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Industry:
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Health Care Plans
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Available Positions
Maintains and reviews financial data regarding groups benefits, services and upgrades existing accounts, as well as Contracts and acquires prospects to increase market penetrations, increase revenue and meet assigned retention and sales objectives on products and services such as flexible spending programs, third party administrative programs, COBRA, association groups, retiree/premium billing ser
Under the general direction of the Manager, Safety Net and State Government Programs, the Safety Net Quality Analyst is responsible for the quality assurance program for call center and sales activities for Safety Net and State Government programs. Oversees all quality review activities for applications processed and received from community-based Facilitated Enrollment. Oversees the quality review
**Three Positions** Conducts case management program activities (including the Case Management process and quality improvement) in accordance with departmental, corporate, state, federal, CMSA and URAC accreditation standards, as well as CMS standards if appropriate to the case assignment. Uses a systematic approach to identify members meeting program criteria, assessing opportunities to coordinat
**Re-Post** Performs a variety of functions related to and resulting in meeting or exceeding the sales goals and retention targets of SeniorChoice in accordance with guidelines set forth by the Medicare Management team and CMS. Responsible for responding to member and prospective member inquiries regarding coverage, benefit interpretation, access to services, receiving and resolving member concern
This position receives general direction from the Director of Advocacy and receives direction on medical and utilization management matters from the Medical Director. Provides supervision and coordination of the workload of the, member and provider Advocacy units which includes grievances, appeals, executive inquiries, regulatory complaints and external review requests. Conducts case work in addit
The Care Guidance Case Coordinator focuses on members identified by predictive model risk stratification to provide focused intervention strategies targeted to individual members. Engages with members through outreach, assesses, plans, educates, coaches, coordinates, motivates, monitors and evaluates members' specific care and lifestyle management needs. Provides support, encouragement and informa
This position is responsible for the efficient and timely coordination of the ordered patient services for an assigned group of PHV from the admission process to discharge. Selected duties associated with patient care documentation are integral responsibilities, as well as communication with PHV and patients. Qualifications: Completion of an approved program of study in medical secretarial science
Conducts case management program activities (including the Case Management process and quality improvement) in accordance with departmental, corporate, state, federal, CMSA and URAC accreditation standards, as well as CMS standards if appropriate to the case assignment. Uses a systematic approach to identify members meeting program criteria, assessing opportunities to coordinate care and treatment
Under general direction of the Manager, plans, coordinates, and manages the availability of resources to meet Corporate goals. In accordance with objectives, policies and controls, directs, coordinates and is accountable for the work of employees engaged in claims processing. Provides supervisory services to employees assigned to the function. Qualifications: AAS degree in Liberal Arts, Business A
Level I and II - Responsible for recording Medicare financial data and the preparation, interpretation and analysis of a wide variety of financial records and statements used to monitor and measure business activity within the limits of established practices, policies and procedures. Level III - Responsible for coordinating and consolidating the interpretation and analysis of a wide variety of fin
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