This position is responsible for assisting in the optimization of the Behavioral Health (BH) department through supporting Behavioral Health Transition of Care (TOC) needs, providing care coordination support to the Behavioral Health Case Managers, and completing front-end behavioral health utilization management processes. This position is also responsible for providing support in the completion of special projects and deliverables by performing...
This position is responsible for gathering and analyzing data related to all aspects of project life cycles. This position works closely with team members across multiple functional areas of the organization and is responsible for team collaboration and escalation when necessary. This position also develops and maintains project documents and creates reports to track and share project progress. This position aids in creating project strategies an...
This position is responsible for providing clinical and clerical support to the Director of Pharmacy Services by processing prescription authorization requests per Oregon Health Plan (OHP) and Medicare guidelines by performing the following duties. Enters Prior Authorization (PA) requests into PBM software program. Requests chart notes to facilitate coverage determination when a prescriber has written a prescription for non-formulary medication. ...
This position is located in Klamath Falls, Oregon and is a hybrid remote position. This position is responsible for member outreach, department administrative coordination, and applicable data capture related to the risk adjustment program. This position will perform In Home Evaluation (IHE)/Comprehensive Annual Visit (CAV) outreach calls to members, outreach to facilities and clinics for documentation requests, and provide technical assistance t...
This position is responsible for adhering to the contractual requirements for state and federal government reporting and regulations in support of the Grievance and Appeals System, including grievances, Notice of Adverse Benefit Determination (NOABD) requirements, appeals, contested case hearings, reconsiderations, continuation of benefits, implementation of reversed appeal resolution, record keeping, and quality improvement. This position is als...
