Transition of Care Specialist I HMSA

This position is responsible for development and implementation of transitional care support for members in inpatient or residential settings stratified as low complexity care management needs in Medicaid, Medicare, and Whole Health markets. Supports members enrolled in Care Management while in a higher level of care facility, along with facilitating member...

This position is responsible for development and implementation of transitional care support for members in inpatient or residential settings stratified as low complexity care management needs in Medicaid, Medicare, and Whole Health markets.Supports members enrolled in Care Management while in a higher level of care facility, along with facilitating member...

This position is responsible for development and implementation of transitional care support for members in inpatient or residential settings stratified as low complexity care management needs in Medicaid, Medicare, and Whole Health markets.Supports members enrolled in Care Management while in a higher level of care facility, along with facilitating member...

CUSTOMER EXPERIENCE Provide all customers with an exceptional customer-focused and positive HMSA Center experience. Ensure that the experience meets the customer's needs and exceeds their expectations. Communicate and promote HMSA's brand message and commitment to service excellence. Build enduring relationships with HMSA's customers/members and other...

CUSTOMER EXPERIENCE Provide all customers with an exceptional customer-focused and positive HMSA Center experience. Ensure that the experience meets the customer's needs and exceeds their expectations. Communicate and promote HMSA's brand message and commitment to service excellence. Build enduring relationships with HMSA's customers/members and other...

Collect, analyze, and utilize data and feedback related to Claims to identify opportunities to improve the relationship between the business and the other entity. This will include direct communication and participation with the Vendor Management Office (VMO) and Transformation Management Office (TMO). Compile reports about incidents, events, and updates...

Coordinate and deliver training programs using an appropriate mode (in-person or virtual) to provide understanding of department technology and workflows, relevant laws, and HMSA plans and benefits. Manage logistics of training including planning, scheduling, and preparation of necessary tools and materials. Assist the department with daily business...

Coordinate and deliver training programs using an appropriate mode (in-person or virtual) to provide understanding of department technology and workflows, relevant laws, and HMSA plans and benefits. Manage logistics of training including planning, scheduling, and preparation of necessary tools and materials. Assist the department with daily business...

Strategic planning and project management. Collaborate with cross-functional teams to develop comprehensive marketing plans and multiplatform campaigns to engage target audiences. Contribute to the development and implementation of various marketing plans, best practices, and guidelines. Contribute to strategic marketing plans to promote HMSA's brand....

Under the general guidance of the Audit Manager: Perform audit support functions related to risk-based, operational, compliance, financial, and information technology audits, and consulting projects for HMSA. Assist in the execution of audit programs and consulting projects, report findings and recommendations, and perform follow-up activities to ensure...

Engagement, Assessment and Planning Engages members with the Event Driven Care program (outreach and successful enrollment) in facilities and other settings using system generated alert, census data or other sources which identify that patient have been admitted in the hospital, or registered in the Emergency Department, and their relative risks for...

Serve as Provider Operations subject matter expert on major department and corporate initiatives, projects, process improvement or any other major activity as assigned by management independently. Independently be able to ensure Provider Operations' needs are addressed; must be able to clearly articulate business needs so that the department is not...

Independently performs quality functions within the Quality Department of a Care Center or office. Coordinates projects resulting in continuous quality improvement and process improvement. Supports the maintenance of a strong quality program, measured processes and reported outcomes.Coordinates assigned quality and process improvement activities which may...

Resolve enrollment, eligibility and billing issues and inquiries timely and accurately from members, employer groups and third party administrators by phone, email and written correspondence by: Researching and collaborating with other units or departments to find a solution Accurately updating member records Contacting external partners who provide...

Monitor, track and analyze legislation introduced at the state levelGenerate weekly Executive Summary Report of key legislation. Develop and distribute weekly updates to HMSA executive staff throughout the legislative session. Monitor legislative hearings and meetings as needed. Conduct legislative research and compile summary reports on state and national...

Resolve enrollment, eligibility and billing issues and inquiries timely and accurately from members, employer groups and third party administrators by phone, email and written correspondence by:Researching and collaborating with other units or departments to find a solutionAccurately updating member recordsContacting external partners who provide services...

a. Project management and facilitation Develops and maintains project plans, timelines, and scope documents for strategy initiatives. Proactively manages deliverables, timelines, and budget: Monitors and takes appropriate action to ensure various task and system-related deliverables are accomplished in an accurate and timely manner. Develops strategies and...

a. Helps to lead and contributes to strategic design, implementation, and management of strategy roadmaps, strategic frameworks, and initiatives. Works with key stakeholders to strategically design and implement strategy initiatives with guidance from executive sponsors, subject matter experts, and other staff as needed Utilizes systems-thinking to ensure...

Find out if this opportunity is a good fit by reading all of the information that follows below.aProject management and facilitation Develops and maintains project plans, timelines, and scope documents for strategy initiatives.Proactively manages deliverables, timelines, and budget:Monitors and takes appropriate action to ensure various task and...

Facilitates department workflow by supporting clinical team with administrative care coordination support. Locates community services and other referral locations for enrollees, arranges access to care, supports communication with hospitals, and providers. Provides non-clinical support to workflows involving utilization management, case management, disease...