Duties:• As a licensed health care professional employed in the Pharmacy Prior Authorization Department your primary responsibility is to make determinations on prior authorization and coverage requests for pharmaceutical products.• Determinations include medical necessity and benefit deci...
Location: Pennsylvania, USA
Duties: • Under the direct supervision of the Supervisor, Pharmacy Services Call Center, the Pharmacy Call Center Technician is responsible for providing knowledgeable and courteous customer assistance and response to members, providers and Pharmacy Call Center Technician inquiries.  Princ...
Location: Pennsylvania, USA
Duties:• Reporting to the Director of National Health Plan Communications, the health plan communications specialist will execute on certain components of the health plans’ communication strategies, including research and development of written materials, and will provide operational supp...
Location: Pennsylvania, USA
Care Manager II Mar-15-2019
The primary purpose of the job is to:• Under the Supervision of the Manager of Care Management, the Care Manager is responsible for the overall accountability for the identification of members appropriate for care management services.  • Completes a comprehensive Initial Assessment an...
Location: Pennsylvania, USA
The primary purpose of the job is to: • Facilitate the automation and timely completion of user provisioning processes and procedures, both from a technical and non-technical perspective. • This role is responsible for: management, oversight and support of the automated process of the crea...
Location: Pennsylvania, USA
Duties: • The primary purpose of the job is to:  Responsible for addressing provider issues and maintaining the provider tracking databases.  • In addition, the Network Coordinator supports the Network Management Department by assisting with root cause analysis and/or the develop...
Location: Pennsylvania, USA
Care Manager II Feb-20-2019
Duties: • Under the Supervision of the Manager of Care Management, the Care Manager is responsible for the overall accountability for the identification of members appropriate for care management services.  • Completes a comprehensive Initial Assessment and gathers pertinent informati...
Location: District of Columbia, USA
Duties:• Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. • Using clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely with member...
Location: Pennsylvania, USA
Duties:    • The primary purpose of the job is to: • Under the supervision of the Community Outreach Services Team Supervisor, the Community Outreach Services Representative interfaces with members in person, on the phone and through correspondence as appropriate to communic...
Location: District of Columbia, USA
Project Analyst Oct-11-2018
Duties:    The primary purpose of the job is to: • To support major existing client projects and new business implementations through coordinating and completing detailed documentation ensuring timely, accurate, and efficient requirements and deliverables for on-time execution. S...
Location: Pennsylvania, USA