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Responsible for providing oversight and leadership of integrated behavioral health benefit, including UM program, network development and care management Be available to meet at the State's requested location within 24 hours' notice from the State Lead and direct matrix teams, coordinate day to day operations to achieve goals and ensure contract compliance of all functional areas supporting behavi
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Assist in opening and closing the clinic, locking and unlocking the doors, and maintaining a clean waiting area Welcome all On Site Clinic patients and visitors by greeting them with a friendly demeanor, answering inquiries and directing them through the registration process. Answer multi phone lines, filing, faxing, scanning documentation and completing daily patient callbacks Collect all insuran
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Create a positive experience and relationship with the member Help member set goals and develop a care plan to achieve those goals Proactively engage the member to manage their own health and healthcare Support the member to improve their wellbeing by staying out of the hospital, and attend regular visits to their primary physician As needed, help the member engage with mental health and substance
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Work is computer based and may include receiving phone calls from prior authorization pharmacy technicians and/or providers where clinical information is involved May include consulting physicians / providers with questions and interpretations of clinical guideline criteria and coverage determinations that have been rendered May include participating in quality improvement and process enhancement
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Answer and resolve inbound technical calls at a large corporate Help Desk, efficiently and professionally, in a fast paced call center environment Troubleshoot corporate applications with the use of a Knowledge Base and assign issues to the appropriate support group as needed Applications Support related to Security Account Management (e.g. password reset and unlock AD accounts) Entry level suppor
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Responsible for preparing, processing and maintaining new member or group enrollments May load new member or group data into the enrollment database and update the database with changes May also respond to member eligibility or group questions and verify enrollment status Work with various types of member correspondence May also be responsible for reconciling eligibility discrepancies, analyzing t
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Conduct in home assessments on health plan members, including past medical history, review of symptoms, physical examination, medication review and depression screening Responsible for checking vitals, conducting a physical exam that includes monofilament test, urine dipstick and foot exam (as appropriate) Identify diagnoses to be used in care management and active medical management in the furthe
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Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Communicate with all stakehol
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Serve as a steward and leader of clinical quality and patient safety for SMS Possess excellent written and oral communication skills, ability to motivate teams Knowledge of accreditation standards, survey methodology and related tools and resources for regulatory and accreditation compliance and survey readiness. Strong organizational and leadership skills including conflict resolution Ability to
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Provide peer to peer utilization reviews and consultations to Alaska Medicaid behavioral health providers, up to and including doctoral level clinical psychologists. Conduct retrospective service authorization reviews for providers/agencies that request them Clinical consultation with Optum Alaska care management staff in order to Recommend clinical or rehabilitation treatment options for Medicaid
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Complete provider orders per state and provider regulations Perform clinical intake with patients to include taking and recording vital signs and patient history Assist patients as needed with walking, transfer, specimen collection, exam preparation, etc. Complete occupational health testing including such services as urine drug screens, breath alcohol testing, hair testing and physicals Complete
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Enter data quickly and accurately in multiple systems Provide exemplary customer service to all patients and caregivers Adjudicate patient claims Communicates with doctor offices, pharmacies, and our customers to ensure superior customer service Meet metrics daily based on team and business needs Maintain updated customer records with strong attention to detail and compliance with HIPAA standards
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Provide exceptional customer service to all patients and members of the clinic staff Under direct supervision of the registered pharmacist, fills prescription orders and makes them available for verification by the Pharmacist. Once verified by the pharmacist, dispenses the prescriptions. Order, receive and store incoming pharmacy supplies. Receive and process wholesaler medication orders. Verify m
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Travel up to 100% Conduct in home assessments on health plan members Identify diagnoses to be used in care management and active medical management Formulate a list of current and past medical conditions using clinical knowledge, judgment and current findings Communicate gaps in care to member's PCP Identify referral needs Identify urgent and emergent situations for proper intervention Educ
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Patient engagement and retention in specific Disease Management Programs Diabetes, Hypertension, CAD, Heart Failure, Asthma , COPD and Depression Utilizes established standards of care to identify and address members' gaps in care Utilizing motivational interviewing techniques for assisting members to move through the stages of behavioral change Working with members to set and achieve SMART goals
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