Review and assess individual member clinical cases for high priority medication related opportunities and recommendations Provide written, consultative medication recommendations for interdisciplinary care management team members Directly contact medical providers over the telephone as needed to discuss pharmacy related consultative recommendations and provide benefit rel

Making outbound calls and taking inbound calls to assess members' current health status Identifying gaps or barriers in treatment plans Providing patient education to assist with self management Interacting with Medical Directors on challenging cases Coordinating care for members Educating members on disease processes Encouraging members to make healthy lifestyle changes

Support network pricing strategies and tactics, in collaboration with local network field leaders and network managers Analyze financial impact of provider contracts (e.g., facility; physician; ancillary) Analyze financial impact of corporate initiatives (e.g., policy changes; healthcare affordability) or external regulations (e.g., healthcare reform) Analyze payment appe

Provide skilled nursing care for expectant mothers in the home care environment Travel to provide in home patient care and continuous education to patients and family members Continually assess the mothers' condition to ensure they are safe in the home environment Modify the plan of care, as appropriate, based upon reassessment, change in prescriber orders, the patient's

Educate members on health education and condition management (formal and informal), as well as plan specifics and member resources, in collaboration with OptumHealth Referral of employees to available clinical programs including premium designated physicians Create, manage and implement employer specific programs based on employer needs Monitors and analyzes customer spec