Evaluate medical requests and treatment plans to ensure they align with clinical guidelines and medical necessity standards. Collaborate with Medical Directors and healthcare providers to document recommendations and communicate review outcomes.
MVP Health Care
7 Remote Job Openings at MVP Health Care
Professional, Individual Product Advisor - Outreach
MVP Health Care
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Full Time
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4 days ago
MVP Health Care
The role involves serving as an Individual Product Advisor focusing on outreach to enhance health care delivery. The advisor will work to build healthier communities through personalized and accessible care interactions.
Clinical Coordinator Long Term Support Services
MVP Health Care
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Full Time
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7 days ago
MVP Health Care
The Clinical Coordinator acts as a bridge between customers, health plans, and community organizations to ensure access to Long-Term Support and Services. They collaborate with RN case managers to develop care plans, conduct SDOH assessments, and empower members to manage their own health and wellness.
Investigate and resolve accumulator-related issues for medical, pharmacy, and behavioral health claims using Facets and Macess systems. Partner with internal business units and external vendors to analyze data trends, document process improvements, and resolve member inquiries.
The role involves adjudicating health care claims using Facets and Macess systems while ensuring the accuracy of provider and member information. The examiner is responsible for resolving suspended claims and coordinating with other departments to maintain quality standards.
Conduct timely and accurate utilization reviews for sub-acute Medicare cases. Collaborate with providers and interdisciplinary teams to ensure optimal patient care and resource utilization.
Payment Integrity Analyst - Data Mining & Savings Reporting
MVP Health Care
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Full Time
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3 months ago
MVP Health Care
In this role, you will analyze healthcare claims data to identify improper payments and cost reduction opportunities. You will also collaborate with cross-functional partners to report savings generated by payment integrity activities.
