To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. Develop, implement and manage all UM processes for continuous and sustained compliance with all applicable state, federal and NCQA regulatory requirements, SCFHP policies and procedures and general business requirements for all lines of business. Develo

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Read, interpret and implement all regulatory guidance related to the handling of appeals and grievances, including the Medicare Managed Care Manual, State and Federal contracts , APLs,DPLs and other memos that provide direction. Demonstrate a solid unde

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Responsible for revenue and cost reconciliation activities using capitation invoices, eligibility files, claims and expense data and other relevant reports. Design and prepare reports that analyze the financial outcome of programs and make recommendatio

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Lead and facilitate medium to large scale HEDIS and quality projects by providing direction for project framing, organization, business case analysis, implementation, and outcome/success measurement. Ensure the accuracy of HEDIS data and timely completi

To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. Ensure PHM initiatives meet all regulatory requirements for PHM. Plan, manage, and evaluate program initiatives to improve performance especially as it relates to key components of PHM (as compliant with all regulatory requirements). Collaborate and coo

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Lead and facilitate new community based Community Supports programs by including program modeling, business case analysis, implementation and outcome/success measurements. Develop and maintain all appropriate documentation, including timelines, project

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Act as the primary point of contact and liaison for SCFHP members and providers contacting the plan regarding general inquiries, concerns or requests for information. Develop a general understanding of all member facing materials, communications and int

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Conduct, review and document comprehensive clinical and/or psychosocial assessments and on going follow up interventions to measure progress towards meeting goals as they relate to a member's physical, psychosocial, environmental, safety, developmental,

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Lead and facilitate medium to large scale HEDIS and quality projects by providing direction for project framing, organization, business case analysis, implementation, and outcome/success measurement. Ensure the accuracy of HEDIS data and timely completi

To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. Business Systems Analyst I Project and task management for small scale projects including facilitate stakeholder and project team meetings, track actionable items, send regular project communications to team members and stakeholders, and escalate identi

To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. Business Systems Analyst I Project and task management for small scale projects including facilitate stakeholder and project team meetings, track actionable items, send regular project communications to team members and stakeholders, and escalate identi

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Act as the primary point of contact and liaison for SCFHP members and providers contacting the plan regarding general inquiries, concerns or requests for information. Develop a general understanding of all member facing materials, communications and int

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Conduct, review and document comprehensive psychosocial assessments for assets and deficits and on going follow up interventions to measure progress towards meeting goals as they relate to a member's physical, psychosocial, environmental, safety, develo

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Act as the primary point of contact and liaison for SCFHP members and providers contacting the plan regarding general inquiries, concerns or requests for information. Develop a general understanding of all member facing materials, communications and int

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Install and support networks, servers, storage, security systems and configure software, hardware, peripherals, services, settings, directories, etc. in accordance with standards and project/operational requirements and in keeping with best practice pro