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With programs for family planning from Maven Clinic to managing diabetes like Livongo, coverage for women's health, support for adult and elder care, paid parental leave, a generous 401(k) plan with matching company contributions, and more.
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This job will deliver value to the Health Plan and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and/or Affordable Care Act (ACA) using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, and Centers for Medicare and Medicaid Services (CMS) coding guidelines.
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Care New England Health System (CNE) and its member institutions; Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.
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Our service lines include Home Health, Hospice, In-Home Services, Meals on Wheels, Public Health, and Wesley Wheels. Collaborates with other Account Executives, Care Navigators, Area Sales Manager, Directors, and Executive Director to develop sales/marketing plan to maintain current client base, grow current client base, and identify potential new referral sources.
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In addition to salary, PepsiCo offers a comprehensive benefits package to support our employees and their families, subject to elections and eligibility: Medical, Dental, Vision, Disability, Health and Dependent Care Reimbursement Accounts, Employee Assistance Program (EAP), Insurance (Accident, Group Legal, Life), Defined Contribution Retirement Plan.
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Staff members are also eligible for paid time off, health/dental insurance, a 401(k) plan and matching employer contributions, a life insurance plan, long-term disability coverage, access to an Employee Assistance Program (EAP), and professional development opportunities.
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Rhode Island Department of Health licensure - LCSW considers; LMFT, LMHC or LICSW preferred. Provides supervision to foster care staff to ensure foster parents adhere to treatment plan and program expectations (i.e., evaluate and review each child/youth's plan or care, etc.
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Through the company's more than 7,600 CVS/pharmacy stores; its leading pharmacy benefit manager serving more than 60 million plan members; and its retail health clinic system, the largest in the nation with more than 970 MinuteClinic locations, it is a market leader in mail order, retail and specialty pharmacy, retail clinics, and Medicare Part D Prescription Drug Plans.
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Data Consulting engages in data quality improvement efforts that span single and multiple product lines (i.e. Health and Welfare, Defined Benefit, Defined Contribution, Stock Plan Services and HR/Payroll) within the implementation and ongoing servicing client lifecycle.
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The position is eligible to participate in FM Global's comprehensive Total Rewards program that includes an incentive plan, generous health, and well-being programs, a 401(k) and pension plan, career development opportunities, tuition reimbursement, flexible work, time off allowances and much more.
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Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management. Serves as subject matter expert on NCQA Health Plan Accreditation UM requirements, advising stakeholders on compliance, and facilitating NCQA UM file universe preparation and UM file reviews.
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Comply with all ASC Environmental, Safety and Health (ESH), Waste Management and Quality Assurance requirements. + Dental options through Delta Dental to include a high or low option plan.
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Establishes an inventory of city-based housing support programs (both direct and in-direct) funded through City of Providence, CDBG, Emergency Solutions Grants, HOME-ARP, American Rescue Plan Act and other allocations that may exist now or in the future.
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Experience with NCQA accreditation survey requirements for health plan with HEDIS specifications, and with state and federal health care regulations applicable to managed care organizations.
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During periods of wellness and injury, the Registered Nurse provides triage per clinical protocols and directs patient towards appropriate level of care in collaboration with the provider develops and understands patients’ health care plan.
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health plan jobs in Johnston, RI
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