applications required * Strong knowledge of member and provider contracts, procedures and systems required * Prior proven EmblemHealth experience preferred * Strong planning, organizational, interpersonal, verbal and written communication skills required * Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required * Ability to successfully manage multiple tasks with competing priorities and deadlines required Additional Information * Requisition ID: 1000002874 * Hiring Range: $56,160-$99,360

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Position Purpose: The Field Retention Representative is responsible for retaining current membership in an assigned territory and must meet the daily production metrics designed to achieve higher membership retention. The Field Retention Representative conducts telephonic and field outreach which includes assistance at community events, provider and community office sites and home visits to new and existing members and must be able to effectively explain, communicate, and assist with all Fidelis Care products. It is the responsibility of the Retention Field Representative to ensure compliance with all regulatory, audit and corporate policies. Field position working within Brooklyn and Staten Island, NY. Fluency in Mandarin required. Provide member resolution by researching, analyzing and documenting inquiries regarding program eligibility Answer application and/or service questions regarding the programs and services in order to maintain/attract membership Conduct outreach and follow up calls to educate members about Fidelis Products and serves as a liaison between the member and the different Fidelis departments Ability to meet and exceed quality assurance standards Ability to undergo rigorous internal training and have complete command of the sales process, all Fidelis Care products, competitive environment in their region successfully pass test(s) as required(with a minimum 85% score)with no more than 2 attempts, that will demonstrate a level of proficiency Have the ability to conduct a needs based analysis to better understand the best course of action based on those needs and be able to answer product feature and benefit questions and provider network questions for members both within and outside of their region Develop and maintain relationships with existing members by providing guidance and assistance throughout the year Demonstrate passion for members by identifying unfulfilled needs and providing necessary education and assistance to promote the value and benefits offered by Fidelis Care Modify delivery skills accordingly to overcome objections and retain members Identify solutions to issues and concerns Document all interactions in the appropriate system (Sales Force, Facets) including marketing leads Track and input interaction taken as a result of each communication in order to ensure all member accounts correctly reflect activities performed Input, update and create member information on databases in order to maintain customer accounts Utilize computer systems to perform administrative functions such as Sales Force Job performance requires fulfilling other incidental or related duties as assigned, assisting and training others, and performing duties of higher rated positions from time to time for developmental purposes Performs other duties as assigned Complies with all policies and standards Education/Experience: High School Diploma, or GED, required. Associates Degree or Bachelors Degree preferred. Minimum 1 year health care related experience preferred. Minimum 1 year of customer service or sales experience preferred. Driver's License may be required by some plans. Specific language skills may be required by some plans. Fluency in Mandarin required. Pay Range: $23.23 - $39.61 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

REMOTE * Identify opportunities to reduce medical expenses and collaborate with other areas to implement and monitor performance. * Develop studies, analyses, and presentation materials needed to appropriately inform decision makers. * Complete pricing analysis, experience analysis and studies, financial projections, and other actuarial/financial calculations. * Run, modify, and create data queries to produce analysis and reports. Responsibilities: * Perform actuarial tasks which are of a mathematical and quantitative nature. * Support analysis of hospital, professional, and drug claim/utilization trends, membership/demographics, and various other ad-hoc analyses. * Maintain appropriate controls around models and other work products. * Ensure quality and on time completion of deliverables. * Assist with rate filings or valuation calculations. * Support preparation of forecasts and monitoring of results or trends. * Support development of efficient and transparent queries to obtain data that is appropriate to the purpose * Ensure internal and external consistency of all work. * Perform reasonability checks dependent on industry knowledge and experience. * Develop and implement analyses for special projects. * Provide technical and analytical support for the actuarial department. * Proactively take on additional work as needed by the team. * Perform duties and assignments as directed or required. Qualifications * Bachelor's degree in Actuarial Science, Mathematics, other physical science, or related finance/business degree required * 3 - 5+ years relevant, professional work experience and/or education required * Must