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Concurrent Review Nurse II (1100105) Position Purpose 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 review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services o
Posted 1 day ago
Behavioral Case Manager (1097040) Position Purpose Perform duties related to the day to day operations of the High Risk 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. Assess members' current functional level and, in collaboration with the member, develop and monitor the Case Manageme
Posted 7 days ago
Manager, Contracting & Network Development (1097693) 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 22 days ago
Program Coordinator II (1094837) Position Purpose Perform duties to 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. Maintain integrity of PHI. Maintain working relationships with other departments. Research claims inquiry specific to t
Posted 1 month ago
Care Manager II (RN) (Office based) (1095560) 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 te
Posted 1 month ago
Care Manager II (RN) (Field based) (1094682) 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
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 4 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 5 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 9 months ago
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