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Develops, assesses and coordinates holistic care management activities, with primary focus and support towards populations with significant mental/behavioral health needs, to enable quality, cost-effective healthcare outcomes. Evaluates member service needs and develops or contri
Position Purpose: Learn about various processes and functions within the Managed Care industry and develop professionally by contributing to projects that support the business. - Learn various job functions within the Managed Care industry and explore various career opportunitie
Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. Responsible for ensuring that all appeal letters generated comply with both State and NCQA requirements. Key Details: This is a remote position.
Position Purpose: The Senior Manager of Credentialing and PDM will oversee all direct processes of credentialing and provider data entry, from triage through provider enrollment and data maintenance. Key Details: Must be authorized to work in the U.S. without the need for employ
Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized car
Position Purpose: Contributes to the design of data integration, processing, reporting, and analytics. Executes strategies for warehouse implementation, data acquisition and access, and data archiving and recovery. Develops data platform specific capabilities and roadmaps, works
Position Purpose: Work with the Pharmacists to accurately assist prescription orders in a timely manner Key Job Details: Pharmacy Technician II (Onsite Specialty Outreach - Customer Service - Phone Outreach with Data Entry). This Licensed Pharmacy Technician II role is located a
Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized car
Position Purpose: Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and the
Position Purpose: Supports the goals and outcomes of the organization by leading the transformation of our business strategy. Ensures deliverables are met, by assisting with design, execution, and value estimation and realization for initiatives. Education/Experience: Bachelor's
Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient s
Position Purpose: Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops
Position Purpose: Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops
Position Purpose: Perform duties to develop, direct and implement a pharmacy benefit management program. Aid the Vice President of Medical Affairs in formulating and administering related organizational policies and procedures, including pharmacy service quality, pharmacy utiliza
Position Purpose: The Manager, Business Insights leads workforce capacity planning and staffing forecast initiatives that support operational performance and enterprise objectives. This role develops and manages staffing models using historical volume, membership forecasts, produ
Position Purpose: Directs the long-term care of members with physical/medical health needs and/or behavioral/mental health needs to develop and assess high quality, cost-effective healthcare outcomes. Develops strategies and objectives within long-term care management to improve
Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephoni
Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Key Details:
Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephoni
Position Purpose: Define and develop standard and custom formularies for assigned plan. Key Details: Indiana Clinical Pharmacist (Formulary & Quality). Current Indiana licensure highly preferred but will also candidates that are willing to be Indiana licensed within 90 days of h