Duties & responsibilities: performs review of medication lists to understand and eliminate barriers to medication therapy while serving as the member's pharmacy navigator to achieve proper medication adherence, minimize gaps in therapy, and prevent medication related adverse events facilitates member access to medication(s) by obtaining refills, facilitating new prescriptions, setting up appointments, facilitating access to medications for members experiencing financial issues, aligning refills to reduce frequency of pharmacy visits, documenting the care delivered, and communicating information to other providers partners with healthfirst pharmacists and other internal and external partners to communicate a medication treatment plan and/or coordinate and integrate an mtm intervention within the broader healthcare management services partners with community pharmacies to monitor and communicate member medication adherence performs patient health assessments to collect information regarding patient medication profile (prescriptions, otc medications, and/or homeopathic/herbal therapy) to identify potential barriers which could lead to poor medication adherence including medication and/or patient-related factors, or access to care handles member and provider communications telephonically (in person may be required in certain situations) additional duties as necessary minimum qualifications: high school diploma or ged from an accredited institution work experience requiring written and verbal communication that is clear, concise, grammatically correct, and professional experienc...
Duties and responsibilities: advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. conducts assessments to identify barriers and opportunities for intervention. develops care plans that align with the physicians treatment plans and recommends interventions that align with proposed goals. generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement and maintenance of successful health outcomes. liaise between service providers such as doctors, social workers, discharge planners, and community-based service providers to ensure care is coordinated and care needs are adequately addressed. coordinates and facilitates with the multi-disciplinary health care team as necessary to ensure care plan goals and treatment is person-centered and maximizes member health outcomes. assists in identifying opportunities for alternative care options based on member needs and assessments. evaluates service authorizations to ensure alignment and execution of the members care and physician treatment plan. contributes to corporate goals through ongoing execution of member care plans and member goal achievement. documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate. occasional overtime as necessary. additional duties as assigned. minimum qualifications: for medical care management: nys rn...
Duties and responsibilities: advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. conducts assessments to identify barriers and opportunities for intervention. develops care plans that align with the physicians treatment plans and recommends interventions that align with proposed goals. generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement and maintenance of successful health outcomes. liaise between service providers such as doctors, social workers, discharge planners, and community-based service providers to ensure care is coordinated and care needs are adequately addressed. coordinates and facilitates with the multi-disciplinary health care team as necessary to ensure care plan goals and treatment is person-centered and maximizes member health outcomes. assists in identifying opportunities for alternative care options based on member needs and assessments. evaluates service authorizations to ensure alignment and execution of the members care and physician treatment plan. contributes to corporate goals through ongoing execution of member care plans and member goal achievement. documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate. occasional overtime as necessary. additional duties as assigned. minimum qualifications: for medical care management: nys rn...
Duties and responsibilities: advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. conducts assessments to identify barriers and opportunities for intervention. develops care plans that align with the physicians treatment plans and recommends interventions that align with proposed goals. generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement and maintenance of successful health outcomes. liaise between service providers such as doctors, social workers, discharge planners, and community-based service providers to ensure care is coordinated and care needs are adequately addressed. coordinates and facilitates with the multi-disciplinary health care team as necessary to ensure care plan goals and treatment is person-centered and maximizes member health outcomes. assists in identifying opportunities for alternative care options based on member needs and assessments. evaluates service authorizations to ensure alignment and execution of the members care and physician treatment plan. contributes to corporate goals through ongoing execution of member care plans and member goal achievement. documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate. occasional overtime as necessary. additional duties as assigned. minimum qualifications: for medical care management: nys rn...
Duties and responsibilities: advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. conducts assessments to identify barriers and opportunities for intervention. develops care plans that align with the physicians treatment plans and recommends interventions that align with proposed goals. generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement and maintenance of successful health outcomes. liaise between service providers such as doctors, social workers, discharge planners, and community-based service providers to ensure care is coordinated and care needs are adequately addressed. coordinates and facilitates with the multi-disciplinary health care team as necessary to ensure care plan goals and treatment is person-centered and maximizes member health outcomes. assists in identifying opportunities for alternative care options based on member needs and assessments. evaluates service authorizations to ensure alignment and execution of the members care and physician treatment plan. contributes to corporate goals through ongoing execution of member care plans and member goal achievement. documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate. occasional overtime as necessary. additional duties as assigned. minimum qualifications: for medical care management: nys rn...
Duties & responsibilities collaborates with management to shape and implement technology strategies and solutions across various infrastructure and database domains. evaluates and offers technical guidance during the design, development, and implementation of database solutions. identifies areas for improvement and proactively champion solutions. ensures database practices align with overall company vision by leveraging relationships with other departments. mentors and cultivates skill growth within the team, emphasizing current technologies and best practices. crafts scalable, robust, and efficient solutions that meet business demands. ensures comprehensive documentation is maintained, while promoting industry best practices. additional duties as assigned. minimum qualifications technical degree from an accredited institution or work experience equivalent with a high school diploma or a ged from an accredited institution senior level of hands-on enterprise experience, management and configuration in oracle, microsoft sql server, postgresql, redshift, mysql, dynamodb, and others experience working in aws cloud, unix/linux, windows maintain database documentation, including data standards, procedures and definitions for the data dictionary ('metadata') across the company and department. experience supporting and integrating database services both on-premises and leveraging cloud-hosted technologies. extensive experience leveraging cloud security best practices and implementing a least privileged model of access in amazon web services (aws). experience with system health moni...
Duties and responsibilities: plays a leadership role in the definition and execution of the information management roadmap. supports data architecture roadmap by managing architectural runway for enterprise data model, enterprise data store/warehouse, information management, and advanced data analytics capabilities. provides data architecture thought leadership to cross-functional teams in the areas of advanced data techniques, including data modeling, data access, data integration, data visualization, data discovery, statistical methods, database design and implementation. partners with business stakeholders, management, and teams to identify needs and guide the delivery of cost-effective, high-performance technology capabilities leveraging enterprise information architecture principles and core data assets. practices self-leadership and promotes learning in others by soliciting and acting on performance feedback. establishes collaborative, cross-functional relationships; communicating information and providing advice to drive enterprise data architecture decisions forward. adapts to competing demands and new responsibilities, providing feedback to others, including upward feedback to leadership. influences, mentors and coaches team members, and fostering open dialogue amongst team members. additional duties as assigned. minimum qualifications: bachelors degree demonstrated leader capable of partnering / driving business and technology colleagues in establishing a highly functioning governance model. a minimum of 5 years of progressively responsible experience in informati...
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