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Plan, organize, monitor, and oversee programs utilizing cross functional teams to deliver defined requirements and meet business needs and strategic objectives. Support business department initiatives that promote, quality, safety and cost of care opportunity Responsible for gathering requirements, creating plans and schedules, managing resources, and facilitate project execution and deployment. U
Posted 1 day ago
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 verifying appointments, obtaining lab results. Assess a
Posted 6 days ago
Behavioral Health Transitional Care Coordinator (1176968) Position Purpose Assist in day to day operations of clinical functions for the Post Hospital Outreach team. Act as primary liaison for clinical personnel to assist with member's post discharge medical needs. Serve as primary point of contact for clinical personnel and department liaison when the Supervisor is not available. Communicate with
Posted 6 days ago
Direct medical management program including utilization management, case management, and quality improvement in accordance with the mission, philosophy, and objectives of the plan and in conjunction with Corporate goals and objectives. Develop department objectives and organize activities to achieve objectives. Evaluate and implement changes to medical service functions and performance in relation
Posted 7 days ago
Responsible for managing a complete program of medical management in accordance with the mission, philosophy, and objectives of plan. The position has oversight for the functions of utilization management and case management. Implement changes to medical service functions and performance in relation to company mission, philosophy objectives and policies, as directed Manage budgets and forecast for
Posted 7 days ago
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 regarding website registration and navigation Document all activiti
Posted 1 month ago
Vice President, Network Development & Contracting (1170417) Position Purpose Direct the provider network and contracting activities. Lead all aspects of provider network strategy including, access analysis, network operations and support decision makers with analysis related to reimbursement and unit cost management. Oversee the coordination and negotiation for the contracting department. Establis
Posted 2 months ago
Oversee the operation of the Contract Implementation Analyst and Claims Liaison teams Oversee the claims operation function, including contracting and configuration Monitor staff performance to identify any process or quality gaps and develop/implement business solutions to correct issues Provide management with necessary data to expedite resolution of claims issues and support in policy decisions
Posted 2 months ago
Senior Transition Care Management Coordinator (1167911) Position Purpose Assist in day to day operations of clinical functions for the Post Hospital Outreach team. Act as primary liaison for clinical personnel to assist with member's post discharge medical needs. Serve as primary point of contact for clinical personnel and department liaison when the Supervisor is not available. Communicate with i
Posted 3 months ago
Oversee day to day functions of the call center that provides preauthorization and referral services to physicians for plan members. Oversee preauthorization nurses and referral specialists in their day to day activities including management of talk times, service levels, abandonment rate, and other key quantitative/qualitative factors Develop, implement and maintain compliance, policies and proce
Posted 3 months 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 4 months ago
Oversee business operations, procurement opportunities, new product implementations and complex initiatives for business development utilizing cross functional business units and corporate teams to meet business unit and corporate strategic objectives. Partner with multiple stakeholders and leadership to establish strategic visions, operational objectives, and policies and procedures ensuring comp
Posted 4 months ago
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