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

Make outbound calls and receive inbound calls to assess members' current health status Make referrals to outside sources Identify gaps or barriers in treatment plans Provide patient education to assist with self management Provide a complete continuum of quality care through close communication with members via in person or on phone interaction Support members with condit

Manage unit cost budgets, target setting, performance reporting and associated financial models Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards and other key process c

Manage unit cost budgets, target setting, performance reporting and associated financial models Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance, trend management and appropriate distribution of provider specialties Evaluate and negotiate contracts in compliance with company templates, reimbur

Oversee initial inpatient admission for psychiatric and chemical dependency patient Make patient assessments and determine appropriate levels of care Administer benefits, review treatment plans, and coordinate transitions between various areas of care Obtain information from providers on outpatient requests for treatment Visit Medicaid members in their homes and/or other

Ensuring delivery of cost effective quality care that incorporates recovery, resiliency, and person centered services Level of Care guidelines and utilization management protocols Oversight and management, along with the Clinical Director and Clinical Program Director, utilization review, case management, and care coordination activities Provide clinical oversight to the

Work in conjunction with our clinics and hospitals to manage, collect and analyze provider data, updating and loading provider data and resolving any escalated issues with the clients Predict emerging customer needs and develop innovative solutions to meet them help develop geographically competitive, broad access, stable networks that achieve objectives for unit cost per

Identify and provide community service linkage Assist enrollees with aftercare appointments Provide subsequent member follow up as determined by individual member needs Work with enrollees to identify gaps in care or obstacles to care and problem solve for successful connection to needed services Review IP Census each day to determine which enrollees on the census are re

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Com

Answer incoming phone calls from prospective members, identify the type of assistance and information the customer needs with the goal to convert caller to a qualified lead and sale Follow up with members on questions or to review current or new products and services Navigate multiple computer systems to document member information while maintaining active listening and e

Provide timely professional service to all clients. Assist other team members with workload and/or issues. Sort incoming mail for sorting/batching, including physical mail. Logs all Certified, UPS, FedEx and Priority mail. Able to Sort and Batch claims with minimal errors. Able to Scan batched claims with minimal errors. Maintain Batch Log Book Capable of maintaining prod

Coach and motivate agents to achieve or exceed sales targets with a focus on quality and compliance Supervise the daily activities of the team by reviewing and analyzing calls / reports, assessing areas of opportunity, managing work assignments and assuring agents are providing a positive consumer experience Develop staff by providing one on one coaching, conducting role

Coach and motivate agents to achieve or exceed sales targets with a focus on quality and compliance Supervise the daily activities of the team by reviewing and analyzing calls / reports, assessing areas of opportunity, managing work assignments and assuring agents are providing a positive consumer experience Develop staff by providing one on one coaching, conducting role

Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered care plans inclusiv

As part of a multi disciplinary care coordination team 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 p