Practices in accordance with the respective state laws and regulations governing the practice of advanced practice nursing or physician assistants Establishes and maintains effective relationships with patients, care givers, and/or their legal representatives, IDT members, PCPs, other collaborating physicians/providers, and facility staff when applicable Performs an initi

Primarily answering prior authorization with inbound calls (up to 50 to 70 calls per day) from providers/members as well as research and resolve formulary and benefit issues using the appropriate reference material Process authorizations through various computer systems and use of job aid/policies/procedures ensuring the accuracy of all data and updating as necessary Have

Strategy development for direct network contracting and quality incentive program policy across the Mid Atlantic region Creating relationships, developing proposals, and driving contract execution across the region Maintaining key hospital, ancillary providers, independent practice associations (IPA's), and large physician groups relationships Leading and managing day to

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For

Provide exceptional customer service to all consumers and members of the clinic staff Fills prescription orders and makes them available for verification under direct supervision of the registered pharmacist Orders, receives and stores incoming pharmacy supplies Receives and processes wholesaler medication orders Verifies medication stock and enters data in computer to ma

Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards and other key process controls Influence and/or provide input to forecasting and planning activities This role is all a

Distributes drugs prescribed by physicians and other health practitioners Provides information to customers about medications and their use Focuses on providing a superior level of customer service Ensures compliance with all relevant laws of the applicable State Board of Pharmacy Administration of immunizations as allowed by State Boards of Pharmacy Any other usual and c

Ensuring the security of PHI while working thru the mail and support processes Maintaining appropriate system access needed to perform daily job functions Printing documentation such as claims, appeals, medical records, itemized bills, EOBs, and any necessary supporting documenting communicated by the operational team Ensuring accuracy and timeliness of outgoing mail, cla

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For

Conduct comprehensive, in home assessments Manage members through an acute medical situation or an exacerbation of a chronic condition, including testing, diagnostics, interventions Manage members during a short term sub acute rehabilitation episode Ensure accurate and complete documentation, including ICD 10 conditions Communicate and collaborate with the interdisciplina

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For