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The Consumer Engagement Representative 1 is responsible for enrollment, education, engagement, and activation for client groups. This role involves basic administrative tasks, supporting member experiences, understanding benefit offerings, and providing guidance on resource utilization. The representative works under supervision and adheres to quality standards to ensure successful enrollment and member education.
As a Case Manager, you will provide social service care management for frail elders and adults with disabilities. Responsibilities include assessing members, collaborating with health professionals, coordinating care plans, and promoting wellness. This role involves significant travel and engaging with members in their communities.
As a Case Manager, you will provide comprehensive social service care management for frail elders and adults with disabilities, coordinate care plans, and support members in achieving their goals. Responsibilities include performing assessments, tracking visits, and educating members on wellness and prevention.
The Quality Improvement Coordinator assists in monitoring quality improvement and compliance processes for the Ohio Medicaid program, managing documentation and reporting in SharePoint and Teams, and coordinating inter-departmental meetings. They prioritize requests and track team commitments while performing outreach calls as needed.
The UM Administration Coordinator assists in the administration of utilization management, performing a variety of administrative tasks such as making calls to providers, managing queues, and documenting clinical information. They collaborate with team members and ensure compliance with policies in a high-velocity environment.
The Principal, Capture Management will lead the development and execution of strategies to capture growth opportunities for Humana’s Medicaid products. Responsibilities include market research, coordinating operational teams, and designing operating models for new markets. This role requires a strong focus on Medicaid managed care operations and cross-functional leadership.
The UM Compliance Analyst conducts compliance audits, analyzes and trends data, manages departmental updates, and ensures adherence to CMS and regulatory requirements. They liaise between compliance and health services, conduct quality assurance audits, and participate in compliance meetings. The role requires strong analytical skills and attention to detail in compliance management and operational processes.
The Senior STARS Improvement Consultant will manage large-scale Pharmacy initiatives, coordinate with physician groups, analyze data for performance gaps, and develop presentations for strategy execution. Responsibilities also include fostering collaborations within teams and promoting the organization's quality performance metrics.
The STARS Improvement Analyst develops and implements Medicare/Medicaid Stars programs, focusing on quality improvement initiatives. Responsibilities include data analysis, report creation, and communication of program results, while collaborating with various departments to identify gaps in care.
As a Senior TBM Analyst, you will develop and maintain the TBM cost and data model in Apptio, collaborate with cross-functional teams, analyze financial and technology data, and drive cost accountability within the organization. The role involves providing insights into IT cost and identifying process improvement opportunities while ensuring data governance.
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