Description. The Pharmacist Utilization Management oversees the administration of the pharmacy department's utilization management program for both traditional pharmacy and infusion-related medications. This individual provides clinical support for other departments quality and health management efforts. This role assists in the development and evaluation of the plan formulary and benefit designs. Location. Candidates must reside in the state of ...
The Population Health Specialist II provides operational support for the Case, Condition Management, Quality, Wellness, Pharmacy, Government Relations, and Utilization Management Departments including requesting and extracting medical records and provider outreach for HEDIS, Health Risk Assessments, Primary Care Provider Attributions, and CIOX medical records. This role assists with supporting and monitoring compliance with CMS federal regulatory...
Network Health’s success is deeply rooted in its mission to build healthy and strong Wisconsin communities. This mission shapes every decision we make, including the selection of individuals who join our growing team. The. Member Experience Representative I. will support our various line of business by addressing benefit interpretations, claims, authorizations, and other member inquiries in a collaborative and innovative environment. This role in...
Description. The Registered Nurse Care Manager provides case management services that are member-centric and include assessment, planning, facilitation, care coordination, evaluation and advocacy to all members across the healthcare continuum. The Care Manager advocates for options and services to meet an individual's and family's comprehensive health needs through communication and coordination of available resources to promote quality, cost-eff...
The Quality Care Coordinator develops, implements and provides ongoing monitoring of intervention plans and quality gap closure. The overall goal of this role is to reduce medical costs and improve quality ratings. The Quality Care coordinator achieves this goal through member and/or provider engagement, internal quality process improvement work, and coordination of overall clinical intervention strategies. The Quality Care Coordinator conducts H...
Description. At Network Health, our success is driven by our mission to build healthy, strong Wisconsin communities. This mission inspires every decision we make, including the exceptional individuals we welcome to our team. We are currently seeking a. Receptionist. to join our Brookfield office. As the first point of contact for our members and visitors, the Receptionist will embody professionalism and a commitment to service excellence. This dy...
Network Health’s success is rooted in its mission to create healthy and strong Wisconsin communities. Network Health is seeking a COB and Recovery Analyst who will use their advanced knowledge of refunds and recoveries and Medicare Part D coordination of benefits to maintain and drive improvements to our refund and recovery operations and Medicare Part D COB process. Individuals in this role will help develop departmental policies and procedures ...
Description. The Population Health Specialist II provides operational support for the Case, Condition Management, Quality, Wellness, Pharmacy, Government Relations, and Utilization Management Departments including requesting and extracting medical records and provider outreach for HEDIS, Health Risk Assessments, Primary Care Provider Attributions, and CIOX medical records. This role assists with supporting and monitoring compliance with CMS feder...
The Population Health Specialist I provides operational support for the Case, Condition Management, Quality, Wellness, Pharmacy, Government Relations, and Utilization Management Departments including requesting and extracting medical records and provider outreach for HEDIS, Health Risk Assessments, Primary Care Provider Attributions, and CIOX medical records, and incoming and outgoing postal mail (requires in-office attendance on a rotating basis...
