Assesses patient and family psychosocial needs and develops plan of care in concert with patient, physicians, nurses, HAs, other members of the departmental team and works in collaboration with other departments/programs such SCC/PAL, CAL AIM, ECM, MOC/SNP, CARE +, regional, SNFs, HIHR, Readmissions, Welcome Wagon, and Psych TOC Works in collaboration with CDOs Legacy App

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. Optum's Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California

Develop and maintain strong relationships with network providers to ensure high quality service delivery and promote IPA growth Network expansion focusing on new PCP/SPC recruitment for identified geographic areas Collaborate with providers to ensure understanding of IPA policies, procedures, and guidelines Assist providers with claim submission and payment processes, inc

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

Understand and follow standardized processes for managing add or change requests and implementing requests in the letter generation system Create and review denial letters to determine compliance with contractual and regulatory requirements of the State and Federal programs, while reviewing for efficiencies and effectiveness of procedures Performs internal Quality Control

Directs patient to proper exam/treatment area and prepares patient for examinations and other procedures. Assists in the transportation of patients and patient flow Obtains records and reports vital signs and any other pertinent patient information to the RN or clinician Administers medication, performs various patient tests and instructs patients on procedural preparatio

Serve as single point of contact to the physician network and is an accountable owner, responsive to physician needs. Knowledgeable about incentive programs, contract reimbursement, Optum's internal processes and priorities, and other Optum initiatives, as applicable Monitors performance of assigned PCPs, identifies low performing PCPs and works with IPA leadership to dev

Directs patient to proper exam/treatment area and prepares patient for examinations and other procedures. Assists in the transportation of patients and patient flow Obtains records and reports vital signs and any other pertinent patient information to the RN or clinician Administers medication, performs various patient tests and instructs patients on procedural preparatio

Provides exceptional customer service to all consumers and members of the clinic staff Fills prescription orders and makes them available for verification under direct supervision of the registered pharmacist Orders, receives and stores incoming pharmacy supplies Receives and processes wholesaler medication orders Verifies medication stock and enters data in computer to m

Assist in efforts to enhance ease of use of physician portal and future services enhancements Assist providers and members with basic inquiries about claims, authorizations, benefits, and other issues Fostering and maintaining proactive, positive relations throughout the provider network by communicating with provider offices through face to face visits, emails, telephone

Primarily answering prior authorization with inbound calls (up to 50 to 70 calls per day) from members as well as research and resolve formulary and benefit issues using the appropriate reference material Process member prior authorization requests through various computer systems and use of job aid/policies/procedures ensuring the accuracy of all data and updating as nec

Delivers high quality patient care through face to face, telephone, and electronic contact for examination, treatment, monitoring, and preparation for diagnostic tests or procedures Collects and documents patient information, including vital signs, chief complaints, reviews of medications, allergies, health risk screening information, the status of extended care benefits,

Assesses patient and family psychosocial needs and develops plan of care in concert with patient, physicians, nurses, HAs, other members of the departmental team and works in collaboration with other departments/programs such SCC/PAL, CAL AIM, ECM, MOC/SNP, CARE +, regional, SNFs, HIHR, Readmissions, Welcome Wagon, and Psych TOC Works in collaboration with CDOs Legacy App

Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect mi

Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect mi