Attend work group meetings with AHCCCS/other LTSS MCOs and disseminate updates and requirements back to team for implementation. This includes verifying implementation and ensuring delivery of any contractual artifacts. Number of meetings will vary by project. An average will be 4 6 standing meetings per month Coordination, review, and submission of all scheduled and ad h

Conduct assessments in a variety of settings 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 and foot exam (as appropriate) Identify diagnoses to be used in care management and active medic

Conduct assessments in a variety of settings 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 and foot exam (as appropriate) Identify diagnoses to be used in care management and active medic

Lead marketing direct campaign execution through Sales Force/Adobe tools and provide insights on best practices based on internal and third party data, establishing a rigorous process for evaluating ROI of marketing initiatives Operational deployment capabilities for IFP direct mail, email, and SMS marketing Works with IFP marketing partners in developing customer journey

Assist in end to end provider claims and help enhance call quality Use pertinent data and facts to identify and solve a range of problems Investigate non standard requests and problems Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers Help implement training and developmen

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 Provide analytical support for value based contracts, unit cost budgets, target setting, perfor

Ability to create products from scratch, document new agreement configuration, as well as changes to existing agreements in the BC Product Workbook Review requirements documents and validate discrepancies or missing information Accurately create, update, implement and test configuration changes Accurately document changes and communicate changes with the business Design n

As part of a multi disciplinary care coordination team Addresses the total patient, inclusive of medical, psychosocial, behavioral, cultural, and spiritual needs Involves the individual patient and caregiver, as appropriate, in decision making Facilitates communication and coordination among members of the care team Provides patient care to include patient assessment prio

Identifies opportunities for specialty/enterprise products on all new sales Negotiate with underwriting when necessary Understand and effectively selling multiple products, requiring knowledge of Health Care Reform guidelines and how they differ between level funded and specialty products Develop and maintain solid broker/consultant relationships, telephonically, includin

Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered care plans inclusiv

Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs. Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs. Develop and implement individualized, person centered care plans inclus

Review, interpret and/or verify contract language, information, and intent to load information into systems properly Ensure contract templates can be administered across operations (pricing config, claims, etc.) Communicate identified discrepancies to Network Mgmt, Contracting and Pricing Requirement teams Review company specific, CMS specific, State specific and competit

Review, interpret and/or verify contract language, information, and intent to load information into systems properly Ensure contract templates can be administered across operations (pricing config, claims, etc.) Communicate identified discrepancies to Network Mgmt, Contracting and Pricing Requirement teams Reviews company specific, CMS specific, State specific and competi

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 estab

Manage unit cost budgets, target setting, performance reporting and associated financial models Help develop geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards, and other key process controls