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Full Job Title Quality Improvement Project Manager Job Number 1800140 Location Louisville , KY Date Posted 1 6 2018 Supports the development and implementation of quality improvement interventions and audits and assists in resolving deficiencies that impact plan compliance to regulatory and accreditation standards. Drives key quality improvement projects requiring the ability to work e
Posted 11 days ago
WellCare Health Plans
- Louisville, KY / Owensboro, KY / Ashland, KY / 3 more...
If position is not primarily telephonic, will travel to inpatient bedside, member's home, provider's office, hospitals, etc as required with dependable car. May spend up to 70% of time traveling with exposure to inclement weather and normal road hazards. Support the lead database by providing feedback with strategies to improve the quality of referrals to ensure the appropriate members are outreac
Posted 27 days ago
Full Job Title Retention Specialist Job Number 1706010 Location Louisville , KY Date Posted 12 13 2017 Works with sales management and corporate offices to identify real time abrasion/disenrollment potentials. Identifies areas of process breakdown and potential disenrollment to help build provider and member retention strategies based on detailed data analysis on Claims, Customer/Provi
Posted 1 month ago
Facilitates and coordinates market review and state approval for all provider and member materials. Supports the design and implementation of databases to ensure key departmental processes are documented and tracked. Candidate Education High School or GED is required Bachelor's Degree in a related field is preferred Candidate Experience 3 years of experience in a regulatory affairs/ compliance env
Posted 1 month ago
Full Job Title Provider Relations Representative Job Number 1705939 Location Hazard , KY Date Posted 12 8 2017 Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area. Provides service and education to network physicians/providers. Achieves company targets through implementation of Network Improvement plans. REPO
Posted 1 month ago
Full Job Title Provider Relations Representative Job Number 1705938 Location Louisville , KY Date Posted 12 8 2017 Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area. Provides service and education to network physicians/providers. Achieves company targets through implementation of Network Improvement plans.
Posted 1 month ago
Full Job Title Behavioral Health Care Manager Job Number 1705611 Locations Louisville, KY Lexington, KY Date Posted 11 29 2017 Conducts comprehensive member psychosocial assessments through root cause analysis and performs clinical intervention through the development of a care management treatment plan specific to each member with high level acuity needs. Manages members with severe m
Posted 1 month ago
Full Job Title Executive Assistant Job Number 1705692 Location Louisville , KY Date Posted 11 30 2017 Provides administrative support to Senior Vice Presidents and his/her director reports. Performs a wide variety of complex administrative tasks requiring initiative, strong attention to detail and extensive working knowledge of the organization and programs. Work entails confidential
Posted 1 month ago
Responds to member, provider and other inquiries on site for walk in requests while meeting all corporate guidelines and performance standards. Records, investigates and resolves member complaints as detailed in the Grievance Procedure narrative. Supports field office member, provider and staff events, coordinates materials and invitations, and plans and orders food where necessary. Occasional wor
Posted 2 months ago
Full Job Title Operations Account Specialist Job Number 1704994 Location Bowling Green , KY Date Posted 11 22 2017 Coordinates and documents provider inquiries. Researches and assists Operations Account Representatives with resolution of claims inquiries for the Medicare and Medicaid lines of business regarding reimbursement issues, health plan payment methods, benefit coordination and
Posted 2 months ago
Full Job Title Appeals Coordinator Job Number 1705224 Location Louisville , KY Date Posted 11 17 2017 Processes appeals from receipt to resolution in a timely and accurate manner. Essential Functions REPORTS TO SUPERVISOR, APPEALS DEPARTMENT HEALTH SERVICES APPEALS & GRIEVANCES POSITION LOCATION LOUISVILLE, KY 40223 Logs, tracks, and processes health service appeals. Serves as a liaiso
Posted 2 months ago
Full Job Title Quality Practice Advisor Job Number 1705205 Location Hazard , KY Date Posted 11 7 2017 Establishes and fosters a healthy working relationship between large physician practices, IPAs and WellCare. Educates providers and supports provider practice sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures. Provides education for HEDIS measures,
Posted 2 months ago
Full Job Title Business Analyst, Sr Job Number 1705207 Location Louisville , KY Date Posted 11 7 2017 Leads in the development of complex adhoc reports to enable process and trend analysis. Provides recommendations on the implementation of new/revised operational and/or reporting processes. Conducts special projects requiring a high degree of confidentiality and expert knowledge of mul
Posted 2 months ago
Full Job Title Behavioral Health Care Manager Job Number 1704852 Location Louisville , KY Date Posted 10 30 2017 "PLEASE NOTE TRAVEL TO THE FOLLOWING COUNTIES AS NEEDED JEFFERSON, HENRY, OLDHAM, SHELBY, TRIMBLE, CARROLL, KENTON, GALLATIN AND GRANT" Conducts comprehensive member psychosocial assessments through root cause analysis and performs clinical intervention through the developme
Posted 3 months ago
Full Job Title BH Medical Director Job Number 1704524 Location Louisville , KY Date Posted 10 17 2017 The position is responsible for providing the clinical leadership for behavioral health in the assigned market. The position will help provide direction and management of behavioral health staff located in assigned markets which may include Behvaioral Health Concurrent Review, case man
Posted 3 months ago
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