The Utilization Review Nurse assesses the medical necessity and quality of healthcare services through pre-service, concurrent, and retrospective reviews. They provide clinical support to the department and Medical Director to ensure compliance with regulatory guidelines.
The Member Advocate will welcome new members, conduct monthly visits, and maintain relationships with network providers and nursing home staff. They are responsible for documenting all activities, ensuring CMS compliance, and coordinating care needs within their assigned region.
The Provider Relations Representative is responsible for contracting and credentialing providers to ensure network adequacy for Medicare Advantage plans. They also educate providers on plan functions and maintain ongoing relationships to support network coverage and patient care goals.
The Provider Relations Representative is responsible for contracting providers, managing network relationships, and educating providers on health plan functions. They also monitor market changes and support internal service areas to ensure CMS network adequacy.
The Member Advocate supports local service areas by welcoming new members, conducting monthly visits, and maintaining relationships with network providers and nursing home staff. They are responsible for documenting activities, ensuring CMS compliance, and coordinating with the TruHealth team to meet member needs.
The Member Advocate will welcome new members, conduct monthly visits or contacts, and maintain relationships with network providers and nursing home staff. They are responsible for documenting all activities, ensuring CMS compliance, and addressing member dissatisfaction.
The Provider Relations Representative is responsible for contracting and credentialing providers to ensure network adequacy for Medicare Advantage plans. They also educate providers on health plan functions and monitor relationships to maintain coverage and compliance with CMS standards.
The Nurse Practitioner will assess medical and mental health needs of long-term care residents to develop and monitor proactive care plans. They will collaborate with an integrated care team, prescribe medications, and ensure compliance with federal and state clinical regulations.
