1 to 10 of 10
Sort by: Date | Relevance
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 5 days ago
Prior Authorization Nurse I (1107255) Position Purpose Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward request
Posted 13 days ago
Program Coordinator I (1106537) 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 necessary to promote member compliance such as verify
Posted 15 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 15 days ago
Provide health education and coaching to members tailored to issues identified within treatment and service plans Coordinate with various healthcare providers for diagnostics, ambulatory care, and hospital services Assist members with social determinants of health including access to exercise and healthy food Promote activities focused on the health of a patient and their community, including with
Posted 1 month ago
Quality Improvement Abstractor (1103698) Position Purpose Lead data collection and abstraction for company quality measures, including HEDIS, CMS, CHIPRA and/or any other custom measurements. Assess vendor delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards Review medical records and abstract data for HEDIS and other measure sets in
Posted 1 month ago
Care Manager II (RN) (1100557) 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 2 months 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 3 months 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 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 12 months ago
Email this Job to Yourself or a Friend
Indicates required fields