- Molina Healthcare (Yonkers, NY)
- …annually or as directed by the Centers for Medicare and Medicaid Services . * Trains grievance and appeals staff, customer/ member services department, ... Grievance and Appeals Unit that is responsible for reviewing and resolving member complaints and communicating resolution to members or authorized representatives in… more
- CVS Health (Ramsey, NJ)
- …to ensure proper and safe discharge with appropriate services in place. The case manager works with the member and care team to develop a care plan and ... to facilitate appropriate physical, behavioral health, psychosocial wrap around services . The care manager will be responsible...member 's overall wellness and help them obtain the services they need to thrive by addressing requests for… more
- Molina Healthcare (Yonkers, NY)
- …Tighter knit proximity ongoing after contract. * In conjunction with Director/ Manager , Provider Contracts, negotiates Complex Provider contracts including but not ... management software. * Targets and recruits additional providers to reduce member access grievances. * Engages targeted contracted providers in renegotiation of… more
- Molina Healthcare (Yonkers, NY)
- …activities. + Works with Health Care Services (eg, with data manager , case managers, etc.) on member -centered interdisciplinary teams. + May prepare ... and statin starts), Adherence follow-up efforts to improve Part D STARS, Medicare /MMP LOB. Molina Pharmacy Services /Management staff work to ensure that… more
- CVS Health (White Plains, NY)
- …impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social ... the care planning process in collaboration with the Care Manager , to include the following actions: assessment, goal setting,...and face to face interactions which include visits to member homes, in the community, and/or provider locations. +… more