1 to 15 of 31
Sort by: Date | Relevance
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program. Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines Track and trend overrides to
Posted 3 days ago
Compliance & Reporting Specialist (1120181) Position Purpose Develop, implement, and perform compliance auditing, monitoring and reporting activities based on established program, policies, and practices to ensure and maintain compliance with federal, state, and local regulatory and contractual requirements. Develop and maintain quality and compliance reports and dashboards Review and analyze deli
Posted 3 days ago
Provide leadership and oversight of all aspects of finance for the Business Unit. Oversee all finance related activities for business unit including developing and monitoring progress against Annual Operating Plan Responsible for financial analysis, identification of month end financial drivers, and forecasting including headcount planning to ensure compliance with state requirements Responsible f
Posted 3 days ago
Chief Medical Director (1118774) Position Purpose Direct and coordinate the medical management, quality improvement and credentialing functions for the assigned business unit based on, and in support of the strategic plan, establishing the strategic vision and attendant policies and procedures. Serves as clinical advisor to and educator of medical management staff making sure correct clinical judg
Posted 7 days ago
Provider Data Management Analyst I (1116978) Position Purpose Perform provider data management related activities based on plan and contract specifications and standard business rules includes data analysis and entry, review of data via internet sites and other systems, and usage of multiple systems and applications to validate data is complete and accurate. Enroll providers and practitioners into
Posted 11 days ago
Field Base Care Manager II (RN) (1118234) 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 g
Posted 14 days ago
Program Specialist I Social Work (1115860) Position Purpose Identify special needs members through the completion of health screens and other resources Work with community outreach/member advocates to coordinate member care Educate providers and community resources on program components and available support services Educate members with special needs to foster compliance with program and positive
Posted 23 days ago
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program. Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines Track and trend overrides to
Posted 23 days ago
Pharmacy Operations Intern Summer 2019 (1114749) Work closely with leadership to gain exposure to the company and participate in a variety of projects and tasks Assist with pilot projects and case studies as needed Support efforts related to quality measures and performance metrics Develop presentation materials for effective communication for various company events Move nimbly from task to task
Posted 24 days ago
Referral Specialist I (1117237) Position Purpose Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations. Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed. Verify eligibility and benefits Answer phone que
Posted 25 days ago
Outbound Services (LPN) (1112952) Position Purpose Provide information and scripted education for inbound and outbound calls; perform duties and responsibilities related to the various outbound call programs such as Health Risk Screenings. Under the direction of a registered nurse perform health risk screenings; provide scripted health education to callers; participate in other health related tele
Posted 25 days ago
Provider Network Specialist II (1113625) Position Purpose Perform health plan provider orientations and conduct ongoing educational outreach with a focus on improving quality and financial outcomes within the provider network. Act as liaison between providers and the health plan to enhance the business relationship. Conduct initial provider orientations as well as ongoing educational outreach Educ
Posted 29 days ago
Utilization Manager (1116660) Position Purpose Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings, provide and/or review intakes and initial evaluations, brief focused treatment interventions, monitor quality of care, collect and analyze utilization and cost of care data, assist with disc
Posted 30 days ago
Learn various job functions within the Managed Care industry and explore various career opportunities Apply academic knowledge and learn new skills by contributing to various projects Research various legal, regulatory, and other topics within functional area and industry Attend training and development presentations to enhance professional competencies Qualifications Learn about various processes
Posted 1 month ago
Customer Care Professional (Outbound) (1111915) Position Purpose Make outbound calls and provide information and education regarding program features and requirements Gather and verify demographic information Document calls, ensure completion and accuracy and submit reporting to management Gather information and encourage callers to perform a specific action based on the needs of the call campaign
Posted 1 month ago
Email this Job to Yourself or a Friend
Indicates required fields