POSITION SUMMARY/RESPONSIBILITIES. Performs a variety of duties required in pharmacy operations and assists the pharmacists in the accomplishment of their duties. Accomplishes under the supervision of the professional staff, competent, efficient and timely performance of assignments within the structure of the Pharmacy Department. EDUCATION/EXPERIENCE. Graduation from high school/GED required or equivalent experience is required. College or com...
POSITION SUMMARY/ RESPONSIBILITIES. Collaborates with team members to collect, support and maintain information on CFHP data systems. Collects, analyzes and prepares reports pertaining to fiscal, procedural and supply records. Works to develop, and maintain accurate and consistent documentation. Meets timelines to deliver accurate reports and documentation for internal and external requests. EDUCATION/EXPERIENCE. Graduation from high school or eq...
POSITION SUMMARY AND RESPONSIBILITIES. The Information Services (IS) Quality Assurance (QA) Programmer is responsible for evaluating and analyzing deficiencies in product function or performance and recommending product or service improvements. The IS QA Programmer will lead the quality and testing of key programs and systems in alignment with Community First’s quality standards and practices outlined in the Quality Management Plan. This role is ...
POSITION SUMMARY/RESPONSIBILITIES. Provides technical expertise and guidance relating to MS SQL Server and Oracle databases. Actively participates in project teams, work groups and development efforts as assigned. Manages multiple SQL server databases, and ensures appropriate levels of performance, availability and security. Works to assure hardware and software resources are adequately being utilized. Documents database procedures and provides t...
POSITION SUMMARY/RESPONSIBILITIES. Coordinates and collaborates with. Community First Health Plans, Inc. (Community First). various departments to ensure that contractual, regulatory, and accreditation requirements. . including. National Committee for Quality Assurance (. NCQA. ). and. Healthcare Effectiveness Data and Information Set (. HEDIS) are met as it pertains to. the. Quality Management Department. Monitors. Community First. performance ...
POSITION SUMMARY/RESPONSIBILITIES. Serve as an advocate to assist and/or represent Special Health Care Needs (SHCN) which includes STAR Kids and STAR PLUS members on their behalf, in providing education and support to access necessary services. To include communication via correspondence as needed. This individual may work closely with the Service Coordination team and may facilitate mediation in cases of reported complaints regarding service coo...
POSITION SUMMARY/RESPONSIBILITIES. Acts as a Project Management Office resource to coordinate development, enhancement and execution of complex, high profile projects. Responsible for performing analysis and documenting business requirements as well as current state and future state business processes. Researches best practices, compiles information and assists process owners to implement change and monitor performance. Responsible for providing ...
POSITION SUMMARY/RESPONSIBILITIES. Provider Relations Representative works as the primary liaison between Community First Health Plans and network participants (physicians, providers, and administrators) of the health plan provider network. This position will build and nurture positive relationships with health plan network participants by providing the on boarding orientation, and delivering guidance and high-quality service through regular enga...
POSITION SUMMARY/RESPONSIBILITIES. Works with the Director of Corporate Communications to develop and implement communications programs for various internal and external constituencies. Responsible for researching, writing, editing, and disseminating information through a wide variety of print and electronic media platforms. Serves as a member of the media relations team. Works with other members of the Community First Health Plans (Community Fir...
POSITION SUMMARY/RESPONSIBILITIES. Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that are beyond the scope of claim examiners and senior claim examiners that affect claims payment. Act as consultant to claims staff in complex claim issue resolution. Work cooperatively with Configuration in testing of contracts used in business operations and reporting to assure auto adjudication...
University Health is currently seeking a. Health Educator. to join our team. This is an exciting opportunity to join a company with a reputation for exceptional service and patient care. . POSITION SUMMARY/RESPONSIBILITIES. Cooperatively plans, organizes, provides, and evaluates community education and health education activities. . EDUCATION/EXPERIENCE. . Licensed Vocational Nurse or Bachelors of Arts/Science in the health education social scien...
POSITION SUMMARY/RESPONSIBILITIES. Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of service delivered to our customers. Identifies processor and phone representative training needs that can be used to improve performance. Requires knowledge of claims processing for HCFA and UB92 for both commercial and Medicaid programs and knowled...
