Manage HMSA's social media profiles and presence. Create, manage, and grow HMSA's business presence across relevant social media channels, including, but not limited to Facebook, Instagram, X (formerly Twitter), LinkedIn, Yelp, and YouTube. Evaluate new social media channels for appropriateness and integrate into the HMSA suite of social media platforms. Responsible for s

Revise and/or develop medical policies in conjunction with assigned medical director and in accordance with Development and Approval of Medical Policy administrative policy; process includes appropriate and timely implementation and publication. Support MM sponsored meetings by preparing and distributing an agenda, minutes, and documents to be discussed, and taking minute

Establishes relationships with business partners and the IT organization in order to provide technical solutions to meet user needs and influence strategic initiatives. Responsible for leading the analysis of IT requirements, alignment of IT resources and processes in order to meet the clients' organizational needs, as well as the design of enterprise solutions. Responsib

Assists in the implementation of care coordination and nursing duties within the scope of education, knowledge and experience and with appropriate supervision by a physician. Examples of duties include, but are not limited to, measuring and recording vital signs, performing routine screening tests, performing basic lab tests and EKGs, preparing and administering medicatio

Investigator Team Leadership and Support Perform Investigator staff oversight, and coaching on day to day investigation activities including, but not limited to FWA case reviews and approvals, regulatory referrals, documentation, reporting, overpayment processing and prevention. Facilitate and lead Investigator level meetings to resolve operational issues, brainstorm FWA

Leadership Identify, initiate, and manage organization wide projects to ensure that all HMSA's Medicare Program contractual obligations are met or exceeded. Manages necessary changes to existing systems, operations or workflows to address new/revised requirements of CMS/DHS/MQD. Structures work plans and project scope to deliver business impact on high priority issues. Ad

Prioritizes approved invoices and check requests according to payment terms. Familiarizes with company policies and navigating steps in Dynamics GP, Certify and CentreSuite. Verifies approver's level of authority to ensure that the cost center and the amount being charged are authorized. Follows through with requestor and obtains appropriate approval as needed. Validates

Quality Improvement Operations Provide direction and manage HMSA's overarching Quality Improvement program, including the oversight of staff and necessary resources required to design and implement programs related to compliance with accreditation, regulatory and program requirements (e.g., NCQA, Med QUEST, CMS, OPM, etc.). Oversee project teams and provide guidance to su

a. Project management and facilitation Develops and maintains project plans, timelines, and scope documents for strategy initiatives. Proactively manages deliverables, timelines, and budget Monitors and takes appropriate action to ensure various task and system related deliverables are accomplished in an accurate and timely manner. Develops strategies and tactics based on

a. Helps to lead and contributes to strategic design, implementation, and management of strategy roadmaps, strategic frameworks, and initiatives. Works with key stakeholders to strategically design and implement strategy initiatives with guidance from executive sponsors, subject matter experts, and other staff as needed Utilizes systems thinking to ensure strategies are d

Resolve enrollment, eligibility and billing issues and inquiries timely and accurately from members, employer groups and third party administrators by phone, email and written correspondence by Researching and collaborating with other units or departments to find a solution Accurately updating member records Contacting external partners who provide services for/to HMSA's

Performance Proactively service and grow HMSA products and services through various methods including site visits, on line meetings, telephone and email correspondence, power point presentations, and one on one customer servicing. Protect HMSA's market share through the successful renewal and retention of assigned accounts by strategically aligning HMSA's value propositio

Support the development of new products and benefits by performing the analysis and coordinating the efforts of others to produce the necessary information to be used in decision making by HMSA leadership. Produce comprehensive assessments of proposed changes through collaborative efforts with internal partners and subject matter experts. Prepare financial, brand, regulat

Execute, monitor, and lead implementation of payment integrity strategy. Assess the success of payment integrity activities for continued alignment with organizational goals (e.g., Healthcare Cost Trend) and ensure expected results are being achieved. Communicating external teams' outcomes, data analysis, complex processes and action plans to internal teams. Provides vend

Manages community health by establishing and maintaining trusting relationships with individuals, families, and providers to promote health, recovery, resiliency, and wellness. Advocating in members and families' best interests to ensure needs/choices are accurately represented/supported, and that timely care/services are delivered. Performs screenings/assessments regardi