make sufficient progress toward obtaining actuarial credentials, defined as sitting for a minimum of one exam per year, scoring above a zero, and obtaining at least a combined score of 5 over two consecutive sittings * When unable to meet the progress outlined in the bullet above, the role will be transitioned to a non-Actuarial job title and job description * Actuarial/analytical experience, preferably in a healthcare environment preferred * Strong mathematical and analytical skills. required * Strong communication skills (verbal, written, presentation) required * Strong working knowledge of MS Office (Outlook, Word, Excel, PowerPoint, etc.) required * Working knowledge of SQL, R, Python or similar required * Capable with Excel, data extraction, simulations, automation required Additional Information * Requisition ID: 1000002849 * Hiring Range: $56,160-$99,360

Lead and drive high value Behavioral Health strategy and initiatives along with Behavioral Health clinical leader. Execute an organizational strategic plan for behavioral health. Identify areas for improvement, implement innovative solutions, and optimize processes to enhance efficiency, quality, and cost-effectiveness of behavioral healthcare. Collaborate with cross-functional teams, analyze data, and develop strategies to streamline operations and drive continuous improvement in behavioral health. Principal Accountabilities * Develop and execute the enterprise behavioral health strategy across all lines of business (Medicare, Medicaid, Commercial). * Serve as operational lead in supervising Behavioral Health (BH) vendor, taking responsibility over Carelon and services provided by them to our members. * Support integration between behavioral health and physical health to support whole-person care. * Partner with internal operations, network, and analytics teams to design efficient workflows, reduce administrative burden, and enhance member outcomes. * Oversee performance of internal and delegated behavioral health operations including care management, appeals/grievances, and quality reporting. * Lead continuous improvement initiatives focused on access, timeliness, and member engagement. * Monitor key performance indicators (PMPM cost, utilization, readmission rate, engagement rate) and drive accountability for results. * Drive Performance improvement initiatives for access, quality and affordability. * Monitor NYS-required settlement activities around service delivery and quality of patient satisfaction to ensure that providers in-network. * Develop and lead behavioral health initiatives with leadership clinical and executive leadership. * Support the innovation agenda for behavioral health, identifying and implementing emerging models of care, digital solutions, and community-based partnerships. * Support the development of EmblemHealth's Behavioral Health member journey, optimizing access and member satisfaction. Develop complaint processes for members and providers with appropriate monitoring and mitigation of any ongoing issues. * Determine and manage the effectiveness of EmblemHealth's behavioral health provider directory, maintaining the effectiveness of response to continual service evaluation. * Direct provider manual adjustments and updates as well as member-facing content adjustments. * Define key evaluation metrics for behavioral health program and manage outcomes across teams. * Provide Behavioral Health thought leadership to plan and external stakeholders. * Collaborate with Provider Network Management & Quality Management to design and operationalize new value-based model(s) with network providers. * Manage & participate in various provider-facing Joint Operating Committee meetings with BH providers. * Represent behavioral health externally and in appropriate regulatory meetings. * Participate in behavioral health committees as well as participate in various cross functional committees. * Establish and maintain continuity in the planning, development and implementation of policies, operational processes, workflows required to execute organizational strategies and to assure consistency in process application throughout Care Management. * Validate and monitor adherence to implemented policies, procedures, workflows and processes: identify, recommend and implement improvement initiatives accordingly. Qualifications * Bachelor's degree required; graduate degree in related field preferred * 10 - 12+ years of relevant, professional work experience, including 5+ years in the healthcare insurance industry * Excellent understanding of Behavioral Health clinical & operations and business needs * Experience with project leadership and management, including planning, execution, and monitoring projects * Strong communication skills (verbal, written, interpersonal) to collaborate effectively with cross-functional teams and stakeholders; ability to drive collaboration and foster highly productive, functional relationships * Demonstrated agility and ability to drive program completion in expedited timelines * Excellent analytical and problem-solving skills, with the ability to interpret data and make data-driven decisions * Proven experience in leading process improvement initiatives and driving change within a healthcare organization * Ability to adapt to a fast-paced and evolving healthcare environment Additional Information * Requisition ID: 1000002860 * Hiring Range: $113,400-$210,600

