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American multinational healthcare company
Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service…
Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved.…
Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning…
Position Purpose: Works with members and providers to close care gaps, ensure barriers to care are removed, and improve the overall member and provider experience through outreach and face-to-face interaction with…
Educate members about needed screenings, including diabetic and breast cancer screenings. Encourage members to schedule appointments and assist with scheduling as needed. Complete assessments, including the Conditions…
Position Purpose: Serve as a liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams. Assesses and performs review of member clinical records and…
Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for…
Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are…
Position Purpose: Develops, assesses, plans, implements, and coordinates complex care management activities based on member needs primarily focused on behavioral health needs (including behavioral health, and social…
Position Purpose: Conduct comprehensive reviews of medical records and documents supporting claims for providers, suppliers, and pharmacies to include but not limited to physicians, inpatient, outpatient, ancillary,…
Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care…
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