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

Finalize required Qualified Health Plan (QHP) Templates owned by business Create and submit product form filings with state and federal regulators Run CMS Provided Review Tools prior to QHP filings Coordinate tracking/analysis of objections for trending and identification of opportunities for business Coordinate Plan Preview/Window Shopping for FFM and SBM Exchanges befor

Extensive work experience within own function. Work is frequently completed without established procedures. Works independently. May act as a resource for others. May coordinate others' activities. Extensive work experience within own function. Applies knowledge/skills to a range of moderately complex activities. Demonstrates great depth of knowledge/skills in own functio

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

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

Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services related to benefit design and coverage and the application of clinical criteria of medical policies Perform Department of Insurance/Department of

Assess, plan and implement care management interventions that are individualized for each member and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals for both healthcare and community based services; including but not limited to financial, psychosocial, community and state supportive services Develop and implement care

Consult with users and technology specialists to define business processes and be the liaison between the two parties Perform Business Analysis Ability to define project objective, scope, write business and technical requirements Business Liaison to refine business requirements Communicate and validate requirements with stakeholders Validate solution meets business needs

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

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

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease 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 Com

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Acts as primary CAHPS Manager Collaborating with leadership, develop and drive tactical plan that can be leveraged across the enterprise to achieve CAHPS goals Manages vendor relationships to support CAHPS program Analyzes key KPI's and data to derive progress and opportunities for improvement Establishes and reviews performance metrics on a regular basis to ensure effort

Telecommute Healthcare Advocate

Telecommute CDI Specialist (St. Louis, MO)