Scan Health Plan
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Facilitates the member grievance and appeal process by investigating, documenting and preparing case files to meet all regulatory requirements.
Effectively interface with provider partners and vendors to monitor, implement and perform HCC Risk Adjustment Data Validation coding and projects.
Accurately explains benefits and plan options in person, via email or telephonically. Educates members, family, providers and caregivers regarding benefits and
Pharmacy benefit manager and/or health plan managed care Part D: 2 years (Preferred). 2+ years of prior managed care experience with Part D at a pharmacy
Assess potential business continuity disruption events reported to the plan and work with supervisor to determine the actions required by the plan.
Provides departmental support by implementing administrative systems, procedures, and policies, and monitoring administrative projects.
Identifies and assists in pursuit of business development opportunities emanating from public agency efforts to address government sponsored health programs
Experience in Medicare managed care health plan, particularly working with IKA or other healthcare systems is preferred. 1 year of clerical experience.
5+ years experience in managed health care, required. Oversee the plans process for tracking new regulatory, and identifying the implications for the plan so
Mails care plans to members and physicians. Completes timely and accurate documentation in multiple computer systems to complete assessment and corresponding
Managed care experience in health plan, PBM, or medical group preferred. Review and create care plans to improve client medication management.
Serves as a resource for internal and external customers by ensuring services are provided within the benefit plan and utilizing contracted providers; works to
Provide clinical support for the review of preservice and post service appeals. Facilitate appropriate investigation of issues and management of medical
Provide positive enrollment and new business opportunities. Develop community relationships that support growth objectives. Generous paid-time-off (PTO).
Maintain strong working knowledge of health plan products benefit structures, and related Federal and/or State related statutes. Generous paid-time-off (PTO).