Coordinate cross-functional meetings
Knowledge, Skills and Abilities Demonstrated, or potential for, excellence in teaching, including both online and in-class health management and
Position Purpose: Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues
Knowledge
Perform duties to conduct and manage the day to day operations of the case management functions Review analyses of activities, costs, operations and
Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals
Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state
ProfessionalPosition Purpose: Responsible for developing and conducting a variety of training programs and auditing tools. • Conduct training
Review information submitted by providers into the database to ensure material is appropriate and consistent
Ensure compliance with contractual guidelines of the corporation and health plans impacted by numerous regulatory agencies with complex and often
Lead assigned recruitments (i.e., physician, hospital and ancillary) and ensure they result in complete and accurate standard contracts that meet
Education/Experience: Bachelors degree in Healthcare Administration, Business Administration, Marketing, related field or equivalent experience
Coordinate urgent care evaluations when necessary. • Assist members with locating providers and
Develop infrastructure and processes for management of activities related to National Committee for Quality Assurance (NCQA) Accreditation and
Our goal is to provide greater access to health insurance, by providing education and assistance to Medicare-eligible individuals through
This position will support the departments growing educational and research programs and will be responsible for teaching, conducting high quality
Provide greater access to health insurance, by providing education and assistance to Medicare-eligible individuals. Distribute Medicare and other
Coordinate services with community based organizations. Attend marketing and outreach meetings as
Empower patients
Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals
Responsible for ongoing review of performance reporting and data, interpreting and prioritizing results and utilizing tools and resources
Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services
Responsible for ongoing review of performance reporting and data, interpreting and prioritizing results and utilizing tools and resources to identify
ProfessionalPosition Purpose: Supervise the daily operations of the utilization management (UM) department • Supervise the daily operations of the
Provide financial and business analysis as required. Determine appropriate actions and present to upper management • Develop a thorough
Empower patients to