Perform complex data analytics to identify insights that can be incorporated into strategic recommendations for improving member care and to drive improvement for Medicaid Pay for Performance program Understand and explain drivers of apparent quality trends (observation bias, metric changes, operational changes, industry trends) Develop and maintain modeling, prioritizati

Generate complex healthcare datasets for external and internal clients Collaborate with colleagues, internal teams, and various levels of management Develop expertise with Optum claims and clinical real world health data (RWD) Maintain high standards of data quality and timeliness Review and verify the quality other analysts' deliverables You'll be rewarded and recognized

Directly manages Clinical Quality Consultants (DNG) to drive consistency, efficient processes and best practices with PCP/ providers designed to achieve a minimum of 4 STAR rating Directs CQC team to develop and create quality CQI initiatives, recommend quality remediation plans and create tools and databases to capture relevant date for region Solves problems and/or revi

Responsible for overseeing and participating in day to day clinical care of patients Performs patient intake process (vital signs, history) Coordinate patient care as directed by physicians, company standards and policies Performs clinical procedures (injections, ear lavage) Assists the providers with invasive procedures and minor surgeries Maintains clinical logs (autocl

Serve as an advisor to business stakeholders for strategic planning and prioritization; as needed, assist in decomposing complex strategies into smaller initiatives to achieve business results rapidly Translate business goals for multiple lines of business, and identify common, shared business solutions Provide impact analysis, high level size of effort, support cost bene

Manage administrative intake of members Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review

The Medical Assistant supports the Care team and its patients through patient care, clinical and administrative tasks including patient intake, receiving and responding to patient phone calls, and documenting patient interactions The MA performs duties within their scope of practice delegated by, and under the supervision of, a provider or physician Performs all duties wi

Establish and maintain positive clinical rapport with patients and their families, working closely with them in the provision of infusion therapy, education related to self care and self administration, and clinical monitoring of patient response to therapy Assess patient appropriateness for infusion therapy, including safety of the environment, availability of caregiver

Review and analyze health assessments to identify unclear or incomplete clinical documentation as well as determine diagnosis codes for each encounter Assigns ICD codes as well as CPT codes to visit encounters Submits queries to providers consistent with established department protocols Maintains 96% or better coding accuracy rate Maintains production standards set by dep

Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with each and every internal and external customer Represents the Company in a professional manner, following all Company policies and procedures Uses, protects, and discloses patients' protected health information (PHI)

Communicates with all consumers of the mental health center regarding the medication services Genoa provides Recruits and enrolls consumers utilizing enrollment forms and copy the consumer's insurance card Facilitates the collection of prescriptions to be faxed to the pharmacy for dispensing Ensures all consumer insurance information is up to date in the Pharmacy system a

Coordinates scheduling and referrals to other healthcare providers and services. Obtains approval for schedule changes or cancellations as appropriate Responsible for collecting data directly from patients and referring provider offices to confirm and create scheduled appointments for patient services Ensures that all medical appointments, special instructions and patient

Gathers information from patient and enters into appropriate database. Seeks appropriate resources to resolve issues about the type, date or location of prescribed procedures Schedules patient procedures in a manner that most efficiently utilizes the patient's time and clinical resources. Coordinates and communicates schedules Communicating with patients, participants and

Patient Registration Greets patients and/or visitors to the facility in a courteous manner Conducts interviews to obtain relevant demographic and insurance data; obtains appropriate signatures on medical, legal, and financial forms Provides copies and interpretation of Hospital policies and regulations to patients including, but not limited to visiting hours, patient righ

Practices in accordance with the respective state laws and regulations governing the practice of advanced practice nursing Understands and complies with long term care policies and procedures, including those that regulate nursing facilities and assisted living communities Establishes and maintains effective relationships with members and their legal representatives, faci