Care Worker UM, HMSA

Utilize project management techniques to coordinate focused medical review projects as assigned. Conduct analysis to understand utilization trends. Document and present relative data and recommendations to management and/or oversight committees. Collaborate to implement strategies to improve quality outcomes and control healthcare cost trend in alignment...

Utilize project management techniques to coordinate focused medical review projects as assigned. Conduct analysis to understand utilization trends. Document and present relative data and recommendations to management and/or oversight committees. Collaborate to implement strategies to improve quality outcomes and control healthcare cost trend in alignment...

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...

Job Summary: Hybrid Work Environment - Must reside on Oahu To provide care coordination for eligible HMSA members and facilitate a collaborative relationship among members, providers, community agencies and HMSA staff to ensure members receive timely and integrated access to services. Case Managers/Health Coordinators with Implementing the health action...

Quality Improvement LeadershipLead and oversee HMSA's comprehensive Quality Improvement initiatives, ensuring alignment with accreditation, regulatory, and program standards (e.g., NCQA, Med-QUEST, CMS, OPM, etc.). Direct project teams and provide expert guidance throughout the phases of planning, development, execution, and assessment to guarantee that...

Job Description**Job Title:** Quality Improvement Director**Job Summary:** We are seeking a highly skilled Quality Improvement Director to lead our Quality Improvement program and ensure compliance with accreditation, regulatory, and program requirements.Key Responsibilities:Program Management: Provide direction and manage HMSA's overarching Quality...

Standard Notification Manage activities related to communication and notification efforts. Coordinate and facilitate deliverables and timelines to ensure notifications are sent within required timelines. Project Implementation Serve as the subject matter expert for Pharmacy Management with regards to communications or notifications. Collaborate with...

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...

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...

Conduct timely face to face assessments and develop, document, and implement targeted health action plans/care plans based on the results of the assessment for members requiring assistance with care coordination. Coordinate a multi-disciplinary team to develop a person- centered care plan to include but not limited to member's PCP, other service providers as...

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...

Job Description**Job Title:** Quality Improvement Director**Job Summary:** We are seeking a highly skilled Quality Improvement Director to lead our Quality Improvement program, ensuring compliance with accreditation, regulatory, and program requirements. The successful candidate will oversee project teams, provide guidance to subject matter experts, and...

Position OverviewThe role of the Care Worker UM at Magellan Health Services is pivotal in enhancing departmental efficiency by providing essential administrative support to the clinical team. This position is responsible for:Identifying and connecting enrollees with community resources and referral services, ensuring seamless access to care.Facilitating...

Responsible for all aspects of the quality program for a business unit within a Strategic Business Unit (SBU) including strategic planning, program development and leadership, and staffing. Serves as a member of the management team in designing, implementing, and monitoring quality operations with well defined processes and uses performance measurement as...

Job SummaryAs a Senior Financial Healthcare Data Analyst III at HMSA, you will lead provider negotiations and projects that include the Clinical Integration Division, Health Management Operations, Finance Division, and Executive Leadership. Your comprehensive statistical analysis will support corporate strategies and initiatives for all Lines of Business.Key...

Job Summary Works independently to lead provider negotiations and projects that include the Clinical Integration Division, Health Management Operations, Finance Division, and Executive Leadership and management. Provide comprehensive statistical analysis from multiple sources that support corporate strategies and initiatives for all Lines of Business. ...

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 role is onsite. Ideal candidate will need to reside in Hawaii.Customer advocate role supporting our members and providers, facilitating care and service. This is a service position providing assistance to Magellan's members, providers, and clients regarding various aspects of our programs, policies, and procedures. Responsibilities include handling...

Job Summary: Hybrid Work Environment - Must reside on Oahu To provide care coordination for eligible HMSA members and facilitate a collaborative relationship among members, providers, community agencies and HMSA staff to ensure members receive timely and integrated access to services. Case Managers/Health Coordinators with Implementing the health action...