Senior Pharmacy PA/Appeals Technician 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
Essential Duties and Responsibilities: - Supervise the work of call center staff to ensure adherence to quality standards, deadlines, and proper procedures, correcting errors or problems as needed - Interview and recommend hiring and promotion of
Essential Duties and Responsibilities: - Responsible for completing medical and/or behavioral health assessments within contract requirements - Conducts on-site, video call and/or telephonic assessments to determine an individuals needs for services and supports, eligibility, level of
Essential Duties and Responsibilities: - Supervise the work of call center staff to ensure adherence to quality standards, deadlines, and proper procedures, correcting errors or problems as needed - Interview and recommend hiring and promotion of
Essential Duties and Responsibilities: - Supervise the work of call center staff to ensure adherence to quality standards, deadlines, and proper procedures, correcting errors or problems as needed - Interview and recommend hiring and promotion of
Essential Duties and Responsibilities: - Answer general inbound calls and place outbound calls with the goal of increasing business, customer satisfaction, and customer retention. - Follow basic procedures and scripts, using fundamental knowledge of company and
Essential Duties and Responsibilities: - Responsible for directing all quality operations including planning, implementation monitoring and reporting functions. - Develop and oversee an effective management system to continuously identify opportunities for improvement while maintaining adherence to
Essential Duties and Responsibilities: - Collaborate with project staff, client office personnel, and community agencies to address and resolve project-related issues effectively. - Deliver public speaking sessions and educational programs to community agencies and local office staff.
Essential Duties and Responsibilities: - Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments. - Provide written clinical rationales for CA Workers Compensation cases.
Essential Duties and Responsibilities: - Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations. - Render determinations for cases assigned. - Resolve all other technical issues within reconsideration assigned. - Review cases or
- Partner with senior business leaders and executives to define and execute HR strategies that align with business goals, driving organizational performance and operational effectiveness. - Provide thought leadership on key HR initiatives, advising leadership on
Essential Duties and Responsibilities: - Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations. - Render medical necessity determinations for Medicare State East cases assigned. - Resolve all other technical issues within Medicare