Assist in any and all of the functions normally associated with a qualified health actuary including IBNR calculation; the determination of rating factors such as age, sex, location, or industry; development of rates and filings for the BOI; suggestions for periodic group rating changes; development of necessary rates for government programs; assistance with the developme

Responsible for managing patient's medical nutrition therapy in accordance with the medical staff approved clinical practice standards for high risk patients. Serves as a resource for nutrition education. Board Certified Specialist in one of the recognized ADA/NATCO/NBNSC specialty certifications Cert Nutrition Support Clinician (CNSC), Renal Nutrition (CSR); Certified Sp

Assist in any and all of the functions normally associated with a qualified health actuary including IBNR calculation; the determination of rating factors such as age, sex, location, or industry; development of rates and filings for the BOI; suggestions for periodic group rating changes; development of necessary rates for government programs; assistance with the developme

The primary role of the Provider Data Enrollment Specialist I is to ensure the data integrity of provider records entered and maintained in the credentialing and/or payment systems. This position may be responsible for all aspects of ensuring accurate and timely processing of provider setup to initiate credentialing, provider record updates and edits, processing provider

Responsible for all areas of customer service as it pertains to the acquisition and/ or retention of members for Sentara Health Plan, Inc. This includes functions associated with the administration of all group information processing of claims, interaction with members, providers and employers. Special reports and projects to include initial review and analysis, recommend

Under the direction of a Pharmacy Team Coordinator (TC), the Pharmacy Prior Authorization Coordinator II (PAC II) is responsible for supporting the day to day operations for the call center and prior authorization cases for all lines of business (Medicaid, Medicare, Exchange and Commercial). Provides knowledgeable and courteous customer service and response to members and

Expected to work closely with the Manager, other clinical and QI staff to assure the overall success of the Healthcare Effectiveness Data and Information Set (HEDIS) Project, appropriateness of care and other QI Projects as assigned. Primarily responsible for conducting medical record reviews, data entry and abstraction of data for HEDIS measures, appropriateness of care