Job Description

This position is responsible for leading our healthcare team in providing health and wellness coaching, case management services, analysis, and expertise regarding medical services.

The role involves monitoring cases and claims, analyzing biometric and health risk assessment data, organizing disease management programs, and proactively interacting with members, physicians, and other providers to ensure efficient and effective service.

This senior-level position oversees an integrated data warehouse including program utilization, disease management programs, and provider network support.

• Develop a comprehensive health benefit program incorporating case management and health/disease management strategies.
• Create a system for coordinating patient care throughout the continuum of care, ensuring seamless transitions and optimal outcomes.
• Analyze data using standard tools and methodologies to inform decision-making and provide leadership in managing cases, events, and diseases.
• Interact with providers and plan members to facilitate case management activities, promoting efficient and effective service delivery.
• Identify high-risk individuals and develop targeted programs to reduce financial and health risks.
• Evaluate the impact of case management on patient populations and adjust strategies accordingly.
• Analyze demographic, utilization, and reimbursement data to inform business decisions.
• Prepare reports to assess claim/cost data and utilization rates, providing insights for continuous improvement.

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