Position Purpose. . Works in partnership with physicians, nurse case managers, and other disciplines to ensure the appropriateness for the corresponding level of care utilizing evidence-based criteria. Responsibilities. . Uses a collaborative process to plan, assess, re-assess, implement, monitor, and evaluate the options and services required to meet the healthcare needs of the patients using the functions of Utilization Resource Management, Tra...
Position Purpose. Exercise the duties and responsibilities delegated to the Provider Relations Representative with the outmost professionalism and dedication. Responsibilities. Responsible for conducting provider orientations of newly contracted providers within the specified time frames as indicated in Policy & Procedure PR 01. Responsible for securing a signed Notice of Educational In - Service Acknowledgement Form upon completion of each and e...
Not a Remote Position-Only Local Applicants. The. Clinical Data Analyst. is accountable to use their knowledge of data processing software and business development strategies to provide sound business recommendations to company leaders. This position is responsible for accurately collaborating with other data professionals to extract data figures, create reports based on findings and monitor key performance indicators (KPIs) to determine busines...
Position Purpose. Configure provider contracts, fee-schedules and claim rules. and manage all related problem-solving. Responsibilities. . Provide business and technical expertise for the system configuration of provider contracts, fee- schedules, claim rules and other related processes to achieve operational. requirements. Perform system testing, analysis and complex problem solving related to provider configurations. make recommendations for. i...
Position Purpose. Nurse Case Manager who is responsible for coordinating the continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery and compliance with medical regime. Responsibilities. . Performs and coordinates the initial assessments and ongoing reassessments of the patient's. status. Documents patient case information within a database system. Performs chart review/audits monthly or ...
Position Purpose. . Exercise the duties and responsibilities delegated to the Provider Relations Representative with the outmost professionalism and dedication. . Responsibilities. Responsible for conducting provider orientations of newly contracted providers within the specified time frames as indicated in Policy & Procedure PR – 01. Responsible for securing a signed Notice of Educational In - Service Acknowledgement Form upon completion of each...
Position Purpose. . Exercise the duties and responsibilities delegated to the Provider Relations Representative with the outmost professionalism and dedication. . Responsibilities. Responsible for conducting provider orientations of newly contracted providers within the specified time frames as indicated in Policy & Procedure PR – 01. Responsible for securing a signed Notice of Educational In - Service Acknowledgement Form upon completion of each...
