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Care Manager II (RN) (Office position) (1084350) 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
Posted 2 days 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 9 days ago
Responsible for supporting housing providers to comply with state and federal housing regulations and evidence based practices related to housing. Responsible for assessing the needs of homeless individuals and families and assisting with obtaining and maintaining permanent housing. Also works with the Housing Administrator to strengthen housing placement and retention efforts for members. Collabo
Posted 9 days ago
Pharmacy Coordinator (1088193) Position Purpose Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program. Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process Perform review of pharmacy and override process in compliance with pharmaceutical related company a
Posted 13 days ago
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, treatment and provider options Utilize assessment ski
Posted 14 days ago
Medical Management Trainer (1086486) Position Purpose Provide hands on training to clinical staff in Medical Management on the various aspects of their job functions and responsibilities. Provide an avenue of consistent training among the clinical staff; define expectations of each specific role for accountability and facilitate clinical training for the staff. Develop and conduct clinical educati
Posted 29 days ago
Behavioral Case Manager (Office based) (1084347) Position Purpose 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 colla
Posted 1 month ago
Program Coordinator I (Hours 10 30a 7p, M F) (Bi lingual preferred) (1084246) Position Purpose Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility. Perform tasks necessa
Posted 1 month ago
Member Connections Representative II (Bi lingual in Spanish preferred) (1084244) Position Purpose Assist the health plan in establishing a presence in the community through home visits and community outreach. Serve as the lead for new Member Connections Representatives, including training and attending home visits with the Representatives Assist with developing and communicating the daily schedule
Posted 1 month ago
Care Manager II (RN) (Field based) (1083502) 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 ter
Posted 1 month ago
Act as an advocate for members and a liaison between the Health Plan and Provider(s) to ensure availability and access to care. Establish a community presence, promote member education, identify and resolve any systemic barriers that limit access to appropriate care. Receive and respond to member complaints and formal grievances and identify potential access barriers and resolve as indicated in th
Posted 2 months ago
Manage and oversee all training activities, including training assessment and evaluation, material development, and training facilitation Assess and identify individual and group training needs through key business indicators and develop various training curriculums, materials and aids Coordinate training efforts to meet training demands Oversee online interactive training initiatives from develop
Posted 2 months ago
Manager, Contracting & Network Development (1082141) Position Purpose Provide support for the management of physician, hospital and ancillary provider recruitment in accordance with corporate, health plan and state guidelines for assigned regions. Implement development activities for the recruitment and contracting of providers in provider networks in new and prospective markets Promote, maintain
Posted 2 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 6 months ago
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