This position is responsible for achieving, supporting and maintaining the performance goals of Meridian Health Plan. This includes developing and coordinating MHP's activities, efforts, and initiatives related to performance and regulations of the National Committee for Quality Assurance (NCQA), URAC or general accreditation including Accreditation, HEDIS and CAHPS, as well as clinical requirements for State of Michigan, OFIR, MAHP, and other quality performance initiatives as determined by MHP.
This position will work with all necessary internal and external partners while leading the Performance Delivery Team (PDT) to successfully drive performance improvement for assigned Value Based Provider Group partners.
This position is to create an educated and comprehensive provider network in all assigned territories. The preferred candidate will have experience contracting with Hospitals, PHOs, large provider groups, and individual practitioners for Medicaid, Medicare and Commercial Networks.
This position is to actively oversee the education and service level of Meridian Health Plan's (MHP) provider network to ensure it is capable of delivering all preventive, specialty and ancillary health services to MHP's enrollees in its contracted service areas and lines of business.
This position is responsible for maintaining the entire enrollment process. The Manager of Medicare Enrollment will oversee a team that is tasked with preparing, processing and maintaining new member or group enrollments.
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Improves quality of service to members by providing prior authorization of formulary drugs, developing programs to provide optimal pharmaceutical care to patients, participating in dispute resolution of drug utilization review, measuring and documenting improvements in patient care, and/or improving claim adjudication for proper provider reimbursement.
Responsible for project implementation and technical support for the organizations Unified Communications related technologies which includes nut not limited to Communications Manager, Unity Connections, Cisco Instant Messaging and Presence(Jabber), Informacast, Cisco Emergency Responder and Expressway C/E.