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

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

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 Com

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

Provide office and community based resource coordination and member education to help improve member wellness and quality of life Provide Housing Supports and Services as defined in state contract to eligible members experiencing housing insecurity Collaborate with internal teams and community organizations to support members through housing related needs Assist members i

Provide office and community based resource coordination and member education to help improve member wellness and quality of life Provide Housing Supports and Services as defined in state contract to eligible members experiencing housing insecurity Collaborate with internal teams and community organizations to support members through housing related needs Assist members i

Accountable for customer (employer) loyalty and satisfaction, as measured by survey results and persistency Establish, cultivate and manage the customer relationship at multiple levels, serving as a healthcare consultant and trusted business advisor to these customers Establish, cultivate and manage relationships with consultants and brokers, recognizing the value they br

Assess, plan, and implement care strategies that are individualized by member and directed toward the most appropriate care Utilize both company and community based resources to establish a safe and effective case management plan for members Collaborate with member, family, and healthcare providers Identify and initiate referrals for social service programs, including fin

Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs) Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems Own problem t

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

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

Promote Excelsior's product portfolio to benefits brokers and help them increase their enrollment and average case size with all product lines Ability to negotiate and close sales Conduct in depth market presentations for brokers and employers Create and drive strategies for top producing agencies and Brokers Collaborate with Sales Management regarding pipeline, persisten

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

Provide primary care, including ordering and evaluating diagnostic/screening/laboratory tests, and management of minor acute illnesses Conduct comprehensive wellness assessments on members either in the clinic or patients' home as needed Assess diagnose and manage chronic conditions for patient population Identify deviations from normal, initiates and evaluates treatment

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