1 to 13 of 13
Sort by: Date | Relevance
Customer Service Representative I (1123088) Position Purpose Respond to customer inquiries via telephone and written correspondence in a timely and appropriate manner. Respond to telephone or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources Provide assistance to members and/or providers regard
Posted 5 days ago
Perform duties related to the day to day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assess members' current functional level and, in collaboration with the member, develop and monitor the Case Management
Posted 5 days ago
Care Manager II (RN) (1125035) Position Purpose Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treat
Posted 9 days ago
Care Manager II (RN) (1126339) Position Purpose Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treat
Posted 9 days ago
Senior Trainer Customer Service (1124539) Position Purpose Responsible for developing and conducting a variety of training programs and auditing tools. Coordinate training efforts with various cross functional areas Develop and administer a universal training curriculum, employ technologies and enhance training development programs Conduct training sessions covering processes specific to departmen
Posted 17 days ago
Plans, organizes, monitors, and oversees projects utilizing cross functional teams to deliver defined requirements and meet company strategic objectives. Manage the full project life cycle including requirements gathering, creation of project plans and schedules, obtaining and managing resources, managing budget, and facilitating project execution, deployment, and closure. Utilize corporate and in
Posted 1 month ago
Update and maintain provider computer records for assigned sites Add, change and terminate new or existing provider records in the medical information system Schedule monthly provider verifications regarding provider enrollment specifications and demographics Oversee Medicare and Medicaid provider directory process including achieving and maintaining compliance with the State and CMS with regards
Posted 1 month ago
Perform duties related to the day to day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assess members' current functional level and, in collaboration with the member, develop and monitor the Case Management
Posted 2 months ago
Manage Case Management and Care Coordination services and activities for members with co occurring behavioral health and medical conditions. Manage clinical team of licensed medical and behavioral health clinicians. Manage clinical services including oversight of clinical policies and procedures and daily activities of integrated care coordination team staff. Ensure adequate staffing to conduct ca
Posted 3 months ago
Perform duties related to the day to day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assess members' current functional level and, in collaboration with the member, develop and monitor the Case Management
Posted 3 months ago
Referral Specialist I (1112977) Position Purpose Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations. Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed. Verify eligibility and benefits Answer phone que
Posted 3 months ago
Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician
Posted 4 months ago
Vice President, Medical Management (1061833) Position Purpose Perform duties to direct and coordinate the medical management, quality improvement and credentialing functions for the assigned health plan based on, and in support of the company's strategic plan; establishing the strategic vision and attendant policies and procedures. Direct and coordinate activities of department and aid the chief o
Posted 17 months ago
Email this Job to Yourself or a Friend
Indicates required fields