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Uses pertinent data and facts to identify and solve a range of problems within area of focus or expertise Extracting, trending and reporting data Solves moderately complex problems and/or conducts moderately complex analyses Works with some guidance; seeks guidance on only the most complex tasks Acts as a resource for other STARS / HEDIS Quality Analysts with less experience Be proficient in under
Posted 1 day ago
Performs screening and diagnostic mammography examinations Assists in maintaining records and reports consistent with MQSA Enter data into computer and ensures accuracy Adheres to policies, procedures and regulations to ensure compliance and patient safety Maintains credentials and/or licensure Attends and participates in departmental meetings Performs other duties as assigned You'll be rewarded
Posted 1 day ago
Managing and administering inpatient behavioral health benefits Reviewing clinical assessments and determining appropriate levels of care Determining if additional clinical services are needed Coordinating benefits and transitions between various levels of care Identifying ways to add value to treatment plans and consulting with facility staff on those ideas Identify appropriate community based se
Posted 1 day ago
Supervises, schedules, and evaluates all clinical and supportive pharmacy personnel as it relates to the clinical services provided, sterile compounding, inventory control and purchasing Directs, coordinates and supervises all pharmacy activities including drug preparation, sterile product preparation, dispensing and clinical pharmacy services Ensures that all pharmacy operations, practices and pr
Posted 1 day ago
Reviews medication orders and evaluates appropriateness and completeness of orders with consideration given to the special needs and behaviors of the specific age group served Verifies all prescriptions not directly received from the prescriber or physician's agent Provides oversight of the safety, appropriateness, and effectiveness of the pharmaceutical care provide to patients (consumers) as it
Posted 1 day ago
Consistently exhibits behavior and communication skills that demonstrate the company's commitment to superior customer service, including quality, care, and concern with internal and external customers Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards Anticipates the clinician's n
Posted 1 day ago
Perform quantitative analysis on Actuarial, financial, utilization and costs data Develop and deploy predictive data models on large data sets Collaborate and communicate effectively with our broader product teams, while supporting ad hoc analytics where needed Design and run complex data programs Execute creative problem solving and critical thinking on the job You'll be rewarded and recognized
Posted 1 day ago
Assigns and reassigns members to appropriate Care Manager under the direction of the Care Management Supervisor Monitors member list routinely to assure accurate assignment of all members Tracks Nursing Facility and Inpatient census data via the Blended Census Reporting Tool (BCRT) Communicates member Inpatient status to the assigned Care Manager Updates Member demographic and placement changes in
Posted 1 day ago
Lead and establish business aligned product architecture roadmaps and solution strategies to provide market distinction, differentiation, agility, scale and cost optimization Partner with business stakeholders for strategic planning, road mapping and prioritization. Lead, solution, deliver and drive capital investments for the assigned product families in collaboration with business and enterprise
Posted 1 day ago
Opportunities with American Health Network, a Part of Optum . When you join American Health Network (AHN), you become part of a team that strives to identify and retain the top healthcare professionals in the markets it serves. At American Health Network, we want to be the best health care organization we can be. Our mission is to improve the health of our patients. We're a physician led organizat
Posted 1 day ago
Coordinate meetings by preparing and distributing materials, including agendas, pre read materials and minutes Project management track action items, request follow ups and take follow up actions to support project deliverables Develop business context diagrams (e.g., business data flows, process flows) to analyze/confirm the definition of project requirements Communicate ongoing updates to all st
Posted 1 day ago
This is a production, matrix, and time based environment that requires a lot of multitasking. Within Epic there are work queues, the order will route to a work queue and that is where you will create the authorization. Manage and organize the queue and prioritize by date and urgency. Verify insurance eligibility, reach out to health plan to obtain the prior authorization guidelines. Lots of phone
Posted 1 day ago
Create a positive experience and relationship with the member Help member set goals and develop a care plan to achieve those goals Proactively engage the member to manage their own health and healthcare Support the member to improve their wellbeing by staying out of the hospital, and attend regular visits to their primary physician As needed, help the member engage with mental health and substance
Posted 1 day ago
Partners with the State Government business in OptumInsight to develop a proactive learning agenda and research plan that spans product, marketing, sales and client management Maintains a pulse on industry dynamics and emerging customer needs, acting as a thought leader and subject matter expert on the State Government market Partners with the business and contributes to ongoing monitoring of comp
Posted 1 day ago
Conducts hospital rounds on all patients referred to the service Provides patient care in a manner consistent with hospital medical staff by laws, and referring physician requests Communicates with families, referring physicians, specialists, administration, and hospital departments in the care and treatment of patients referred to the service Works with hospital and Monarch clinical staff to init
Posted 1 day ago
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