Leads and coordinates technology initiatives across multiple disciplines, business functions, and vendors to ensure project goals are met within scope and budget. Contributes to the improvement of IT processes and supports the adoption of new technology and practices.
The role involves identifying, researching, and resolving customer inquiries regarding health insurance benefits and medical necessity. The reviewer must maintain accurate records and ensure compliance with state, federal, and organizational standards.
The Product Owner will collaborate with business and IT partners to develop strategic technology plans and manage the product backlog. They are responsible for prioritizing user stories, facilitating Scrum ceremonies, and ensuring business requirements are met throughout the development lifecycle.
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.
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.
