Receive referrals or requests to provide support for members' health or psychosocial needs Validate appropriateness of referral or follow relevant guidelines (e.g. protocols, procedures, job aids) to provide initial response to referral Review specific diagnosis and member case files to understand reason for referral and identify critical data or information Leverage unde

Develop and implement effective/strategic business solutions through research and analysis of data and business processes Support short and long term operational/strategic business activities through analysis Develop the prioritization and refinement of product requirements and translation of specifications from the clinical and operations team in partnership with all ven

improving the quality, cost and experience of health care. Here, we focus on delivering the best patient care, rather than volume. Through innovation and superior care management, we support patients and your well being as a team member. Join a team at the forefront of value based care and discover the meaning behind Caring. Connecting. Growing together. Hours Full Time,

Conduct comprehensive assessments Manage members through an acute medical situation or an exacerbation of a chronic condition, including testing, diagnostics, interventions Manage members during a short term sub acute rehabilitation episode Ensure accurate and complete documentation, including ICD 10 conditions Communicate and collaborate with the interdisciplinary care t

Oversee and be responsible for behavior support services provided to individuals receiving LTSS (long term services and supports) and comparable populations Responsible for working with the BH CMO to oversee the ongoing management of behavior crisis prevention, intervention, and stabilization services Responsible for working with the other medical officers and the Pharmac

Performs all duties within the scope of a LVN (procedures, injections, diagnostic testing, phlebotomy) Coordinates healthcare screening results as directed by providers, company standards, and policies Broad knowledge of information required to complete health screenings required Travels with the mobile team to clinics and centralized locations to conduct screening clinic

Here at Optum, part of the largest network of medical groups in the nation, we are seeking a dedicated and patient centric Non Invasive Cardiology Physician to join our growing team the greater Jersey City, NJ care region (i.e., previously a Riverside Medical Group practice). Optum, part of United Health Group, is a Fortune 5, value based care delivery network of organiza

Obtain accurate and updated patient information, such as name, address, insurance information Perform insurance verification on the date of service Obtain patient signatures for required documents Upload a valid Government issued state ID of patient and patient insurance cards File and maintain medical records Consistently correct registration work queue errors Confirms a

Primarily answering prior authorization with inbound calls (up to 50 to 70 calls per day) from providers/members as well as research and resolve formulary and benefit issues using the appropriate reference material Process authorizations through various computer systems and use of job aid/policies/procedures ensuring the accuracy of all data and updating as necessary Have

Primarily answering prior authorization with inbound calls (up to 50 to 70 calls per day) from providers/members as well as research and resolve formulary and benefit issues using the appropriate reference material Process authorizations through various computer systems and use of job aid/policies/procedures ensuring the accuracy of all data and updating as necessary Have

Examine patients and their medical records Order and study diagnostic tests (blood tests, X rays etc.) Diagnose health conditions and illnesses Propose treatments for chronic and infectious diseases Prescribe medications Maintain accurate records and schedules Inform patients about their health conditions and prescribed medications Educate patients and their family member

Screen and assess patients for common mental health and substance abuse disorders Provide treatment for a variety of mental health conditions using treatment approaches including cognitive behavioral therapy, dialectical behavioral therapy, and other evidence based methods Systematically track treatment response and monitor patients for changes in clinical symptoms and tr

Screen and assess patients for common mental health and substance abuse disorders Provide treatment for a variety of mental health conditions using treatment approaches including cognitive behavioral therapy, dialectical behavioral therapy, and other evidence based methods Systematically track treatment response and monitor patients for changes in clinical symptoms and tr

Obtains patient histories and vital signs and records accurately in the electronic medical record Prepares patients for examination and treatment and documents chief complaints Retrieves laboratory and radiology test results and instructs patients regarding medications and treatment per clinician's instructions Stocks supplies and prepares exam rooms and instruments for e

Market Monitoring Build out and develop analytics monitoring (and ideally forecasting) competitor pricing strategies across both traditional competition and market disruptors Monitor and forecast trends of drug acquisition costs over time Monitor and forecast trends of brand drug costs over time Assess, evaluate and predict the impact of market events (new drugs to market