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Position Purpose:Serve as a liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams. Assesses and performs review of member clinical records and services related to behavioral health and substance use. Key Details: This is a remote po

Position Purpose: Maintains relationships with physicians, hospitals, ancillary providers and Fidelis' internal Provider Network Management Dept. Acts as first line contact for providers/hospitals on claims projects and other non-routine claim issues. Oversees, in conjunction with the Adjustment and

Position Purpose: Coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi-specialty groups) and ancillary service agreements that are in accordance with corporate, health plan and State guidelines. Key Details: Must be authorized to work in the U.S. without the need for

Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate

Position Purpose: Supports community connection activities including connecting members to community resources to support their care management journey and provide necessary care resources in a cost-effective manner. Provides members with known community resources and supports the care team to ident

Note: This is a fully remote role with Central time (CST) working hours along with 10% travel. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including empl

This position covers the state of NJ and requires the candidate to reside in that state. Position Purpose: Perform day to day duties of assuring that providers are set up accurately in the provider information system for state reporting, claims payment, and directories. Responsible for multiple stat

Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephonically or through hom

Position Purpose: The Program Manager IV is responsible for coordinating the implementation of new regulatory requirements, including the REAL Health Providers Act, Medicaid Mega Rule, state-specific directory regulations, and ongoing compliance reporting activities such as RARR. The role also serve

Position Purpose: The Consumer Experience Analyst Sr. is responsible for utilizing a variety of analytical techniques, current system applications, consumer research data, call center and other ad hoc and system generated reports and other data sources within the organization to address business obj

Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephonically or through hom

Position Purpose:The Health Benefit Representative (HBR) is responsible for educating and assisting individuals with enrolling in affordable health insurance coverage through the NY State of Health Marketplace. This includes Medicaid (NYM), Child Health Plus (CHP), Essential Plan (EP), Qualified Hea

Position Purpose: Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care

Position Purpose: Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care

Position Purpose: Performs care management duties to assess, plan and coordinate aspects of medical and supporting services across the continuum of care for post-discharge members, promoting quality and cost effective care. Completes medication review for pre-admission and post-discharge reconciliat

Position Purpose: Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care

Position Purpose:Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care p

Position Purpose:Participate in the development of strategic business plans, coordinate and communicate the product strategy and determine key priorities, policies and procedures for product lines and programs. Key Details: Identify and advance growth, innovation, and member experience opportunities

Position Purpose: Develops, assesses and coordinates holistic care management activities, with primary focus and support towards populations with significant mental/behavioral health needs, to enable quality, cost-effective healthcare outcomes. Evaluates member service needs and develops or contribu

Position Purpose: Represent the company to all prospective and existing clients. Monitor client satisfaction and recommend changes to enhance satisfaction. Key Details: Due to travel requirements of the role, we are seeking candidates who live within an hour of Raleigh, North Carolina or Richmond, V