**Opportunities with Optum in the Tri-State region** (formerly CareMount Medical, ProHEALTH New York and Riverside Medical Group). Come make a difference in the lives of people who turn to us for care at one of our hundreds of locations across New York, New Jersey and Connecticut. Work with state-of-the-art technology and brilliant co-workers who share your passion for helping people feel their best. Join a dynamic health care organization and discover the meaning behind **Caring. Connecting. Growing together.** **Long Island Pediatric Ophthalmology and Strabismus,** part of Optum, has an immediate opening for a friendly, patient focused and detailed oriented Associate Patient Care Coordinator to join our team. The **Associate Patient Care Coordinator** is responsible for the completion of set processes and protocols. Works cooperatively with all members of the care team to support the vision and mission of the organization, deliver excellent customer service and adhere to Lean processes. Supports the teams in meeting financial, clinical and service goals. **Schedule:** Monday through Friday between the hours of 8:00 am to 8:00 pm. (to work one night per week until 8:00 pm) Two Saturdays per month between the hours of 8:00 am to 4:00 pm. This is a 37.5-hour work week to be determined by the supervisor. **Location:** **146 Manetto Hill RD, Plainview, NY 11803** **Primary Responsibilities:** + Obtain accurate and updated patient information, such as name, address, insurance information + Perform insurance verification on the date of service + Obtain patient signatures for required documents + File, Fax and maintain medical records, + Confirms and schedule appointments + Answering incoming and outgoing telephone calls promptly and courteously + Follow the Payment Security policy and procedures according to Optum Medical guidelines + Ability to maintain a work queue list- complete any pending actions ie referrals, scheduling appointments + Check In and Check Out patients + Ability to maintain and work the front desk in-basket pool. + Perform referral documentation promptly + Performs certain follow-up services for patients in a prompt and courteous manner, such as scheduling specialist appointments, scheduling follow-up appointments + Adhere to the standards identified via Sparq regarding Optum Employee Policies + Work cohesively with fellow employees to achieve specific team goals + Comfortable working in high pace environment + Assure the continuity of care through scheduling and tracking systems + Provide effective communication to patient / family team members and other health care professionals as evidenced by documentation, case conferences, communication notes, and evaluations + Comply with administrative policies to ensure quality of care + Demonstrate precision and efficiency in scanning documents and monitoring the fax server, retrieving and / or scanning documents and assigning to the appropriate electronic chart + All employees are expected to keep abreast on current medical requirements relevant to their position, which includes maintaining patient confidentiality and abiding by all HIPAA and OSHA requirements + Performs other duties as assigned **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:** + Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays + Medical Plan options along with participation in a Health Spending Account or a Health Saving account + Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage + 401(k) Savings Plan, Employee Stock Purchase Plan + Education Reimbursement + Employee Discounts + Employee Assistance Program + Employee Referral Bonus Program + Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) + More information can be downloaded at: ************************* 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:** + High School Diploma/GED (or higher) + 1+ years of computer proficiency experience (multi-task through multiple applications including Microsoft Outlook, Excel, and Word) + 1+ years of customer service or healthcare related experience **Preferred Qualifications:** + 1+ years of experience working in medical front office/ Urgent Care position performing duties such as scheduling appointments, checking patients in/out, insurance verification, collecting co-pays, and maintaining medical records + Experience working with an electronic health record (EPIC) + Knowledge of Medical terms **Soft Skills:** + Ability to work independently and as a team, and maintain good judgment and accountability + Demonstrated ability to work well with health care providers + Strong organizational and time management skills + Ability to multi-task and prioritize tasks to meet all deadlines + Ability to work well under pressure in a fast-paced environment + Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others 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 $16.15 to $28.80 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

* Develop/gather business requirements for queries needed to analyze vendor payment data. * Utilize pre/post claim editing, auditing, and claim recovery programs that will drive incremental value year over year. * Analyze and interpret claims, payment, and vendor data to identify, prevent, and recover overpayments, as well as to drive process improvements and cost containment. * Leverage data analytics, competitor benchmarking, and outcomes to continually identify savings opportunities; to detect trends, discrepancies and inefficiencies, and to support corrective actions. * Collaborate