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Combine two of the fastest growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. The
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Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For
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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 medica
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CME Quality Audit discipline which entails organizing, tracking progress of audits and ensuring defect finding resolution Oversee post load provider contract audits using various databases and/or source documents Validate provider configuration within Facets/NetworX Organize and track progress and findings of audit in Source of Truth Matrix (SOTM) Summarize audit results
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Drive high priority strategic initiatives for the Customer Success team and proactively provide insights based on data and analysis to improve revenue, retention, and churn metrics Design and execute scalable processes for the Customer Success team, reduce friction in existing processes, and make suggestions new processes Own and drive the Custom Success Team's adoption a
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Demonstrate mobile development with React Native, iOS and Android experience JavaScript and TypeScript development Node Js Redux, Redux Saga for state management Maintain architectural diagram designs and documentation Develop custom tools and automation through programming and scripting Recommend enhancements and modifications to improve enterprise system performance, ef
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Develop and maintain a strong understanding of department operations, processes, procedures, and operational effectiveness, and establish a rapport with internal and external team members Work effectively with department management to create and maintain key metric reporting, ensuring data integrity and accuracy Develop, perform, and manage various reports as well as perf
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Regular, consistent, on site, and timely attendance Schedules patient appointments for designated departments Schedules appointments utilizing scheduling software tools Provides testing instructions to assure smooth services Secures authorization and referral if applicable Customer Focus. Assesses customers' needs and considers customer in all decision making processes to
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Performs daily oversight and coordination of the UM queues and email box to meet established performance metrics Oversees inventory related to prior authorization, claims review, and concurrent review inventory and regulatory timeframes Responsible for supervising all aspects of the inventory and coordination Serves as a primary point of contact and provides explanations
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Assist in end to end provider claims and help enhance call quality Assist in efforts to enhance ease of use of physician portal and future services enhancements Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers Support development and management of provider networks Help i
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Performs all duties within the scope of a Certified Medical Assistant (procedures, injections, diagnostic testing, phlebotomy) Coordinates healthcare screening results as directed by providers, company standards, and policies Travels with the mobile team to clinics and centralized locations to conduct screening clinics to support contracted physician network Rooms patient
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Respond to and resolve, on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence Help guide and educate customers about the fundamentals and benefits of consumer driven health care topics to select the best benefit plan o
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Primary Care Delivery Deliver cost effective, quality care to assigned members Manage both medical and behavioral chronic and acute conditions effectively in collaboration with a physician or specialty provider Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare
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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
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Assisting in the review of medical records to highlight Star/HEDIS opportunities for the medical staff Review medical records for data collection, data entry, and quality monitoring including health plan/WellMed form submission and chart collection activities that close gaps in care Partner with the leadership team, the practice administrative or clinical staff to identif
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