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Chronic Condition Management Case Manager
Medical Mutual - Cleveland, OH
Under limited supervision, evaluates and provides support to members, their families, and physicians in addressing member needs. Educates members and families to make informed personal health care decisions and determines the most effective treatment options. Facilitates communication between member, physician and community. Responsibilities I...
Member Health & Wellness Chronic Condition Coach - Medicare
Medical Mutual - United States of America
Provides education and coaching to rising and moderate risk members with chronic conditions. Completes assessments and develops individualized care plans for members with the goal of improving self-efficacy in managing their chronic condition(s). Collaborates with both internal and external care team members. Assists manager with staff training, assigning and monitoring work queues and stand...
Member Health & Wellness Chronic Condition Coach
Medical Mutual - United States of America
Provides education and coaching to rising and moderate risk members with chronic conditions. Completes assessments and develops individualized care plans for members with the goal of improving self-efficacy in managing their chronic condition(s). Collaborates with both internal and external care team members. Assists manager with staff training, assigning and monitoring work queues and stand...
Provider Contract Analyst
Medical Mutual - Cleveland, OH
Supports each contracting region of the Company's provider network with financial analysis. Maintains market intelligence and analyzes network performance to provide Provider Engagement with consultative and analytical insights. Responsibilities Analyzes contracted rates to assist with determining appropriate rates for provider contracts. Coordinates with...
Acute and Post-Acute Nurse Reviewer II - Medicare Advantage
Medical Mutual - Cleveland, OH
Under limited supervision, applies medical necessity guidelines in making authorization determinations for inpatient admissions, concurrent, and retrospective reviews in collaboration with physician reviewers. Applies evidence-based discharge planning so that patients have a safe and timely transition to next appropriate level of care. Responsibilities Ev...
Social Worker-Case Management
Medical Mutual - Cleveland, OH
Provides members with the psychosocial support needed to cope with chronic, acute, or terminal illnesses. Advises family care givers, provides member education and counseling, and makes referrals for other health-related services, including community resources. Assists with members transitioning from various level of care to optimize quality and reduce costs to ensure members are...
Bravo- User Experience Designer
Medical Mutual - Cleveland, OH
Under supervision, collaborates with team to execute the design strategy and process across multiple channels of the users' experience. Responsibilities Follows directions to help creates design consistency across the entire participant experience including the portal, email, text and other print/digital communications via designated brand standards.
Dental Claims/Customer Care Specialist-TPA
Medical Mutual - Brooklyn, OH
Processes routine to complex healthcare claims and responds to inquiries from third party administration and/or ancillary product services customers regarding benefits, coverage or claim status in accordance with established performance expectations and service philosophy. Responsibilities Processes routine to complex healthcare claims ...
Bravo- Director of Onsite Services
Medical Mutual - United States of America
Under minimal supervision, manages strategic and daily aspects of screening services and all other onsite products. Oversees all aspects of related third-party vendor relationship. Responsibilities Develops and executes operational business plans and resulting client experiences for all onsite services, including internal training and documentati...
Claims Associate - Temporary
Medical Mutual - Centerville, OH
Superior Dental Care, a Medical Mutual company located in Centerville, OH is searching for a Claims Associate to support their team. Preparing and processing various insurance claim forms, and other administrative duties. Responsibilities Perform data entry of various types of dental claims Sustain a level of productivity needed to complete daily claims w...
Infrastructure Engineer III (Telecom Engineer)
Medical Mutual - Brooklyn, OH
Ensures reliability and stability of assigned platforms and systems as a highly trained and experienced technology expert on host platform(s). Completes complex technical tasks, leads projects, troubleshoots issues, researches new methods and systems, provides off hours support (on-call) as a part of a rotation, all under minimal supervision Responsibilities ...
Director, Provider Network Management
Medical Mutual - Cleveland, OH
Creates and implements corporate strategies, policies and initiatives to assigned geographic region, health system or line of business. Oversees the company's relationships with physician, professional, institutional and ancillary providers including negotiation and implementation of contracts and reimbursement strategies with the goals of achieving the best- in- market mix of cost, ac...
HEDIS Value Based Analyst II
Medical Mutual - Cleveland, OH
Designs, executes and delivers analyses and reports to provider groups and internal stakeholders. Identifies actionable opportunities in data through quality improvement and in-depth analyses and recommendations that improve care and health plan quality ratings. Collaborates with provider engagement and provider groups to design, create and deliver reporting and analytic results....
Membership Services Specialist
Medical Mutual - Brooklyn, OH
Under general supervision, processes routine to moderately complex enrollment and billing transactions for an assigned block of customers following underwriting guidelines. Maintains eligibility records on various claims processing systems. Controls billing and reconciliation processes on membership and accounts receivable systems. Responds to routine to moderately complex inquiries from cus...
Customer Experience Analyst I
Medical Mutual - Brooklyn, OH
Under direct supervision, supports the Customer Analytics program for the Customer Experience team. Delivers analytic insights by conducting routine or standard quantitative analysis supporting strategic business decisions. Focuses on measuring and analyzing customer behaviors across channels and interactions. Primarily works indirectly with internal business customers. Respon...
