Overview. Assesses member needs and identifies solutions that promote high quality and cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state and federal regulations. Delivers timely notification detailing clinical decisions. Coordinates with management, subject matter exper...
Overview. Leads the development, analysis and reporting of key risk adjustment metrics, as well as oversees analyses of new legislation and regulations regarding Risk Adjustment and assessing the impact of any changes to the programs. Maximizes revenue strategies for VNS Health Plans. Coordinates multiple cross functional activities and projects related to risk adjustment across all departments as well as interactions with external vendors. Overs...
Overview. Supervises the day-to-day operations and coordinates all work activities of the non-clinical authorization team. Ensures a customer-focused operation that meets organizational standards, goals, and objectives. Makes recommendations on operational improvements for the department. Works under general direction. Compensation. $62,400.00 - $72,000.00 Annual. What We Provide. Referral bonus opportunities. Generous paid time off (PTO), starti...
Overview. Assesses member needs and identifies solutions that promote high quality and cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state and federal regulations. Delivers timely notification detailing clinical decisions. Coordinates with management, subject matter exper...
Overview. Directs plans, evaluates, and coordinates Behavioral Health and Social Care needs for multiple lines of business including HIV-SNP -HCBS/HARP, MAP, MAPD, and DSNP Plans. Demonstrates a commitment to delivering high-quality, personalized Behavioral Health services, placing member needs and recovery goals at the forefront of all initiatives. Compensation. $122,300.00 - $164,000.00 Annual. What We Provide. Referral bonus. opportunities. Ge...
Overview. Plans, manages, and evaluates clinical orientation and ongoing education and training programs for staff for VNS Health Plans with strong Medicare focus. Collaborates with regional/program leadership in the delivery of new hire and ongoing clinical education and competency development. Develops new and modifies existing curriculum and training materials to ensure all clinical training and educational needs are met. Recommends and implem...
Overview. Builds and maintains relationships with community-based organizations, local leaders and other external entities to assist VNS Health in meeting its mission and strategic objectives. Works with Health Plan leadership in developing new and strengthening existing relationships with key organizations, community leaders, centers of influence (e.g., Providers, IPA's, and LHSCAs), and other agencies that serve VNS Health Plans member and memb...
Overview. Develops and implements the strategic Information Technology sourcing and vendor relationship strategies. Manages the selection, acquisition and monitoring of contractual agreements for hardware, software and IT services for the enterprise. Works under general direction. Compensation. $77,200.00 - $96,500.00 Annual. What We Provide. Referral bonus opportunities. Generous paid time off (PTO), starting at 30 days of paid time off and 9 co...
Overview. Educates consumers who have reached out to VNS Health Plans and existing VNS Health Plans MLTC members about the benefits of enrolling in MAP, MAPD and/or DSNP products. Achieves monthly conversion rate and quality/compliance metrics. Works under general supervision. Compensation. $70,200.00 - $87,700.00 Annual. What We Provide. Referral bonus opportunities. Generous paid time off (PTO), starting at. 30 days of paid time off. and 9 comp...
Overview. Performs outreach to identified new and existing members to help navigate positive experiences with the Health Plan and ensure member satisfaction to minimize rapid disenrollments. Advocates will assist by resolving escalations and complex issues and eliminate service interruptions to retain members. Works under moderate supervision. Compensation. $25.46 - $31.86 Hourly. What We Provide. Referral bonus opportunities. Generous paid time ...
Overview. Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health. Ensures regulatory compliance, timeliness requirements and accuracy standards are met. Coordinates efficient functioning of day-to-day operations according to defined processes and procedures. Creates and maintains accurate records documenting the actions an...
Overview. Establishes new and maintaining existing relationships with key community organizations and leaders, including but not limited to Community Based Organizations (CBO's), FBO's, political leaders, advocacy groups, and the provider community. Educates consumers in the communities served by VNS Health about MAP, MAPD or DSNP products and the benefits of enrolling in these VNS Health Plans products. Achieves monthly enrollment requirements a...
