Customer retention, based on established annual goals Strategic planning for multi year initiatives to identify opportunities to better manage healthcare trends Responsible for communicating and managing escalated issues and problem resolution as appropriate Maintains appropriate documentation including action plans, meeting notes, Strategic Customer Business Plans, Sales

Review, validate and maintain financial and other records as they relate to client specific programs for Taft Hartley Fund Responsible for timely reconciliation of all accounts Process payments and retrieve required statements from websites Communicate financial discrepancies and resolve Responsible for all financial exchanges related to participant accounts Identify erro

Maintain general ledger accounts and related activities for the production of financial statements and reports for Taft Hartley Trust Funds Create, document, review and approve journal entries Analyze investment statement activity and reconcile for journal entries Process payments and retrieve required statements from websites Reconcile, analyze, and review general ledger

Acts as resource to members calling into a customer service setting addressing medical/health questions Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow up with the member Provide process and status on previously submitted prior authorizations or pre determination requests Effectively refers and enrolls memb

Work closely with cross functional teams and leadership to build consensus and successfully lead and support strategic planning and delivery for a variety of enterprise strategic initiatives, programs and events Collaborate with internal stakeholders, including C suite executives and matrixed business partners, to understand program and event requirements and goals in ord

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least 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

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 Co

Provide a complete continuum of quality care through close communication with members via in person or on phone interaction Support members with condition education, medication reviews, and connections to resources such as Provider Services, Private Duty Nursing, DME, and supplies Assist members with the transition from a care facility back to their home This role involve

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least 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 Co

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least 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 Co

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least 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 Co

Utilize the Preferred One medical criteria and those of other regulatory bodies, (i.e. NCQA, DOH), the exempt and focused review programs, and the patient's benefit plan summary to perform medical necessity, level of service and appropriateness review Perform inpatient and outpatient pre admission, concurrent review and decision support based on medical necessity, appropr

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least 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 Co

Provide advocacy and system navigation of behavioral health services and social services and supports Build partnerships with individuals, families, youth, and key stakeholders to promote recovery, resiliency, and wellness Oversee the provision of, and ensure the availability of, Peer Support services by having access to reports to monitor, track, and trend these services

Perform telephonic customer outreach to improve health quality outcomes in collaboration with clinical pharmacists Provide additional telephonic engagement with providers and pharmacies Assess and interpret customer needs and requirements, triaging to a clinical pharmacist when appropriate Outbound calls to CAHPs detractors and MedAdhmembers to improve member experience a