Delivers high quality patient care through face to face, telephone, and electronic contact for examination, treatment, monitoring, and preparing for diagnostic tests or procedures at various sites and departments within an assigned geographic region Collects and documents patient information, including vital signs, chief complaints, reviews of medications, allergies, heal

Consistently exhibit behavior and communication skills demonstrating Optum's commitment to superior customer service, including quality, care, and concern with every internal and external customer Perform all functions of a UM nurse reviewer Compose denial letter in a manner consistent with federal regulations, state regulations, health plan requirements and NCQA standard

Independently collaborates effectively with ED and outpatient care teams to establish an individualized transition plan for members Independently serves as the clinical liaison with hospital, clinical and administrative staff and performs transition of care/care coordination for ED discharges using evidenced based criteria within the documentation system Performs expedite

Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each internal and external customer Perform all functions of the UM nurse reviewer Composes denial letter in a manner consistent with federal regulations, state regulations, health plan requirements and NCQA sta

Positions in this function analyze and monitor claims against potential fraud, waste and abuse related to network pharmacies Investigate, review, and analyze claims data applying knowledge of pharmacy policy and practice and data mining techniques to determine details of potential fraudulent, erroneous, or abusive billing activity on Real Time Application System and vario

Deliver high quality patient care through face to face, telephone, and electronic contact for examination, treatment, monitoring, and preparation for diagnostic tests or procedures Collect and document patient information, including vital signs, chief complaint, review of medications, allergies, health risk screen information, the status of extended care benefits, and oth

Oversee processing of physician adds, terms and demographic changes Review and verify provider panel status and current health plan IDs Manage and maintain current roster of primary care and specialty care physicians Support patient retention workflows during provider network changes Distribute materials, performance/patient data, and communications to physician network S

Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer. Serves as a primary point of contact between patient and health care team to anticipate and appropriately address patient questions and concerns. Confirms patient u

Life Changing Work Want to make a real difference in the lives you touch? LOOK NO FURTHER. Optum provides management services to multiple long respected physician groups in Southern California. We are passionate about patients. We are leading the state of California toward better healthcare practices. And we are looking for amazing doctors like you. As part of our continu

Prepare, process and maintain new member or group enrollments Respond to member eligibility or group questions and verify enrollment status Reconcile eligibility discrepancies, analyze transactional data and submit retroactive eligibility changes Research errors by comparing enrollment error reports against system information along with records from the Center for Medicar

Manages ongoing contract relationships and service delivery to clients for up to 30 accounts Acts as outward facing, dedicated resource for assigned accounts, typically with direct client contact (not call center) and large or complex accounts Builds relationships with Provider leadership and serves as the primary point of contact for overall and day to day service delive

Greets patients as they arrive and manage appropriate standard wait times Complete check in and check out tasks to include patient demographic verification, insurance verification, complete pre authorizations and/or precertification of procedures, and copy required documents Collects co payments, co insurance, and deductibles and issues receipts Manages cashier box and da

Manage the evaluation of payer proposals related to Fee For Service (FFS), capitation arrangements and value based contracts Partner with the payer contracting team to manage the modeling and negotiation process, evaluate proposals, and provide guidance to senior leadership on the financial impact and viability of the contract Work closely with the Finance and Actuarial t

Provides department and client level oversight for the development of processes and initiatives designed to improve Revenue Cycle performance in assigned areas which includes Demonstrating excellent customer services skills by facilitating communication between client leadership, patients, supporting teams, and payors Development, deployment, and improvement of the Optum

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, c