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

Develop, lead and execute category management strategies, conduct sourcing / RFX events, manage suppliers and conduct financial analysis Primary responsibilities surround Pharmaceutical Draft, Review, and lead negotiations of third party supplier contracts, including Master Services Agreements (MSAs), Statements of Work (SOWs), Non Disclosure Agreements (NDAs) and amendme

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least 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

Assesses and interprets customer needs and requirements Identifies solutions to non standard requests and problems Solves moderately complex problems and/or conducts moderately complex analyses Translates concepts into practice Provides explanations and information to others on difficult issues Coaches, provides feedback, and guides others Acts as a resource for others wi

Serve as primary contact as it relates to all enrollment tasks for assigned book of business, which include multiple group customers; maintain satisfied customers by providing superior service and practice attention to detail in various responsibilities. Answer member, provider, and group customer phone calls; adhering to department expectations for answering calls and pr

Evaluation of member discharge needs including delays in care and readmission prevention plan Collaboration with providers and members to coordinate care post discharge Participate in rounds with the Medical Director to discuss cases as needed Identification of internal or community based program support or resources Coordination with the facility Discharge Planner to ens

Evaluation of member discharge needs including delays in care and readmission prevention plan Collaboration with providers and members to coordinate care post discharge Participate in rounds with the Medical Director to discuss cases as needed Identification of internal or community based program support or resources Coordination with the facility Discharge Planner to ens

Provide general claims support by reviewing and processing claims Calculate other insurance and benefits Participate in meetings to share, discuss, and solution for question or error trends, as well as potential process improvements Consistently meet established productivity, schedule adherence, and quality standards You'll be rewarded and recognized for your performance

Assess, plan, and implement care strategies that are individualized by member and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for member transition to community request and provide assist with social service programs, including financial, psychosocial, community and state supportive services Manage the care plan th

Provide day to day paralegal and legal services support including leading or assisting on special projects from the Legal Team Work closely with Legal, Quality Management and Regulatory Affairs (QMRA), Compliance and other cross business and functional stakeholders on activities related to enterprise wide regulatory and quality management systems, including coordination,

Work to improve quality and promote evidence based medicine Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement Support initiatives that enhance quality throughout our national network Ensure the right service is provided at the right time for each member Work with medical director teams focusing on

Create scripts and provide copywriting support Coordinate studio, pre and post production functions throughout the life of a project Help manage production schedules, budgets, and timelines Project manage a variety of production types, including live action, motion graphics and studio events Track and update workstream progress in team project management application, Adob

With guidance from audit management or audit lead, execute internal audits including audit planning, detailing control procedures, and the related testing and reporting in accordance with professional and departmental standards including financial (Sarbanes Oxley testing) and operational projects Prepare clear, accurate, and complete workpapers in accordance with departme

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least 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

Lead in the development and execution of internal audits including audit planning, detailing control procedures and the related testing and reporting in accordance with professional and departmental standards including financial (Sarbanes Oxley testing) and operational projects Prepare clear, accurate and complete workpapers in accordance with department quality standards