Peach State Health Plan

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Monitors and evaluates effectiveness of care plan and modifies plan as needed. Assesses, plans, implements, monitors and evaluates options and services to meet

Facilitate EPSDT related reviews and follow up that are initiated by the state. Ensure compliance of EPSDT with all state and federal requirements and NCQA

Data enter assessments and complete member centric care plans. Assist members with accessing needed services, recognize potentially serious problems to prevent

Assist Provider Relations and various departments with educating providers on the health plans pharmacy process. Medicare and/or Medicaid experience preferred.

Development of launch plan and subsequent launch plan variables. Develop and roll out work plan and timelines for program.

Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required. Licenses/Certifications: Current states RN or LPN

Associates degree in health care or a related field preferred. Update delegated provider Medicare and Medicaid documents on a monthly and ad hoc basis and

Coordinate behavioral health treatment, and discharge plans, with Primary Care Professionals (PCPs) and behavioral health providers using a script of structured

Ensure operational processes and policies are compliant with corporate standards and applicable local, state, and federal regulations.

Provide education on health plans innovative contracting strategies. Position Purpose: Perform duties to act as a liaison between providers, the health plan

Serve as primary contact for providers serving as a liaison between the provider and the health plan. Position Purpose: Perform duties to act as a liaison

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time

Coordinate provider data between the health plan database and various external vendors and internal business systems. High school diploma or equivalent.

Coordinate and implement community events such as baby showers, health fairs, and other health education events.