Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan The Clinical Systems Analyst works with Medical Management and IS to ensure that the medical management applications function properly and that all upgrades, enhancements, and implementations are successful. In this role, the associate will pr...
Care Manager, Medicare (RN/MSW)
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Position Summary: The Care Manager (RN/SW) assists members appropriate for care coordination and case management services in achieving their optimal level of health. The Care Manager (RN/SW) is responsible for engaging the member and providers...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Hours: 8:30 am to 5:00 pm Position Summary: Under the direct supervision of the Supervisor, Manager and/or Director of Operations Quality Auditing, responsible for the timely and accurate review of various tasks performed by Operations (includ...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Hours: 8:30 am to 5:00 pm Number of Positions: 3 Position Summary: Under the direct supervision of the Provider Maintenance Supervisor, the Provider Maintenance Invalid Provider Queue Representative is responsible for resolving all claims that...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Position Summary: Coordinates the planning, administration, and implementation of corporate wide telecommunications services Provides equipment setup and installation of end user equipment, educating and orienting end users. Provides support t...
Dir, Quality Mngment, Medicare
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Position Summary: Under the general direction of the Clinical Quality Lead, the Director of Quality Management for Medicare programs is responsible and accountable for the successful, ongoing development, refinement, implementation, measuremen...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Position Summary: To validate contractual, business, and configuration requirements are met prior to release to the production environment. Principal Accountabilities: • Analyze contractual, business and configuration terms/documentation to id...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Hours: 8:30 am to 5:00 pm Reporting to the Vice President of Service Operations, the Director of Vendor Management is responsible for oversight of all contracts which support the Operational functions areas (Contact Center, Claims, Enrollment)...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Position Summary: Reporting to the Director of Financial Services - Enterprise Operations, this position will work in a collaborative manner with all departments within Enterprise Operations (Operations and Information Solutions). The position...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Principal Accountabilities: Strategy & Planning: • Creates updates and enforces technical standards and database migration procedures. • Ability to work with Unix System Administrators, SAN Administrators, and Microsoft Intel Administrators to...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Position Summary: Provides strong leadership in the planning, development, and execution of reporting, information, and data policies, activities, and products that drive achievement of strategic goals and business success in the Medical Manag...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Position Summary: This position is responsible for driving the delivery of all activity across the server infrastructure domain. He/she reports to the VP of IS-Infrastructure and will have direct reports to support various functions such as Wi...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Under the general direction of the Senior Manager, Corporate Audit/Investigations, the Clinical Investigator: • Helps execute strategy to reduce fraud, waste and abuse (FWA) • Reviews medical and payment records to identify potential errors an...
Keystone Mercy - Omaha, NE
Facility: Keystone Mercy Health Plan Principal Accountabilities: •Demonstrates a working knowledge and ability to explain Plan regulations, policies and procedures to providers. This requires the Account Executive to stay current with all updates and revisions. •Responsible for M...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Hours: 8:30 am to 5:00 pm Under the general direction of the Director of Corporate Training, the successful individual in this position effectively works in a matrix role, reporting to the Instructional Designer Manager for day-to-day processe...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Hours: 8:30 am to 5:00 pm Number of Positions: 3 Responsible for maintaining/developing workflow processes to meet client contracted response times, manage claim inventory, administrative oversight and staff development of Claims Examiners. Tr...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Position Summary: Dir, Architecture & Data Management is responsible to develop, implement and maintain the data systems that will enable AMFC to achieve business objectives that are dependent on having efficient, timely access to high quality...
Production Incident Specialist
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Under the general supervision of the IS Production and Change Control Manager, responsible for Tidal Application Support, Production Incident Tracking, Production Scheduling, Production SLAs and Production Documentation. Position Functions: • ...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Number of Positions: 6 positions available Position Summary: Business Analysis is the set of tasks, knowledge and techniques required to identify business needs and determine solutions to business problems and opportunities. Solutions often in...
Keystone Mercy - Philadelphia, PA
Facility: Keystone Mercy Health Plan Following project methodology, responsible for leading the research, analysis, design, coding, testing, debugging, documentation and maintenance of information systems development and issue resolution for all database environments. Performs ve...