Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values Educates primary care physicians regarding systems, structures, processes and outcomes necessary for assurance of regulatory compliance related to market activities Participates in case review and medical necessity determination

Works with the providers and clinic staff to identify patients at high risk through transitions of care. This is to support the market initiative of reducing utilizations, including ER visits, hospital admissions, and hospital readmissions. Supports longitudinal care of the patient with chronic care conditions by performing assessment of health conditions initiating medic

Works with the providers and clinic staff to identify patients with chronic disease diagnoses Supports longitudinal care of the patient with stable chronic care conditions by performing focused assessment of chronic care conditions performing medication reconciliation conducting Motivational Interviewing and Self Management Goal setting providing patient education using s

Performs all duties within the scope of a Medical Assistant's practice. Operates diagnostic equipment (cannot interpret tests), remove staples from superficial wounds, changes wound dressing and obtains cultures, administers non intravenous medication, performs simple specimen collection via noninvasive techniques and collects blood specimens via venipuncture or via capil

Performs all duties within the scope of a Medical Assistant's practice. Operates diagnostic equipment (cannot interpret tests), remove staples from superficial wounds, changes wound dressing and obtains cultures, administers non intravenous medication, performs simple specimen collection via noninvasive techniques and collects blood specimens via venipuncture or via capil

Performs all nursing duties within the scope of a Licensed Vocational/Practical Nurse (procedures, injections, medication administration, EKGs, phlebotomy) as determined by the applicable State Board of Nursing Participates in implementing established education plans for patients and their families with common health problems and well defined health learning needs Coordin

Conduct classes to meet the goals and objectives of the enterprise Plan, design and implement curricula utilizing established standards and evidence based information and select or create educational material to support effective teaching Provide education sessions for patients and their families or caregivers in both group and 1 1 settings Demonstrate a well developed un

Conduct in home assessments including an evaluation of past medical history, review of systems, medication reconciliation, vital signs, and comprehensive physical exam Perform evidence based practice screenings including point of care testing (as appropriate) Identify diagnoses to be used in care management and active medical management in the furtherance of treatment For

Performs all duties within the scope of a Medical Assistant's practice. Operates diagnostic equipment (cannot interpret tests), remove staples from superficial wounds, changes wound dressing and obtains cultures, administers non intravenous medication, performs simple specimen collection via noninvasive techniques and collects blood specimens via venipuncture or via capil

Conducts audit reviews of Organization Determinations, Adverse Determinations and Notice of Medicare Non Coverage documents (NOMNC) and Detailed Explanation of Non Coverage (DENC) documents to assure accuracy and compliance with UM health plan, CMS, NCQA, URAC and Department of Insurance guidelines Utilizes audit tools to perform documentation audits on job functions with

Performs all duties within the scope of a Medical Assistant’s practice. Operates diagnostic equipment (cannot interpret tests), remove staples from superficial wounds, changes wound dressing and obtains cultures, administers non intravenous medication, performs simple specimen collection via noninvasive techniques and collects blood specimens via venipuncture or via

Performs all duties within the scope of a Medical Assistant's practice. Operates diagnostic equipment (cannot interpret tests), remove staples from superficial wounds, changes wound dressing and obtains cultures, administers non intravenous medication, performs simple specimen collection via noninvasive techniques and collects blood specimens via venipuncture or via capil

Documents all patient interactions in a concise manner that is compliant with documentation requirements for Model of Care, NCQA and Center for Medicare and Medicaid Services (CMS) regulations. Receives and responds to incoming Care Coordination inquiries from all communication venues e.g. phone queue, TruCare, portal, claim queue, department e mail box or Rightfax. Coord

Performs all duties within the scope of a Medical Assistant's practice. Operates diagnostic equipment (cannot interpret tests), remove staples from superficial wounds, changes wound dressing and obtains cultures, administers non intravenous medication, performs simple specimen collection via noninvasive techniques and collects blood specimens via venipuncture or via capil

A partner of the Optum Care network, WellMed Medical Group, is seeking a nurse practitioner or physician assistant to join our WellMed at Seguin clinic in San Antonio, TX . Position Highlights Quality vs. quantity typically see 14 to 16 patients per day (30 min per visit) Instead of RVU or volume metrics, our providers are measured and rewarded on quality of care (most pr