with internal teams and vendors to optimize financial recovery and ensure compliance with regulatory and contractual requirements. * Develop mitigation strategies to avoid future overpayments/underpayments and implement plans to achieve business goals. Responsibilities: * Work directly with management on highly visible projects to understand business needs and current challenges, developing innovative solutions to meet those needs. * Assist in the development of a comprehensive claims strategic roadmap to recover, eliminate, and prevent unnecessary medical overpayments by reviewing upstream and downstream processes. * Assist in the design and delivery of presentations on project status and outcomes to management. * Proactively identify and investigate payment issues, developing mitigation strategies, workflow and process impacts, root cause analysis, and member/provider impact. * Collaborate with internal teams (Claims, COB, Provider Network Management, Finance, etc.) to integrate overpayment prevention strategies. * Maintain and apply knowledge of current trends, practices, and developments in healthcare. * Analyze financial recovery vendor operations to ensure compliance with contracts, regulations, internal policies, and SLAs. * Develop and execute vendor management strategies to maximize recoveries on negative balances, offsets, and overpayments. * Analyze vendor performance data to identify trends, gaps, and areas for corrective action or process improvement. * Establish and track KPIs and SLAs for all vendors to drive accountability. * Assist with the resolution of escalated issues for alignment on overpayment prevention strategies. * Report on vendor performance, recovery metrics, and process improvement initiatives to leadership and stakeholders. * Identify overpayment/underpayment opportunities via data mining, investigations, and quality reviews (benefit configuration, COB, claims logic, etc.). * Collect, compile, and analyze data to measure and report on current and process enhancements. * Structure large data sets to find usable information and define, design, and create reporting solutions with actionable insights. * Create reports for internal teams, external clients, and stakeholders with data visualizations (graphs, dashboards, infographics). * Produce standard periodic reports and ad hoc analyses as requested. * Utilize Excel, Power BI, Tableau, and other tools to analyze performance drivers and create dashboards for self-managed reporting. * May write and execute SQL queries to support data validation, reporting, and issue resolution. * Conduct regular gap analyses of internal and vendor processes to identify and mitigate risks for overpayments. * Perform gap analyses on claims data to identify discrepancies, compliance risks, and opportunities for process improvement. * Identify opportunities for process enhancements to streamline workflows, reduce errors, and prevent overpayments. * Drive continuous improvement initiatives by recommending and implementing best practices in payment integrity and overpayment prevention. * Collaborate on the design and implementation of internal controls and process improvements. * Monitor process designs to measure operational effectiveness and improve performance of key metrics. * Participate in interdepartmental work groups in support of process improvement projects. Requirements * Bachelor's degree required; additional experience/specialized training may be considered in lieu of degree * 4 - 6+ years' experience in health care healthcare industry, managed care and health plan operations, including vendor contracting and oversight required * Extensive knowledge of health care provider audit methods and provider payment methods, clinical aspects of patient care, medical terminology, and medical record/billing documentation required * Experience in claims business process analysis, preferably in healthcare (i.e. documenting business process, gathering requirements) or claims payment/analysis required * Experience in a hospital or managed care environment with a focus on claims data analysis, provider contracting, or decision support, especially in cost and utilization analysis required * Understanding of NYS, CMS and Medicaid reimbursement guidelines; a working knowledge of industry coding (revenue codes, ICD 9 classifications, CPT codes, etc.). Familiarity with claim coding practices and industry issues in payment methodologies; strong problem solving, root cause analysis, critical thinking skills, and meticulous attention to detail required * Technical knowledge of health insurance claims/Financial Recovery/Vendor Oversight required * Proven ability to apply quantitative and/or qualitative research and data analysis techniques to improve operational processes; and to identify and interpret trends, patterns, and anomalies within complex datasets of trend information required * Experience working with internal or external stakeholders to understand business needs and translate them into technical solutions; to manage expectations; and provide HIPAA-compliant guidance to business partners, vendors, and end-users, per industry standards for EDI protocols required * Strong understanding of data structures, relational databases, and query logic required * Excellent communication skills (verbal, written, presentation, collaboration, persuasion); with all types/levels of audiences; ability to influence management decisions required * Experience in Continuous Improvement Management for Operations and process mapping/documentation required * Energy, drive and passion for End-to-End excellence and customer experience improvement required * Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.) and other data systems required * Proficiency in SQL for data querying/analysis; data visualization tools such as Power BI/Tableau Reporting or similar preferred * Ability to work collaboratively with cross-functional teams required * Familiarity with data visualization best-practices and interactive dashboard development required * Skilled in presenting data findings in a clear and accessible format to both technical and non-technical audiences required Additional Information * Requisition ID: 1000002852 * Hiring Range: $68,040-$118,800

