Responsible for conducting telephonic or face to face holistic evaluations of Member's individual dynamic needs and preferences gathering relevant data and obtaining further information from Member/family identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services, and long term services and sup

Addresses the total patient, inclusive of medical, psychosocial, behavioral, cultural, and spiritual needs Involves the individual patient and caregiver, as appropriate, in decision making Facilitates communication and coordination among members of the care team Provides patient care to include patient assessment prior to physician's/nurse practitioner's examination, serv

Maintain general ledger accounts and related activities for the production of financial statements and reports Reconcile, analyze and review general ledger accounts in preparation for month end close Prepare journal entries and review accounting classifications, in accordance with generally accepted accounting principles Prepare documentation in support of external and in

Driving and contributing to effective advocacy efforts to advance and protect the Company's objectives at the federal level Actively engaging in lobbying activities by communicating and advocating for priorities and building and deepening the Company's relationships with federal legislative and executive branch officials and staffs Anticipating, influencing and monitoring

Investigate and manage escalated claim/call/appeals issues through root cause analysis and communicate outcome (in person, telephonically or via written communication) Assist with navigating the healthcare system by providing resources for scheduling appt. and assisting with issues related to prolong periods for scheduling appts Assist participants with completing health

Provide skilled nursing care for expectant mothers in the home care environment Travel to provide in home patient care and continuous education to patients and family members Continually assess the mothers' condition to ensure they are safe in the home environment Modify care plans as appropriate based on reassessment, change in prescriber orders, the patient's need for f

Contribute and oversee strategic projects, ETL design and architecture, performance tuning activities, Code Reviews, and Best Practices Responsible for approving and certifying the architecture and design of the data warehouse, data marts and BI reports which will support various data initiatives Supervision of development of ETL code with our current toolset, Informatica

Primary focus will be on a Local Market book of business Intricate focus on product integration to maximize company financials Work closely with underwriting and local market sales to derive competitive financial responses Meets quarterly reporting requirements Anticipates customer needs and proactively develops solutions to meet them Serves as a key resource on complex a

Receive assigned provider inquiries and perform a code review on both professional and facility claims Make determinations on cases after a coding review is complete Review various edits on cases and complete audit of medical records received to ensure proper editing is applied Review medical charts electronically Abstract and code diagnosis and procedures from the medica

Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medicati

Primary focus will be on a Local Market book of business Intricate focus on product integration to maximize company financials Work closely with underwriting and local market sales to derive competitive financial responses Meets quarterly reporting requirements Anticipates customer needs and proactively develops solutions to meet them Serves as a key resource on complex a

Perform telephonic outreach to improve health quality outcomes Optimize pharmacy therapy through additional telephonic engagement with providers and pharmacies Oversee pharmacy projects from inception to completion Provide responses to drug information requests Assess and interpret customer needs and requirements Identify solutions to non standard requests and problems Co

Visit members in the hospital prior to discharge Provide a complete continuum of quality care through close communication with members via in person or on phone interaction Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels Assist members with the transition from a care facility back to th

Addresses the total patient, inclusive of medical, psychosocial, behavioral, cultural, and spiritual needs Involves the individual patient and caregiver, as appropriate, in decision making Facilitates communication and coordination among members of the care team Provides patient care to include patient assessment prior to physician's/nurse practitioner's examination, serv

Make calls to qualified members to provide information and answer questions about health plan programs. Provide "best in class" customer service to enrollees Meet established productivity, schedule adherence, and quality standards while maintaining good attendance. Identify, qualify, and engage members into the most appropriate health and wellness programs to meet their n