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Deliver associate relations counseling and support to mangers and associates Provide guidance and assistance with the development and delivery of appropriate feedback Manage low to moderate risk cases on a variety of topics including performance, attendance, conduct, and conflict resolution Work with others in HR such as members of the Leave team and HR Business Partners to provide associate relat
Posted 6 days ago
The Personal Care Connector (PCC) is a high touch, extremely effective service specialist, responsible for supporting the daily operations of Medicare Member Services (Personal Service Program), integrated care management, and utilization management program interventions. The PCC performs in a contact center environment, effectively handling calls from Members, Providers and other areas, internal
Posted 18 days ago
The Off Shift Clinical Care Reviewer will be scheduled to work non traditional hoursto provide access to medical necessity determinations for urgent or contractually required coverage requests on a 24/7, 365 basis. The Off Shift Clinical Care Reviewer will be required to work 1 Summer holiday and 1 Winter holiday. Under the direction of the Medical Management Manager, the Clinical Care Reviewer is
Posted 18 days ago
This is a part time role with a minimum of 20 hours per week. The Off Shift Clinical Care Reviewer will be scheduled to work non traditional hours to provide access to medical necessity determinations for urgent or contractually required coverage requests on a 24/7, 365 basis. The Off Shift Clinical Care Reviewer will be required to work 1 Summer holiday and 1 Winter holiday. Under the direction
Posted 18 days ago
Responsible for managing the day to day activities of the Network Management department and staff related to alternative reimbursement models Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication. This position is also responsible for tracking all performance metrics and analysis of contract performance. Also updates and ma
Posted 22 days ago
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely with members andproviders to collect all information necessary to perform a thorough medical necessity review. It is within the nurs
Posted 1 month ago
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. It is within the nur
Posted 1 month ago
Under the supervision of the Supervisor for Utilization Management, this position is responsible for completing medical necessity reviews by using clinical knowledge and nursing experience. Requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review Pend requests for additional infor
Posted 3 months ago
Under the supervision of the Manager for Utilization Management, this position is responsible for providing daily oversight of UM Nurses, UM Technicians and staff members within Utilization Management. Responsibilities include providing clinical, technical and operational support and direction, including organization and monitoring of all medical services. Responsible for direct supervisory oversi
Posted 3 months ago
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