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The Sales Operations Coordinator serves as the primary contact for assigned field sales teams, providing support with onboarding agents, ensuring system access, and resolving issues. They monitor sales goal attainment through reporting and communication between internal teams and external partners, while maintaining relationships with external vendors and providing first-level support for sales systems.
The Provider Engagement Account Manager will maintain partnerships with health plan and provider networks, serve as the primary contact for providers, triage issues, handle claims, educate providers about policies, manage network performance, and drive improvements in care quality and cost. The role requires local travel and involves project management within a medical setting.
The Case Manager evaluates and coordinates care for members with significant mental and behavioral health needs. They assess member needs, develop care plans, educate members and families about available services, and facilitate access to community resources. Frequent home visits are required to assess member condition and facilitate education on treatment options and benefits. The role also includes providing feedback for improving service delivery and compliance with guidelines.
The Manager of Accreditation ensures compliance with NCQA and CMS standards, oversees accreditation preparation for health plans, conducts readiness assessments, manages policy reviews, and develops training initiatives to maintain accreditation standards.
Responsible for managing and maintaining provider account relationships and service responsibilities, overseeing contract implementations, and providing training on products and services to clients. Also involved in coordinating product enhancements, resolving account issues, and delivering strategic business insights to management and clients.
The position involves managing daily operations of provider data management, including overseeing data entry, analysis, and issue resolution, ensuring data quality, leading team workflows, and facilitating meetings with health plan representatives. The role also includes training and mentoring other team members.
The Provider Network Specialist I serves as a liaison between healthcare providers and the health plan, facilitating communication and resolving issues. Responsibilities include conducting training, investigating claims, documenting provider interactions, and educating providers on policies and procedures.
Identify, negotiate, and manage high performing provider and vendor partnerships. Lead financial analyses and operational reporting for vendor and provider agreements. Develop and initiate corrective action plans for partnerships. Collaborate with internal teams and lead meetings to review agreement performance data and strategy.
The role involves coordinating and monitoring quality improvement initiatives, ensuring compliance with NCQA and URAC standards, supporting project execution, and collecting data for quality projects. Candidates should have experience in clinical settings and quality functions.
The Authorization Specialist I assists with prior authorization requests, ensuring accurate documentation and compliance with policies while working with the utilization management team to track authorizations and referrals.
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