The Care Manager Assistant provides face-to-face visits, ongoing support and care coordination to members. Responsibilities include face-to-face visits, communication and follow up with members and reviewing of person centered service plan with member/members family and coordination of covered and non-covered benefits. Fieldwork required. Bilingual Mandarin Cantonese required. Essential Responsibilities. Regular communication with members. Regula...
Job Overview. Provider Relations Specialist performs full range of activities related to Provider Relations Department, including assisting with contracting, credentialing and provider service. Job Location. New York, NY. Essential Responsibilities. Assist with the credentialing and/or re-credentialing process for a variety of providers including practitioners and organizational providers by running reports, contacting providers, and reviewing do...
Job Overview. The Medicaid Quality Improvement Manager is responsible for the improvement of the plan’s ratings in the Medicaid Quality Pool and Consumer Guide programs. This position supports the Medicaid Quality team across the MLTC and MAP LOBs, through coordination, materials development, management, facilitate quality improvement education with provider partners, meeting facilitation and provide project managements for quality initiatives an...
Job Overview. The Medicaid Quality Improvement Manager is responsible for the improvement of the plan’s ratings in the Medicaid Quality Pool and Consumer Guide programs. This position supports the Medicaid Quality team across the MLTC and MAP LOBs, through coordination, materials development, management, facilitate quality improvement education with provider partners, meeting facilitation and provide project managements for quality initiatives an...
Job Overview. The Member Experience Program Manager is be responsible for development and implementation of strategic objectives aimed at optimizing performance and enhancing the qualiyt of member experience across all lines of business. Essential Responsibilities. Assist in strategy development with leaders to create collaborative process to prioritize the available resources to maximize overall performance. Work with matrix leadership across th...
The Revenue Optimization coder will work closely with the VP of Strategy and Innovation and the rest of the Revenue Optimization team on all areas of efficiency and optimization of funds related to reimbursement, payments, and member care including but not limited to. Responsibilities related to Medicare Risk adjustment processes. o Review of encounter report to identify priority claims and providers for review. o Review of medical records and cl...
The Care Manager Assistant provides face-to-face visits, ongoing support and care coordination to members. Responsibilities include face-to-face visits, communication and follow up with members and reviewing of person centered service plan with member/members family and coordination of covered and non-covered benefits. Fieldwork required. Essential Responsibilities. Regular communication with members. Regular face-to-face visits with members duri...
The Transitions of Care (TOC) Care Manager is responsible for working to coordinate discharge and services between hospitals, acute care facilities, and home. The TOC CM will collaborate with admitting facilities to coordinate safe discharge for members. The TOC CM will participate in case conferences, connect members to medical providers and services, and ensure a safe discharge of the member. Essential Responsibilities. Coordinate Hospitalizati...
The Transitions of Care (TOC) Care Manager is responsible for working to coordinate discharge and services between hospitals, acute care facilities, and home. The TOC CM will collaborate with admitting facilities to coordinate safe discharge for members. The TOC CM will participate in case conferences, connect members to medical providers and services, and ensure a safe discharge of the member. Essential Responsibilities. Coordinate Hospitalizati...
The role of the Member Service Representative provides support and service to members of the Medicare Advantage Plan, by answering questions, resolving issues and educating callers in an accurate, respectful and timely manner. Essential Responsibilities. Deliver high-quality customer service, listening to members’ requests and working to find the appropriate solution by either transferring members to the appropriate departments or assist them the...
The UM Nurse manages providers, members, or care manager generated requests for medical services and renders clinical determinations in accordance with Hamaspik Choice policies as well as applicable state and federal regulations. UM Nurse delivers timely notification detailing Hamaspik Choice clinical decisions. Participates in UM review process of claims. Essential Responsibilities. Reviews planned, in process, or completed health care services ...
