Implement and maintain data bases necessary to complete standard reportable event reports and analysis within agreed upon deadlines surrounding the HCBS LTSS population Complete ad hoc reports and analysis as requested by State partner or internal LTSS leadership Routinely analyze results of reportable event submissions, substantiations, and CAPs to identify trends such a

Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medicati

Provide Key Accounts new business sales support for the Account Executives handling cases in the 100 5,000 segment for Medical and Specialty (ancillary) products Will also provide support for the Strategic Account Executives managing existing Key Accounts cases in offering new coverages (i.e., renewal upselling) Coordinate and execute the new business presale process to a

Provide members with tools and educational support needed to navigate the health care system and manage their health concerns effectively and cost efficiently Assist members with adverse determinations, including the appeal process Teach members how to navigate UMR internet based wellness tools and resources Outreach to membership providing pre admission counseling to mem

Oversee performance of end to end provider servicing Resolve complex problems and provide guidance to members of own team Drive the design and implementation of programs that build / nurture positive relationships between the health plan, providers, and practice managers Ensure implementation of training and education programs for external providers Identify gaps in netwo