Create an overall vision for the health plan team to ensure they can navigate a rapidly changing industry and leverage innovation to capture opportunities for growth and/or improvement Develop and execute market specific strategies to drive sustainable and profitable growth while setting the strategic direction to drive business growth Drive industry leading customer serv

Serves as the advocate for providers by demonstrating accountability and ownership to resolve issues Service Providers in a multi channel environment including call, concurrent chat, as required. Quickly and appropriately triage contacts from healthcare professionals (i.e. physician offices, clinics, billing offices) Seek to understand and identify the needs of the provid

Manage facility based admissions for mental health and substance abuse through the continuum of care Effectively collaborate with treating providers and facilities to ensure consumers are receiving treatment in line with best practice and level of care guidelines Effectively communicate with consumers about their benefit coverage and provide appropriate resources and refe

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact

Understand and follow standardized processes for managing add or change requests, and implementing requests in the letter generation system Collaborate with our business partners, Letter Owners, and other Letter Maintenance Administrators (LMA's) regarding letter template design and development Develop new templates and / or change templates for approved letter requests L

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Co

Lead and oversee the end to end integration process of acquired entities into our corporate services framework, ensuring alignment with organizational goals and objectives Develop and implement comprehensive integration strategies, leveraging cross functional collaboration and stakeholder engagement to drive successful outcomes Develop procurement expertise to establish c

Lead and oversee the end to end integration process of acquired entities into our corporate services framework, ensuring alignment with organizational goals and objectives Develop and implement comprehensive integration strategies, leveraging cross functional collaboration and stakeholder engagement to drive successful outcomes Develop real estate expertise to establish c

Develop and maintain the global Threat Management strategy and governance structure for the organization Lead the Threat Management program and team globally under the oversight of the VP, Risk Management Develop, refine and apply Threat Management standards, SOPs, job aids, methodologies and processes across the enterprise in line with industry best practices Lead the cr

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact

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Care Management allocation Care Management responsibilities 80% time allocation which includes case consultations with a case load of 45 50 Utilization of hotspotting tool and other internal resource tools that identify at risk AI members Community, relationship building, education 20% (Interventions and efforts to be logged and tracked, reviewed with Manager, including o