Monitors actual FCR and NPS performance against corporate targets; presents findings; proactively investigates and communicates explanations for variation and conducts root cause analysis. Provides critical data analysis and recommendations to establish corporate goals related to FCR and NPS. Conducts deep analysis on data related to FCR and NPS, reviews member surveys, l

Responsible for the coordinated management of multiple large scale, critical or complex projects. The Senior IT Project Manager (PM) is responsible for overseeing all aspects of project work to ensure that goals and objectives are accomplished within the constraints of the budget, schedule, and stakeholder expectations. Monitors progress according to plan, identifying and

The Manager Clinical Audit provides oversight and leadership of the Clinical Audit Team within the Payment Integrity Department. The Clinical Audit team performs detailed medical record and chart audit review of the health plan's claims to ensure that all reimbursement to the provider is paid accurately. The Clinical Auditors are a liaison and resource between the health

At the direction of the Manager of Behavioral Health Operations, the Behavioral Health (BH) Program Manager, New Hampshire (NH) is responsible for leading and resolving high visibility behavioral health (BH) initiatives, issues and priorities through significant interface with the health plan's material subcontractor. Key deliverables include the oversight of New Hampshir

Investigate, document, track and assist with claims resolution Interact with various operational departments to assure accurate and timely payment of claims in accordance with WellSense policies and procedures Identify system changes impacting claims processing and work internally on resolution Identify systematic issues and trends and research for potential configuration