Addresses the total patient, inclusive of medical, psychosocial, behavioral, cultural, and spiritual needs Involves the individual patient and caregiver, as appropriate, in decision making Facilitates communication and coordination among members of the care team Provides patient care to include patient assessment prior to physician's/nurse practitioner's examination, serv

Partner with UMR operations and Vendor partner, own the service experience of customers at the field level by working with the UMR Operations Team and other matrix partners as required to ensure issues are resolved promptly and accurately meeting the customers' expectations Develop and maintain solid relationship with internal partners in the UMR Service Team to manage cu

Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies Perform Department of Insurance/Department of

Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medicati

Leadership (Measured through performance metrics, Colleague Reviews) Overall local market health plan clinical operations for all products including achievement of annual clinical, quality/affordability and utilization management goals Local market SME for all clinical/medical management programs and contractual requirements Lead, coach/develop, trains (in conjunction wit

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Com

Mainly handling inbound calling, NO knocking on doors Answer incoming phone calls from prospective members and identify the type of assistance and information the customer needs with the goal to convert the caller to a qualified lead and ultimately sale Ask appropriate questions and listen actively to identify specific questions or issues while documenting required inform

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact

Build high performance data pipelines from POC to mature algorithmic data cubes Implement automated workflows and routines using workflow scheduling tools Develop set processes for data mining, data modeling, and data production Integrate new data management and engineering tools into existing structures Build and use tools to understand data lineage and eliminate data du

Serves as the advocate for providers by demonstrating accountability and ownership to resolve issues Quickly and appropriately triage contacts from healthcare professionals (i.e. physician offices, clinics, billing offices) Seek to understand and identify the needs of the provider, answering questions and resolving issues (e.g. benefits and eligibility, billing and paymen

Work Life Balance/$15,000 Sign-On Bonus/Fortune 5 Company/Excellent Benefit Package!

Answer incoming phone calls from prospective members, identify the type of assistance and information the customer needs with the goal to convert caller to a qualified lead and sale Follow up with members on questions or to review current or new products and services Navigate multiple computer systems to document member information while maintaining active listening and e

Assist with care management for high medical risks / needs members with comorbid behavioral health needs As a Care Coordinator Assess members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered

Field inbound calls in a queue from members and providers for purpose of assessment and triage Focus on initial inpatient admission for psychiatric and chemical dependency patients Make patient assessments and determining appropriate levels of care Participate in member crisis calls Determine if additional clinical treatment sessions are needed Manage inpatient mental hea

Build an Elite Team of Field Account Managers As a Director of Account Management, you will be responsible for leading a team of Field Account Managers to support execution of the client's daily activities Execution of customer satisfaction and retention Work directly with Strategic Account Executives, Project Manager, and Operation team to ensure your team is executing o