* Provide support and assistance to mainstream Medicare, Medicaid, HARP, Child Health Plus and Essential members telephonically (inbound and outbound) with a variety of non‐clinical healthcare and membership needs: completing health care gaps, health related assessments, and state required applications to ensure continuous eligibility of healthcare coverage. * Facilitate and aid Medicaid, HARP, CHP members as NYS Certified Application Counselor with state redetermination process including educating members on state qualifications, necessary proof of income and associated documents while completing required applications and submission to the state. * Proactively lead, facilitate, and assess member experience through targeted Medicare member outreach, including members with multiple complex issues, grievance and appeal cases as well as access to care challenges to continually improve healthcare performance and consumers assessment of EH ability to provide high quality services. * Navigate and provide direction and guidance during member interactions utilizing extensive knowledge of EmblemHealth's products, complex processes, and multiple systems to enhance member's health journey. * Responsible to grow/increase membership enrollments in value added services: Member Portal, Medicare Rewards, Auto Pay and Paperless through telephonic member interactions, etc. Roles and Responsibilities * Provide seamless care coordination and individual needs assessments from member onboarding and throughout member lifecycle to support Medicare, Medicaid, HARP, and CHP members with care/risk health gaps and health risk assessment. * Provide member assistance with initial and annual health assessments. * Identify members qualifying for Care Management programs and resources and collaborate through referrals to Care Management Team. * Assist, coordinate and schedule members with primary care and specialty visits, tests and necessary screenings. * Intermediary and professional liaison with member and healthcare providers and provider facilities. * Meet state mandated deadlines maintaining and acting with a sense of urgency. * Facilitate and aid Medicaid, HARP, CHP members as NYS Certified Application Counselor with New York State of Health redetermination process including educating members on state qualifications, necessary proof of income and associated required documents while completing application and submission to the state. * Lead and facilitate complex application issues including mixed immigration status households, multi-tax household, family enrollment issues and complex income situations. * Intermediary and professional liaison with the member and New York State of Health for coverage redeterminations including handling and submitting sensitive member information. * Proactively lead, facilitate, and assess member experience through targeted Medicare member outreach, including members with multiple complex issues, grievance and appeal cases as well as access to care challenges to continually improve healthcare performance and consumers assessment to provide high quality services. * Provide guidance, advice, and direction; and engage team members to solve for member issues. * Collaborate and provide feedback to Director of Customer Retention and Loyalty team to understand member pain points and identify opportunities to mitigate. * Onboard newly state assigned members and serve as guide for member plan and benefits. Set member expectations and enroll members in EH value added services including Member Portal, Member Rewards, Auto Pay while identifying member communications preferences including paperless. * Retain members targeted for termination of plan by New York State of Health. Assist and educate members on next steps, required paperwork; and institute temporary plan extensions for resolution. * Retain members targeted for termination of plan due to lack of premium payment. Assist member in payment options and avoid loss of coverage. * Support goals of the department by meeting quarterly with Customer Retention and Loyalty leadership team to review results and discuss ways to continually improve member satisfaction, loyalty, revenue (Quality and Risk Scores) and reduce costs. * Participate in weekly meetings with manager and team members to discuss customer concerns, improvement opportunities (people, processes, and technology), and other company priorities. * Assist, support, and conduct user acceptance testing as appropriate and outside of normal business hours. * Participate in state meetings as needed. * Ongoing learning of EmblemHealth and Connecticare products and services, including any recent changes in business rules or decisions