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Manager, State Pharmacy Kentucky (1700382) Provides clinical pharmacy direction for the health plan including, but not limited to Disease Management, Pharmacy, Utilization and Quality Management. Provides drug utilization review and intervention while targeting high utilizing physicians and reviewing prescribing patterns including non preferred drugs and quality indicators. Makes recommendations o
Full Time
Posted 15 days ago
SIU Investigator, Sr (1701642) The Senior Investigator investigates cases of health care fraud and abuse within the Special Investigations Unit (SIU). He or she will assume responsibility for higher profile and more complex cases and will also be expected to serve as a resource to more junior SIU staff. Essential Functions Manages large caseloads and investigates allegations and complex issues per
Full Time / Bachelor's Degree Required
Posted 15 days ago
Field Service Coordinator RN (1701553) "PLEASE NOTE THIS IS WORK FROM HOME OPPORTUNITY" POSITION TO BE LOCATED IN ONE OF THE FOLLOWING COUNTIES BATH, ELLIOTT, MENIFEE, MORGAN, ROWAN OR FLEMING WITH REPORTING RELATIONSHIPS TO THE ASHLAND, KY OFFICE" Works with Care Coordination MVP Team members to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the healt
Full Time / Bachelor's Degree Required
Posted 17 days ago
Provider Relations Representative (1701674) "PLEASE NOTE THIS POSITION TO BE LOCATED IN KNOTT, JOHNSON OR FLOYD COUNTY WITH REPORTING RELATIONSHIP TO THE HAZARD, KY OFFICE" 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
Full Time / Bachelor's Degree Required
Posted 17 days ago
Field Service Coordinator RN (1701413) "PLEASE NOTE THIS IS A WORK FROM HOME OPPORTUNITY" THIS POSITION TO BE LOCATED IN ONE OF THE FOLLOWING COUNTIES CAMPBELL, BOONE, KENTON, GRANT, PENDLETON AND GALLATIN WITH REPORTING RELATIONSHIPS TO THE LOUISVILLE, KY OFFICE" Works with Care Coordination MVP Team members to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to ma
Full Time / Bachelor's Degree Required
Posted 22 days ago
Field Service Coordinator, RN OB (1701600) "PLEASE NOTE THIS IS A WORK FROM HOME OPPORTUNITY" THIS POSITION TO BE LOCATED IN ASHLAND, BOWLING GREEN, HAZARD, LEXINGTON, LOUISVILLE OR OWENSBORO, KY Works with Care Coordination MVP Team members to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member. Coordinates, monitors and ensures th
Full Time / Bachelor's Degree Required
Posted 22 days ago
Community Advocate (1701376) Cultivates relationships with community based organizations, advocacy and civic/community leaders throughout an assigned area or state. Researches social safety net providers (community based and other) in order to populate and update "My Family Navigator," a database of regional social safety net programs and services, and identify creative gap fill strategies and fun
Full Time / Bachelor's Degree Required
Posted 1 month ago
WellCare Health Plans - 
Tampa, FL / Chicago, IL / Columbia, MO / 20 more...
QI Project Manager, Sr (1700948) 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 effectively in a matrix environment in order to receive needed data that reflects the overall he
Full Time / Bachelor's Degree Required
Posted 2 months ago
Community Relations Specialist, Sr (1700818) Implements programs to develop relationships with organizations to build community coalitions and promote health awareness and managed care. Develops and implements approved marketing strategies for events to interested candidates in the service area according to prescribed rules and regulations. REPORTS TO DIRECTOR, STATE REGULATORY AFFAIRS DEPARTMENT
Full Time / Bachelor's Degree Required
Posted 2 months ago
Provider Relations Representative (1700006) " PLEASE NOTE THIS POSITION TO BE LOCATED IN SOMERSET, KY AND REPORTING TO THE LEXINGTON, KY OFFICE" 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 I
Full Time / Bachelor's Degree Required
Posted 3 months ago
Field Service Coordinator RN (1700739) "PLEASE NOTE THIS POSITION CAN BE LOCATED IN ONE OF THE FOLLOWING COUNTIES PULASKI, CASEY, RUSSELL, WAYNE OR MCCREARY" Works with Care Coordination MVP Team members to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member. Coordinates, monitors and ensures that appropriate and timely primary, acu
Full Time / Bachelor's Degree Required
Posted 9 days ago
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