General Summary. To plan, direct, evaluate and coordinate the activities associated with the Monitoring & Oversight department of Customer Services, as it relates to key HAP initiatives and service excellence. To perform auditing and real-time monitoring of complaints, grievances and, appeals for all product lines (HMO, AHL, Medicare Advantage (MA) and Prescription Drug Plan (PDP) to ensure complete, accurate and timely processing, in accordance ...
General. Summary. Responsible for case management activities for Health Alliance Plan (HAP) dual eligible members using a multi-disciplinary, patient-centered approach. Provides bio/psycho/social assessments, develops an individualized care plan, implements case management interventions, facilitates an interdisciplinary care team, coordinates care, monitors outcomes and evaluates the delivery of quality, cost effective health care services across...
