Assist in end to end provider claims and help enhance call quality Coach, provide feedback and guide others Assist in efforts to enhance ease of use of physician portal and future services enhancements Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers Help implement training and development of exte

Provides leadership and support in establishing the Quality Performance Initiatives at the market level Collaborates with physicians to execute the implementation of the clinical quality initiatives as defined by enterprise Provides expertise to the training department on STAR/HEDIS measures and on the tools that support the collection of STAR/HEDIS data Work with IT on the interpretation of techn

Moderate work experience within own functio Some work is completed without established procedures Basic tasks are completed without review by others Supervision/guidance is required for higher level tasks Moderate work experience within own function Some work is completed without established procedures Basic tasks are completed without review by others Supervision/guidance is required for higher l

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 Communicate with all stakehol

Ensuring capital programs stay aligned to Enterprise strategy while leveraging existing components and capabilities across the business segment landscape Modeling the technical landscape to analyze the alignment of business capabilities with delivered technology and IT solutions Analyzing the current technology environment to detect critical deficiencies and collaborating with Enterprise Architect

Provide a complete continuum of quality care through close communication with members via in person or on phone interaction Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels Assist members with the transition from a care facility back to their home Expect to spend about 80% of your time in the field visiting our m

Performing all phases of software engineering including requirements analysis, application design, code development & testing Designing and implementing product features in collaboration with business and IT stakeholders Design, develop and test reusable frameworks, libraries, Java & Big Data components Working very closely with Architecture group and driving technical solutions Be innovative in s

Provide general claims support by reviewing, researching, investigating, processing, and adjusting claims. Conduct data entry and re work Analyze and identify trends and provide reports as necessary Consistently meet established productivity, schedule adherence, and quality standards Recognize claims by determining claim type HCFA, Hospital, Dental, and/or RX Identify more complicated claims and r

Perform Radiology and Mammography procedures Supervise Radiology Department Coordinate Staffing Perform Quality Assurance Procedures Prepare for Accreditations, inspections and audits Maintain equipment, Contact Vendors Conduct staff training Identify concerns You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it ta

Monitors agents and representatives for compliance with established processes, policies and guidelines Provides feedback and coaching to agents and representatives based on evaluation results Analyze information and utilize to build recommendations to reduce errors and improve process performance Creates, maintains and tracks reports in relation to performance Serve as subject matter resource to t

Assess, screen, triage and perform treatment ordered for patients Perform medical treatment as ordered by provider or established MedExpress standing orders Prepare and assist provider with dispensing prescribed medications (in states where applicable) Assists the provider with examinations, procedures and other duties Oversee and coordinate the daily patient care flow Assist patients as needed w

Assist in opening and closing the clinic, locking and unlocking the doors, and maintaining a clean waiting area Welcome all On Site Clinic patients and visitors by greeting them with a friendly demeanor, answering inquiries and directing them through the registration process. Answer multi phone lines, filing, faxing, scanning documentation and completing daily patient callbacks Collect all insuran

Forecasting, Budgeting & Monthly Financial Close Partners with Sr. and departmental leaders to oversee the budget creation and periodic forecasting Develops cost/benefit analyses and staffing needs for key strategies or initiatives Participates and develops company wide business plan and strategies Assists in performing monthly reporting around our financial close and variance analysis to budget o

Recommends applicable technical patterns and solutions that are aligned with architectural guiding principles and standards through a regular cadence of delivery and continuous improvement initiatives Drives enabling and executing the architecture vision through leading technical architects 50% hands on, 50% solution oversight Works closely with engineers and other architects on assessing, designi

Assist in end to end provider claims and help enhance call quality Coach, provide feedback and guide others Assist in efforts to enhance ease of use of physician portal and future services enhancements Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers Help implement training and development of exte