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Anticipate customer needs and proactively develop solutions to meet them Support and validate provider network contracting and unit cost management Conduct financial and network pricing modeling, analysis and reporting Perform unit cost and contract valuation analysis in support of network contracting negotiations and unit cost management strategies Manage unit cost budgets, target setting, perfor
Posted 1 day ago
Assess and interpret customer needs and requirements Identify solutions to non standard requests and problems Solve complex problems and/or conduct complex analyses Provide explanations and information to others on difficult issues Coach, provide feedback, and guide others Train new hires Act as a resource for care advocates/navigators on the team Provide Care Advocacy and support for families nav
Posted 1 day ago
Provides clear direction to achieve goals, creating an environment that fosters team commitment and employee engagement. Maintains the perseverance to drive and sustain the changes that occur at MedExpress, while being resilient and flexible, and inspiring and motivating the team. Constantly communicates to the team, is open to opinions and feedback from team members and follows through on commitm
Posted 1 day ago
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough. Preferred location in is on the West
Posted 1 day ago
Answer incoming phone callsfrom customers and identify the type of assistance the customer needs (i.e.benefit and eligibility, billing and payments, authorizations for treatment andexplanation of benefits (EOBs) Ask appropriate questionsand listen actively to identify specific questions or issues while documentingrequired information in computer systems Own problem through toresolution on behalf o
Posted 1 day ago
Contact health care providers and customers by telephone using inbound / outbound phone queue to retrieve missing medical and / or dental components on service paperwork. Including discussing medical and / or dental services with providers to ensure services are completed correctly and up to the customer / LHI contract guidelines Update internal LHI and external customer database(s) by inputting m
Posted 1 day ago
Provide exceptional customer service to all patients and members of the clinic staff Under direct supervision of the registered pharmacist, fills prescription orders and makes them available for verification by the Pharmacist. Once verified by the pharmacist, dispenses the prescriptions. Order, receive and store incoming pharmacy supplies. Receive and process wholesaler medication orders. Verify m
Posted 1 day ago
This isn't packaged goods. It's a bigger challenge than that. Here you're making a difference in people's lives, starting with your own. Join us and start doing your life's best work.(sm) Position Description Involved in the development, presentation and delivery of community outreach initiatives, activities and market strategies to support the Medicaid business and drive membership growth. Primar
Posted 1 day ago
Optum is seeking a Pharmacist with a clinical background in pediatrics whose professional interests also include navigation of highly individualized, complex health benefits concerns. The position is salaried, full time with eight paid holidays annually. You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. The Clinical Pharmacist will be r
Posted 1 day ago
Act as a Subject Matter Expert for other team members Manage the intake of members or the admission/discharge information post notification Work with hospitals, clinics, facilities and the clinical team to manage requests for services Manage the referral process, processing incoming and outgoing referrals and prior authorizations, including intake, notification and census roles Resolve inquiries f
Posted 1 day ago
Bring us your experience, your head for strategy, your strength with relationships and your eye for opportunity. In return we offer an unmatched place to grow and develop your career among a richly diverse group of businesses driven by the power and stability of a leading health care organization. Come help us heal and strengthen the health care system as you do your life's best work.(sm) You'll e
Posted 1 day ago
Conduct in home assessments on health plan members, including past medical history, review of symptoms, physical examination, medication review and depression screening Responsible for checking vitals, conducting a physical exam that includes monofilament test, urine dipstick and foot exam (as appropriate) Identify diagnoses to be used in care management and active medical management in the furthe
Posted 2 days ago
Obtain and review medical history, conduct physical and psychosocial assessments, analyze and diagnose conditions and develop appropriate plan of care Identify gaps in care, interpret diagnostic test and reports and refer appropriately Identify risk factors and help mitigate barriers to access care and reduce risk Develop interventions to assist members in attaining established goals of care Evalu
Posted 2 days ago
Conduct in home assessments on health plan members, including past medical history, review of symptoms, physical examination, medication review and depression screening Responsible for checking vitals, conducting a physical exam that includes monofilament test, urine dipstick and foot exam (as appropriate) Identify diagnoses to be used in care management and active medical management in the furthe
Posted 2 days ago
Conduct in home assessments on health plan members, including past medical history, review of symptoms, physical examination, medication review and depression screening Responsible for checking vitals, conducting a physical exam that includes monofilament test, urine dipstick and foot exam (as appropriate) Identify diagnoses to be used in care management and active medical management in the furthe
Posted 2 days ago
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