that may impact customer experience. * Perform other duties assigned, directed, or required Qualifications * Bachelor's Degree * Additional experience/specialized training may be considered in lieu of degree requirements required * Must have NYS Certified Application Counselor certification; or obtain certification within 90 days of hire date as a condition of continued employment. Must maintain up‐to‐date, valid certification status to remain employed in the role. * 3 - 5+ years of experience working with members in customer service, medical or managed care environment required * Experience communicating directly with customers, assessing needs, and connecting customers with resources required * Knowledgeable on how to navigate all aspects of medical care and managed care system; health and wellness preferred * Knowledge of healthcare related regulations, processes, services, and products preferred * Ability to demonstrate excellent service knowledge and hospitality required * Technologically savvy, with the ability to quickly learn and navigate different information technology systems required * Flexibility to travel to, and work in a physical office site when needed required * Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required * Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience required Additional Information * Requisition ID: 2504M * Hiring Range: $52,000-$92,000

$1,000 Sign On Bonus For External Candidates Excellent benefits within 30 days, PTO, paid holidays, 401K , tuition reimbursement and more! 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 to start Caring. Connecting. Growing together. The role of the Associate Medical Assistant is to provide care to patients/significant others via direct and/or telephone contact, following established standards and practices. S/he coordinates with other members of the care team to ensure seamless care delivery, maximal coordination of efforts, and active patient participation in planning and care. Assists physician or other provider with clinical procedures. Work Schedule: Monday-Friday 37.5 hours per week between 8am-6pm. Travel to Garden City and Bethpage. Primary Responsibilities: * Demonstrates clinical competence in the direct care of patients in established area(s) of practice and assisting MDs with procedures * Performs clinical duties within scope of practice complying with the accepted department standards, policies, and protocols * Demonstrates a proactive approach to patient care, focusing on addressing each patient's individual and family needs at the time of service; communicates identified needs in a timely manner * Directs and/or escorts patients to exam rooms in a timely manner * Demonstrated clinical competence when assisting physician/mid-level healthcare professional and/or nurse during exams and office diagnostic procedures/treatments * Performs authorized procedures competently (i.e. vital signs, vision screening, selected laboratory tests) as directed by physician or nurse in clinical practice area * Seeks validation/guidance from physicians, mid-level healthcare professional and/or nurse when necessary * Prepares e-prescriptions for processing to pharmacies when instructed to do so by physician per policy * Inspects, cleans/prepares and processes instruments/equipment according to manufacturers' guidelines * Processes specimens for transport to laboratory, ensuring that specimens are properly labeled, and appropriate orders have been placed in EPIC 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: * High school diploma or GED * Relevant entry level work experience Preferred Qualifications: * Graduate of an accredited medical assistant program with 1+ years of recent experience as a medical assistant * Current CPR / BLS certification 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 $22.00-$27.25 per hour based on full-time employment. This role is also eligible to receive bonuses based on sales performance. 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. OptumCare 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members. Oversee operations for multiple support functions, including configuration, claims support services, provider relations, call center and field operations. + Perform duties as chief liaison between the business unit and Corporate policies & standards. + Develop operational vision, objectives and policies and procedures to support the overall strategic plan for the business unit. + Ensure cost effective, client-responsive programs are developed and maintained, identify improvement opportunities and oversee successful implementation of those changes throughout shared services. + Identify operational efficiencies, meet regulatory and client expectations and develop a "best practice" approach for all operations. + Responsible for achieving business unit financial targets and requirements based on service level, state, compliance and contractual agreements. + Oversee new system and product implementations for assigned areas. + Assess organizational strengths and weaknesses to recommend enhanced operating model. **Education/Experience:** Bachelor's Degree in Business Administration, Healthcare Administration or related field required. Master's Degree preferred. 10+ years in Business Administration, Healthcare Administration or related field required. Must reside in and/or relocate to NYC area. Pay Range: $280,000.00 - $490,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act