Conduct a high volume of outbound calls to members to discuss reasons for non compliant to medication(s), schedule pharmacy telephonic appointments, and/or obtain important follow up information from providers. Outbound calls are made primarily using an auto dialer requiring precision to detail and adaptability to type of response needed May answer inbound calls from memb

Conduct a high volume of outbound calls to members to discuss reasons for non compliant to medication(s), schedule pharmacy telephonic appointments, and/or obtain important follow up information from providers. Outbound calls are made primarily using an auto dialer requiring precision to detail and adaptability to type of response needed May answer inbound calls from memb

Performs nursing assessments and develops, implements and evaluates plans of care in conjunction with the physician, patient and caregivers per agency policy and procedure Evaluates the effectiveness of the plan of care, the patient's response to care and outcomes of care and revises the plan of care as needed Re evaluates patient nursing needs to include on going assessm

Implements and leads all aspects of Caregiver SOS in an assigned geographic area, including oversight of assistants and volunteer staff Develops an annual business plan with measurable objectives, and targeted activities to achieve those objectives Builds relationships and collaborates with key leaders, professionals, organizations and other stakeholders that serve caregi

Implements and leads all aspects of Caregiver SOS in an assigned geographic area, including oversight of assistants and volunteer staff Develops an annual business plan with measurable objectives, and targeted activities to achieve those objectives Builds relationships and collaborates with key leaders, professionals, organizations and other stakeholders that serve caregi

Provides consistent professional nail care to include trimming and buffing of toenails Organizes exam and treatment rooms, replenishes stock levels, cleans rooms and sterilizes medical instruments Keeps inventory of supplies and places replenishment orders as needed Returns any and all patient messages in a timely manner Attends, participates in and supports training and

Completes assigned daily cases by processing prior authorization and medical necessity requests for specialty CMS part B medications and meet production, performance metrics as determined by the department in order to comply with CMS Part B turnaround times (TAT) Review specialty medication prior authorization requests (i.e. biopharmaceuticals) according to established tr

Performs all duties within the scope of a LVN (procedures, injections, diagnostic testing, phlebotomy) Coordinates healthcare screening results as directed by providers, company standards, and policies Broad knowledge of information required to complete health screenings required Travels with the mobile team to clinics and centralized locations to conduct screening clinic

Provides exceptional customer service to all consumers and members of the clinic staff Fills prescription orders and makes them available for verification under direct supervision of the registered pharmacist Orders, receives and stores incoming pharmacy supplies Receives and processes wholesaler medication orders Verifies medication stock and enters data in computer to m

Appropriately adapts assigned assessment, treatment and/or care methods to accommodate the unique physical, psychosocial, cultural, and age specific and other developmental needs of each person served Receives relays and documents written and electronic orders in the patient's medical record Corroborates a patient's clinical history with procedure and ensures information

Ensure the accuracy of Enterprise and Department Risk Adjustment initiatives by corresponding with various internal WellMed departments to gain insight and knowledge on processes Build/maintain functional relationships with business area leadership and staff along with a general understanding of individual area workflows Partners with departmental leadership and staff to

Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values Educates primary care physicians regarding systems, structures, processes and outcomes necessary for assurance of regulatory compliance related to market activities Develops strategies for improving all aspects of market performa

Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values Educates primary care physicians regarding systems, structures, processes and outcomes necessary for assurance of regulatory compliance related to market activities Develops strategies for improving all aspects of market performa

Reading and interpreting provider contracts, or other pricing artifacts, to complete provider configuration design templates Loading provider contracts into Facets (using Facets or NetworX capabilities) Extracting and analyzing pricing data to help assess load accuracy and to resolve provider pricing inquiries and/or pended claims Complete quality control measures to ensu

Creates and executes Project plans and revises appropriately to meet changing requirements and needs. Plans and schedules Project timelines and milestones using the appropriate tools. Manages day to day operational and tactical activities of a Project. Develops and delivers Progress Reports, Proposals, Requirements Documentation and Presentations. Diagnoses task/procedura