The Director of Utilization Management provides leadership, management, oversight, and assessment of all aspects of management and is responsible for managing overall utilization while ensuring delivery of essential services that address the total health care needs of The Health Plan members. The Director of UM works collaboratively with the Chief Medical Officer, Vice President of Medical Economics, Program Evaluation and Clinical Strategic Init...
Job Description. Job Description. The Director of Case Management provides leadership, management, oversight, and assessment of all aspects of clinical program management and is responsible for ensuring quality provision of member driven care continuum programs while ensuring delivery of essential services that address the total health care needs of The Health Plan members. The Director of Case Management works collaboratively with the VP of Clin...
Job Description. Job Description. Under the direction of the Director, Provider Network Management, the Practice Management Consultant provides education, training and guidance for providers in the assigned provider network. drives quality discussions to increase member care, member satisfaction and provider satisfaction, responsible for performing on-site reviews of new and re-credentialed providers within their assigned territory. identify and ...
Job Description. Job Description. To assist with administration of the UMWA 1985 Construction Workers Pension Plan and the 1978 Retired Construction Workers Benefit Trust. Required. High School graduate or equivalent work experience. Strong organization skills, verbal and written communications. Excellent phone skills. Ability to multi-task, prioritize work to meet deadlines. Knowledge of Microsoft Office Programs (Word, Excel, Outlook). Data ent...
Job Description. Job Description. The Compliance Support Coordinator is expected to provide the Compliance Manager and Government Compliance Officer with administrative and organizational support. The Compliance Support Coordinator is expected to complete tasks as assigned and perform additional duties as deemed appropriate by the Compliance Manager. Required. Minimun High School Diploma. Knowledge of Microsoft Office Systems - Word, Excel and Po...
Job Description. Job Description. Under the direction of the Director, Provider Network Management, the Practice Management Consultant provides education, training and guidance for providers in the assigned provider network. drives quality discussions to increase member care, member satisfaction and provider satisfaction, responsible for performing on-site reviews of new and re-credentialed providers within their assigned territory. identify and ...
. Under the direct supervision of the Manager of Credentialing, responsible for credentialing of providers and associated activities in support of the credentialing process in accordance with established Health Plan credentialing policies following NCQA, Medicare, the state of West Virginia, West Virginia Medicaid, and the state of Ohio policies and procedures. . Required. High school diploma/equivalent and two years related healthcare experience...
The Social Worker is responsible for the navigation and advocacy of identified members stratified relevant to their practice. These members require coordinated care and integration into multiple health and social systems. This may include providing the member with information and assistance to access a wide spectrum of services directed at social, medical/behavioral and lifestyle interventions to promote health and wellness and support individual...
Under the general direction of the Unit Manager or Unit Supervisor, the Clinical Service Member Advocate is responsible for completing outreach activities for the member engagement into various programs as well as performing additional program, unit, and interdepartmental support functions. The Member Advocate is responsible for coordinating administrative or simple clinical functions within a program or line of business which may include, but ar...
