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Act as the first point of customer contact for incoming or outbound healthcare contact center calls. Gather and verify demographic information, utilize tools and critical thinking, and route calls as appropriate following standard operating procedures. Resolve basic and complex verbal member issues in real time. Answer incoming or make outbound healthcare contact center calls Gather and verify dem
Posted 3 days ago
Care Manager I (RN) (1068724) 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 Develop, assess and adjust, as necessary, the care plan and promote desired outcome Assess the member's current health status, resource utilization, past an
Posted 3 days ago
Program Coordinator I (1086705) Position Purpose 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 verify
Posted 6 days ago
Manager, Case Management (1087179) Position Purpose Perform duties to conduct and manage the day to day operations of the case management functions communicating with departmental and plan administrative staff to facilitate daily department functions. Review analyzes of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes. Pro
Posted 6 days ago
Behavioral Case Manager (1087204) Position Purpose Perform duties related to the day to day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assess members' current functional level and, in collaboration with t
Posted 6 days ago
Health Net
- North Charleston, SC
Serve as a liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams Implement and manage procedures for tracking, identifying and problem solving operational issues Interpret and present program results and develop data driven analysis and metrics used to measure effectiveness and ROI of all current and new products Act as the clinic
Posted 10 days ago
Quality Improvement Coordinator II (1086877) Position Purpose Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communicate with agencies and providers. Perform quality on site reviews of delegated entities, phys
Posted 11 days ago
Office Services Coordinator (1087341) Position Purpose Responsible for the overall coordination of the office facilities and support services while providing administrative support to the entire location. Oversee storage and destruction of all company records on site and off site Assist management in coordinating all office services activities and facilities activities Work with Corporate IS telec
Posted 12 days ago
Sales Representative (Medicare) (1078415) Position Purpose Provide sales coverage and develop best possible market penetration for all products to present and prospective accounts in his/her assigned territory in accordance with company's policies and programs. Provide greater access to health insurance, by providing education and assistance to Medicare individuals. Distribute health education mat
Posted 27 days ago
Responsible for analytic data needs of the business unit. Handle complex data projects and acts as a lead for other Data Analysts. Provide advanced analytical support for business operations in all or some of the following areas claims, provider data, member data, clinical data, HEDIS, pharmacy, external reporting Extract, load, model, and reconcile large amounts of data across multiple system pla
Posted 1 month ago
Care Manager II (RN) (1083436) 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 goals, treat
Posted 1 month ago
Communications Specialist (1082908) Position Purpose Develop and coordinate company written documents and communications Develop, produce and upload various print communications for client promotion of wellness, disease management and work life/EAP programs Develop mock ups for client presentations and precision production art for print vendors Edit and design articles, announcements, emails and n
Posted 1 month ago
Care Manager I (RN) (1083435) 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 Develop, assess and adjust, as necessary, the care plan and promote desired outcome Assess the member's current health status, resource utilization, past an
Posted 1 month ago
Care Manager I (RN) (1082425) 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 Develop, assess and adjust, as necessary, the care plan and promote desired outcome Assess the member's current health status, resource utilization, past an
Posted 1 month ago
Senior Care Manager (RN) (1081914) 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 goals, tr
Posted 2 months ago
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