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Healthcare Analyst (Policy Writer)
Medical Mutual - Cleveland, OH
Provides support to the health plan in creating and maintaining policies used in clinical review process along with assistance in researching new technologies presented to the plan for reimbursement consideration. This individual will also be responsible in managing and performing the process used to assure all policies used in medical necessity determinations remain compliant with NCQA requ...
Bravo- Agile Scrum Master II
Medical Mutual - Cleveland, OH
Under minimal supervision, provides agile project management to Bravo's software product development teams; Identifies and manages potential, liabilities and mitigation plans to the projects. Establishes and leads team operations using agile values and principles, industry best practices, techniques, and standards. Responsibilities Partners with stakehold...
Account Administrator - Small Group
Medical Mutual - Brooklyn, OH
Provides administrative support to brokers and other external customers in the sales and underwriting of new and existing accounts in the small group market. Responsibilities Handles small group and broker support calls on underwriting and administrative inquiries. Reviews new group/individual submissions for completeness and compliance ...
Medical Economics Analyst (Level I, II, Senior or Lead)
Medical Mutual - Cleveland, OH
Assist the Director, Medical Economics with delivering analytics around key clinical performance opportunities through quantitative analyses of utilization and health care costs data. The Medical Economics Analyst identifies areas for medical cost savings and utilization improvements across all Medical Mutual products and lines of business. Responsibiliti...
Clinical Quality Analyst - Job Family
Medical Mutual - Cleveland, OH
Design, execute and deliver of analyses and reports to provider groups under innovative and emerging payment models. Identify actionable opportunities for providers to achieve success within those arrangements by improving appropriate use of care that increases the receipt of high quality, evidence-based care and reduces total costs of care. Examining and identifying drivers of h...
Manager, Customer Experience Project Management
Medical Mutual - Brooklyn, OH
Creates the roadmap for, and leads the implementation of strategic, cross-functional projects related to the implementation of new capabilities and systems that affect the member experience, driven by corporate initiatives and regulatory compliance. Facilitates alignment with Sales, IT and business stakeholders to enable effective solution implementation. Performs organizational and cl...
HEDIS Analyst II
Medical Mutual - Cleveland, OH
Supports corporate and departmental strategies and goals for the annual HEDIS submission process. Effectively applies business knowledge and technical expertise to support business initiatives to report clinical quality of care received by members. Works closely with the Quality team to develop year-round strategies to improve quality of care received by members, members' health outcomes. Succe...
Bravo- Business Development Associate
Medical Mutual - United States of America
Provides support to the sales team including lead generation and qualification of new customers through prospecting. Responsibilities Assists in the development of a strong pipeline of new business opportunities through customer contact and prospecting (phone, email, social selling and direct mail). Qualifies lead generation inquiries from...
Marketing Data Analyst (Job Family, Level I, II, Senior, Lead)
Medical Mutual - Cleveland, OH
Reviews project life cycle from segmentation, modeling, audience selection, testing strategies, execution and results reporting. Provides analysis to drive marketing decisions and analyze results. Provides marketing analysis and reporting processes associated with individual health insurance media and marketing channels (offline and online). Responsibilities ...
Clinical Pharmacist Liaison
Medical Mutual - OH
**This position can work remotely in the state of Ohio** Collaborates with key partners including health systems, pharmacy chains, and other provider groups to help advance pharmacy care management, clinical pharmacy initiatives, and close medication-related gaps in care while improving quality for members. Supports overall relationships in a consultative capacity to assist in the dev...
Financial Analyst III
Medical Mutual - Brooklyn, OH
Provides analysis and accurate and timely financial information. Generates management reports and interfaces with corporate departments where necessary. Works independently to solve problems, complete special projects, and conduct monthly activities. Acts as a resource for colleagues with less experience. Responsibilities Supports corpor...
Case Manager II - Medicare Advantage
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...
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...
