Manage end to end conference/event related planning that drive a consistent attendee experience, providing on site support when needed Review and manage relationships with existing and potential vendors, ensuring mature utilization of existing tools and roadmap development Provide ongoing work direction to Attendee Managers regarding registration, reporting, attendee comm

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Co

Educate members on health education and condition management (formal and informal), as well as plan specifics and member resources, in collaboration with OptumHealth Referral of employees to available clinical programs including premium designated physicians Create, manage and implement employer specific programs based on employer needs Monitors and analyzes customer spec

Front Facing Practice Level Leadership Targeted Quality Improvement Gaps in Care Closure Relationship Management, Internal and External Community Engagement and Interaction Provider and Practice Education, Quality Oriented Health Topics Supports effective deployment of program at the practice level through strategic partnerships with participating practitioners and practi

Responsible for conducting telephonic or face to face holistic evaluations of Member's individual dynamic needs and preferences gathering relevant data and obtaining further information from Member/family identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services, and long term services and sup

Manage end to end attendee management that drive a consistent experience, providing on site support when needed Manage relationships with existing and potential vendors, ensuring mature utilization of existing tools and roadmap development Provide ongoing reports to Event Managers and business partners regarding registration, reporting, attendee communications and mobile

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 prior to physician's/nurse practitioner's examination, serv

Driving and contributing to effective advocacy efforts to advance and protect the Company's objectives at the federal level Actively engaging in lobbying activities by communicating and advocating for priorities and building and deepening the Company's relationships with federal legislative and executive branch officials and staffs Anticipating, influencing and monitoring

Investigate and manage escalated claim/call/appeals issues through root cause analysis and communicate outcome (in person, telephonically or via written communication) Assist with navigating the healthcare system by providing resources for scheduling appt. and assisting with issues related to prolong periods for scheduling appts Assist participants with completing health

Provide skilled nursing care for expectant mothers in the home care environment Travel to provide in home patient care and continuous education to patients and family members Continually assess the mothers' condition to ensure they are safe in the home environment Modify care plans as appropriate based on reassessment, change in prescriber orders, the patient's need for f

Contribute and oversee strategic projects, ETL design and architecture, performance tuning activities, Code Reviews, and Best Practices Responsible for approving and certifying the architecture and design of the data warehouse, data marts and BI reports which will support various data initiatives Supervision of development of ETL code with our current toolset, Informatica

Answer incoming phone calls from prospective members, identify the type of assistance and information the customer needs with the goal to convert caller to a qualified lead and sale Follow up with members on questions or to review current or new products and services Navigate multiple computer systems to document member information while maintaining active listening and e

Receive assigned provider inquiries and perform a code review on both professional and facility claims Make determinations on cases after a coding review is complete Review various edits on cases and complete audit of medical records received to ensure proper editing is applied Review medical charts electronically Abstract and code diagnosis and procedures from the medica

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

Review, validate and maintain financial and other records as they relate to client specific programs for Taft Hartley Fund Responsible for timely reconciliation of all accounts Process payments and retrieve required statements from websites Communicate financial discrepancies and resolve Responsible for all financial exchanges related to participant accounts Identify erro