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Clinical Appeals Consultant

4 months ago

Manila, National Capital Region, Philippines Optum, a UnitedHealth Group Company Full time

Position in this function includes those responsible for management and administration of multiple Medical & Clinical Operations Functions, or managing general operations which are not specific to one of the functions in the Medical & Clinical Operations job family.Provides leadership to and is accountable for the performance of managers and/or senior level professional staff. Impact of work is most often at the operational or local business unit or market level.Owns an end-to-end process. Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities. Identifies and resolves technical, operational and organizational problems outside own team. Product, service or process decisions are most likely to impact entire functions and/or customer accounts.Engage members either face to face or over the phone to have a discussion about their health -Review available member service records and relevant documentation (e.g., utilization history, functional level, stratification information, current plan of care). Conduct comprehensive member assessment that includes bio-psychosocial, functional, and behavioral health needs. Utilize interviewing techniques and active listening to collect and retain member information and incorporating responses as they are presented to complete assessment