The Integrated Care Manager is responsible for assessing, planning, and coordinating care options to ensure continuity and quality outcomes for members. This role involves handling health insurance-related inquiries, reviewing medical records for necessity, and collaborating with providers and families.
The position involves updating and maintaining accounting records while reconciling financial accounts and preparing reports. The role also requires corresponding with customers via telephone, in writing, or in person to resolve inquiries.
The role involves building partnerships with individuals and families to promote recovery and wellness while identifying barriers to service delivery. The liaison will also collaborate with providers and stakeholders to ensure compliance with policy requirements and advocate for person-centered care environments.
The Initial Clinical Reviewer is responsible for identifying, researching, and resolving customer inquiries while applying medical necessity criteria to benefit requests. They must maintain accurate records and coordinate with internal and external stakeholders to ensure compliance with health insurance standards.
Develop strategic plans for technologies impacting claim payment operations and manage the product backlog and prioritization of user stories. Act as the voice of the business to the IT team, ensuring traceability between requirements and final delivery.
Direct and provide professional oversight for medical management activities including utilization, case, disease, and quality management. Collaborate with physicians and hospitals to ensure medical policies align with community standards of good medical practice.
Design, create, and maintain sustainable reporting solutions and analytical insights to drive data-driven decision making for the Medicaid segment. Partner with business leaders to provide high-quality reporting on financial and clinical outcomes, network performance, and claims processing.
