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The primary focus of the Manager of Network Development is to engage independent physicians and build relationships in order to execute managed care agreements for participation in the Optum Health Network RBE. This directly contracted network is the cornerstone for RBE growth across the region for all current and future capitation contracts.
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They work as part of a care team including a Nurse Practitioner, Case Manager (Behavioral Health Advocate or Registered Nurse), Care Navigator, and other supporting team members.
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4+ years of fee-for-service/ACO/value-based care contracting or managed care experience at an integrated delivery system, population health services company or health insurance plan+ Experience in external facing contract negotiation & Medicare Advantage network build.
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The Community Health Worker in the Optum at Home program acts as a liaison for DSNP and CSNP members to ensure appropriate care is accessed, home and social assessments are completed, resources leveraged, and education provided.
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To do this, Mid Atlantic will pursue strategic growth and development opportunities across the full ambulatory care delivery spectrum, including physician offices, ambulatory surgery centers, home care, behavioral health, post-acute care and digital care assets.
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4+ years of fee-for-service/ACO/value-based care contracting or managed care experience at an integrated delivery system, population health services company or health insurance plan.
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The Manager will play a lead role in relationship development and facilitate agreement execution and maintenance of the contracted network with the ultimate goal of increasing the number of participating physicians and at-risk Medicare members in the Mid-Atlantic states ( GA, TN, SC, NC or VA) RBE. In this capacity, the role will collaborate closely with cross functional team leads in the region (e.g., Market Operations, Data Analytics, IT/Analytics, Finance, and Executive.
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The health care system needs to evolve even further than it has and it has to do so at a lightning fast pace. Currently, Optum Health employs physicians inside its medical group assets and also runs a large risk-bearing entity (RBE) with global risk contracts covering over 250,000 dual-eligible MA members across several states.
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JWCH Institute, Inc. Wesley Health Centers is a private non-profit health agency that is working towards increasing access to high quality health care resulting in decreased health disparities among at-risk populations through the expansion of comprehensive and preventative health care programs and services.
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Job DetailsEssential Job Functions Primary Responsibilities The RNCC partners with the Texas Independence Health Plan Institutional Special Needs Plan (ISNP) Nurse Practitioner (Plan NP) to coordinate care for ISNP Beneficiaries (Plan Members), maintaining routine contact with Plan Members, family, and facility staff, and informing Plan NPs and/or facility staff when there are potential medical, emotional, or behavioral changes in a Plan Member’s condition.
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Top-Tier Patient Satisfaction Scores | Largest Teaching Health Center FQHC | 11 Locations offering 44 Specialties | NCQA Patient-Centered Medical Home Level 3 Certified Multi-Site Approved for NHSC & NCLRP loan forgiveness programs - NHSC/Nurse Corps/Pediatric Specialty | HPSA Scores: Primary: 17 | Dental: 25 | Mental: 20 What We Are Looking ForThe CMT Behavioral Health Care Manager provides medical or personal guidance and direction to individuals.
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Job Responsibilities:Client services and direct care - provide proactive behavioral health case management to Apicha's Primary Care Clinic patients including comprehensive assessment, re-assessment, and individualized care plan development to ensure access to care and other services including communication with the multidisciplinary care team at regular intervals to ensure patients have positive health outcomes.
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Provides Clinical Oversight of ECM Health Risk Assessments and determines if Member’s Care Management needs are sufficient to be managed by a ECM Lead Care Manager or require the Consultant’s intervention in the form of recommendations to implement in their Care Plan.
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POSITION SUMMARY : The primary role of the Community Case Manager is to provide services that are designed to reduce risks facing victim/survivors who have been assessed through the program’s LAP to be at high risk of homicide.
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Position Purpose: Develops, assesses and coordinates holistic care management activities, with primary focus and support towards the most complex or high risk/high acuity populations with primarily medical/physical health needs, to enable quality, cost-effective healthcare outcomes.
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behavioral health primary care at risk manager jobs in Mililani-town, Hawaii
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