THE LARGEST COLLECTION OF JOBS ON EARTH
company:(health net inc)
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Position Purpose: Supervise the daily operations of the utilization management (UM) department Supervise the daily operations of the UM staffn Ensure appropriate usage of resources in order to facilitate the..
Position Purpose: Supervise and coordinate the operations of the provider relations department Supervise the day-to-day workflow of the provider relations function in compliance with health plan, corporate and state policies,..
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..
Position Purpose: Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician..
Position Purpose: Respond to customer inquiries via telephone and written correspondence in a timely and appropriate manner. Respond to telephone or written correspondence inquiries from members and/or providers within established..
Education Bachelor's Degree Master's Degree Skills NCQA Standards Managed Care This role is responsible for leading all aspects of provider services, including building and maintaining strong provider relations with key..
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..
Position Purpose: Serve as a liaison between Customer Service Representatives CSRs), management and other various departments. Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner...
Position Purpose: Conduct quality monitoring and auditing of all call agents at assigned call centers and plans. Perform quality check of calls received for new call centers and existing plansn..
Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review..
Position Purpose: Identify special needs members through the completion of health screens and other resources.Work with community outreach/member advocates to coordinate member care.Educate providers and community resources on program components..
Position Purpose: The Data Support Specialist will assist the sales staff with data entry.nReviews all incoming mail for project request verification.nnReviews all incoming mail for priority status justification.nnCreates detailed spreadsheets..
Position Purpose: Act as liaison between Provider Service Representatives, management and other departments. Responsible for resolving provider and customer inquiries via telephone and written correspondence in a timely and appropriate..
Position Purpose: Oversee and ensure accurate, timely, and efficient reporting related to all core business functions Ensure the timeliness and accuracy of internal and external state report deliverablesn Manage scheduled..
Position Purpose: Responsible for inputting and locating participant information in member management system. May contact participants for scheduling and enrollment information. Utilize Policy and Procedures for locating participant demographics when..
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..
Position Purpose: 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..
Position Purpose: Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development, assessment,..
Position Purpose: Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations and act as trainer and mentor to less experienced..