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Monitors and evaluates the quality, timeliness, and accuracy of inpatient UM reviews and discharge planning. Under the guidance of the UM Director and Managers, employs recommended techniques to foster team work and staff development. Uses subject matter expertise as well as knowledge of the interconnection between UM, claims, and regulatory requirements to respond to complex and/or escalated inqu
Posted 1 day ago
Investigate, document, track, and assist with claims resolution. Interact with various operational departments to assure accurate and timely payment of claims in accordance with the plan’s policies and procedures. Identify system changes impacting claims processing and work internally on resolution. Identify systematic issues and trends and research for potential configuration related work.
Posted 1 day ago
Define the test automation strategy and framework to be used across IT, and continue to enhance and modify based on industry best practices. Participate in the selection of automation tools. Execute automation strategy, define and manage automation metrics, and drive process improvements Provide technical leadership, direction, strategy and hands on assistance to other members of the team Mentors
Posted 1 day ago
Responsible for helping develop and administer annual marketing and digital communications plans. Manages BMC HealthNet Plan’s digital presence– Including website, social media, online advertising, texting, automated calls, and email communications—in conjunction with the Marketing team. Optimizes PPC and SEO accounts across our three business lines, with the support of our digit
Posted 1 day ago
Utilizes audit background relating to knowledge general auditing standards, Sarbanes Oxley and/ or Model Audit Rule to assess how to approach a workflow review. Works with VP Finance with goal to move towards a control based external audit versus a substantive audit. Interacts with various departments within the organization to assist and modify existing workflows to ensure success in eliminating
Posted 1 day ago
Manages a panel of high risk, medically complex members Completes timely initial and on going face to face comprehensive assessments with Member to evaluate Member’s medical, behavioral health, functional status, and socioeconomic needs Administers MDS HC assessments and other required assessment tools Facilitates meetings of the PCT and serves as clinical subject matter expert and advocate
Posted 1 day ago
Completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the member’s needs for alternative services. Assesses short term and long term needs and establishes condition management objectives Provides ongoing telephonic and in person outreach to conduct ongoing focused assessments Educates and assists members in understanding their pregnancy/diseas
Posted 1 day ago
Analyzes financial, statistical and mathematical data and performs actuarial calculations. Assists in the rate development through analyses of benefit design, rating factors, claims experience, regulatory mandates, admin allocation, and projection of future claim cost. Assists in regulatory rate filings, and prepares data or response for additional inquiries. Assists in the development of monthly
Posted 1 day ago
• Deliver the message on our value to key stakeholders, partners, prospects and members. • Lead the marketing staff to create a high performing team. • Help achieve the goals of the company by reaching marketing and communications KPI targets. • Develop an effective annual marketing plan that grows targeted membership. • Establish an efficient communications process to sat
Posted 1 day ago
Business Object Developer EPIC The analytics analyst /developer will be responsible for full report delivery cycles; including requirements analysis, report design, data design, and report development and delivery. In this delivery cycle, the analytics analyst /developer will take ownership of requirements development, partner with position’s manager, clinicians, administrative staff, bus
Posted 1 day ago
Own the interaction with callers by delivering outstanding service as a means to build loyalty, improve retention, and satisfy corporate best in service goals and objectives. Complete responsibility to resolve customer inquiries and problems through effective interaction Responds to a high volume of incoming calls (call length can vary widely from 5 minutes to 45 minutes or more). Ability to take
Posted 1 day ago
Own the interaction with callers by delivering outstanding service as a means to build loyalty, improve retention, and satisfy corporate best in service goals and objectives. Complete responsibility to resolve customer inquiries and problems through effective interaction Responds to a high volume of incoming calls (call length can vary widely from 5 minutes to 45 minutes or more) Utilizes appropri
Posted 1 day ago
Provides support of applications used by the BMCHP business areas including the Web, SharePoint and ServiceNow applications and external member and provider portals Responsible for the on going operations, support and maintenance of production applications. Responsible for understanding and supporting the integration points between applications and to provide support of those applications by under
Posted 1 day ago
Responsible for ensuring compliance with contractual and regulatory requirements and for effectively documenting the components of the programs necessary for compliance with regulatory and accreditation standard and submission to external agencies. Responsible for analyzing the impact of accreditation and regulatory changes and makes recommendations on programmatic changes to ensure compliance. Di
Posted 1 day ago
Own the interaction with callers by delivering outstanding service as a means to build loyalty, improve retention, and satisfy corporate best in service goals and objectives. Complete responsibility to resolve customer inquiries and problems through effective interaction Responds to a high volume of incoming calls (call length can vary widely from 5 minutes to 45 minutes or more) Utilizes appropri
Posted 1 day ago
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