Medica’s Support Specialist II works as part of a team to track, analyze and complete documentation to support larger processes or programs within our care coordination segment. This Support Specialist will serve as a subject matter expert and manage a variety of administrative functions which include (however are not limited to). Receiving, managing, and entering authorizations and referrals from external partners. Managing email inboxes, and re...
Description. The Senior Financial Planning Analyst will prepare financial and regulatory reporting. The Senior Financial Analyst will be responsible for the annual regulatory reporting and lead regulatory audits in relation to the reporting. The role will improve financial status by analyzing results. monitoring variances. identifying trends. recommending actions to management. This position will also research and apply accounting standards and r...
The Account Manager is responsible for building relationships with new clients while maintaining existing client base, coaching clients on all aspects of Medica's programs/products and client implementation. This role will also be responsible for the effective and timely resolution of service issues. The Account Manager will work with both self-funded and fully insured clients. Qualifications. Bachelor's degree and 3 years of experience OR 7 year...
Description. This Program Manager opportunity will work within Medica's Health Services division, supporting optimization efforts for clinical systems and integrations. Our Program Manager will be accountable to work with matrixed and cross-functional teams to achieve strategic business outcomes and represent the voice of the customer by providing domain knowledge and expertise to drive business outcomes, including the coordination of people, pro...
The Provider Auditor provides verification of accurate provider contract intent, credentialing, demographic and reimbursement loading while working to drive improvement of manual processes and identification of setup and system errors. Key Accountabilities. Perform and/or lead audits as defined by the annual audit plan. Verify accurate system configuration against source data. Review policies and procedures and ensure that the submission follows ...
Strategic Account Executive's primary responsibility includes strategic management of a robust prospect pipeline along with building and maintaining key broker/agency relationships in the Prevea 360 service area. Responsible for the sale and implementation/onboarding of new groups. Career-level position. Considered highly skilled at sales techniques and demonstrates strong understanding of company products / services. Comprehensive knowledge with...
Description. The Senior Finance Analyst supports financial reporting along with the completion of filings required by MN DHS and CMS. Additional responsibilities may include the analysis of financial data by collecting, monitoring and creating financial models for decision making as well as monitoring variances, identifying trends, and recommending actions to management. This is a senior level professional position and is accountable for more com...
Description. Medica's Medical Director of Quality and Care Management supports the Clinical Services team via quality improvement activities including but not limited to collaborating with quality teams to improve the care received by our members as judged by HEDIS performance, state Medicaid programs, and other established quality measurement standards. In support of the Senior Medical Director for Quality, Care Management and Public Policy, thi...
Description. This position is responsible for the oversight of clinical review and the direction of UM staff to ensure productivity and quality standards are met at all times. The manager must have a comprehensive knowledge of all state and federal regulations in addition to accreditation standards related to UM and ensure compliance and maintenance of Medica's accreditation status and audit performance. The manager will also maintain confidentia...
Description. Lean Six Sigma Architect collaborates closely with cross-functional leaders, vendors and employees at all levels. We have adopted a holistic approach to Lean Six Sigma where we identify Process Owners for ongoing continuous improvement in 7 key Value Streams. Each Value Stream is supported by a Black and Green Belt that evaluates, documents, designs, manage and monitors the end-to-end processes and underlying systems through the cont...
Description. The St. Louis Market Leader serves as the face of Medica in the Market, building and enhancing relationships with providers, brokers, community and members. This senior leader will be accountable for developing and executing strategic growth plans for a defined geographic region based on Medica's corporate objectives. Key Accountabilities Include. Developing and executing a local market strategy. Develops and drives the regional grow...
The St. Louis Market Leader serves as the face of Medica in the Market, building and enhancing relationships with providers, brokers, community and members. This senior leader will be accountable for developing and executing strategic growth plans for a defined geographic region based on Medica’s corporate objectives. . Key Accountabilities Include. . Developing and executing a local market strategy. Develops and drives the regional growth and re...
