Peak Health

Graphics Designer

• Perform a variety of tactical functions to support the timely and successful execution of marketing plans and other activities for the Marketing/Communications Department.
• Design creative and engaging marketing materials, including brochures, fliers, sales collateral, and member materials that communicate key messages about health insurance products.
• Collaborate with the marketing and communication teams to create visually appealing and user-friendly content for both internal and customer-controlled materials.
• Develop and design materials for social media, websites, online ads, and digital presentations that align with our brand identity and marketing strategies.
• Create infographics and visual aids that simplify complex health insurance information, ensuring it is clear and easily understood by our audience.
• Ensure consistency in all design materials, maintaining the integrity of the brand’s voice, tone, and visual identity.
• Edit and prepare files for print, digital publishing, and social media campaigns.
• Responsible for graphic design of Peak Health marketing collateral and other printed pieces, signage, video, and digital marketing tactics.
• Work on projects that support both external marketing and internal communication needs, such as presentations and reports.

Graphic Designer – Marketing Specialist

Manager

• Manage and triage self-referrals, identifying high risk members through HRA
• Reporting and admissions data, auditing patient charts of delegated case management programs to meet accreditation standards
• Connect members with in-network providers and resources
• Participate in activities related to care management program build, implementation, oversight, and delegation
• Perform utilization management reviews as needed according to accepted and established criteria, as well as other clinical guidelines and policies
• Assist members in understanding their available medical benefits
• Identify barriers preventing the member from meeting maximum quality of life
• Review and Evaluate Health Risk Assessment (HRA) data to help drive development of programs and services geared toward member needs
• Review and Evaluate member outcomes data and work with other team members on performance improvement opportunities
• Utilizing NCQA standards in auditing processes of member records as part of care management oversight processes
• Investigating potential quality of care issues that may affect the quality or safety of the health of members

Care Manager, RN

• Oversees the build and Implement utilization management review processes (Prior Authorization, Predetermination, Concurrent Reviews, Retrospective Reviews) that are consistent with established industry and regulatory standards/guidance.
• Manages the build and implement all utilization management reviews according to accepted and established criteria, as well as other clinical and regulatory guidelines and policies.
• Assists in the development and implementation of policies and procedures related to the Utilization Management processes.
• Ensures that utilization management interventions are collaborative and focus on maximizing quality member health care outcomes.
• Supervises the facilitation of the Peer-to-Peer Review process, and work with the Medical Directors to continuously improve member and Provider Network services for this process.
• Oversees the education on utilization management that is provided to internal and external stakeholders and partners to continuously improve processes and build network relationships.
• Facilitates a collaborative environment that focuses on collaboration with other members of the medical management team to identify members whose healthcare outcomes may be enhanced by coaching and/or case management interventions.
• Educates team members on the data that is collected within the position and facilitate improvement in outcomes within the team.
• Assists with monitoring performance standards, productivity and ensuring staff coverage to meet the needs of the department.
• Formulates, implements and evaluates educational strategies for staff.
• Maintains a working knowledge of the requirements of regulatory and compliance entities.
• When needed, fill in for staff members to ensure that the operations of the utilization management team are never compromised.
• Commits to a career of life-long learning and continuous improvement of processes that span the realm of Utilization Management.
• Provides clinical, procedural or interpretational assistance.
• Ability to present complex ideas and data to a wide variety of stakeholders from frontline employees to executive c-suite.
• Other duties as assigned or requested.

Manager, Utilization Management, RN

Customer Support

• Supervises and coordinates activities and employees related to all Enterprise Customer Service and processing including billing, self-pay collections, customer service, and financial counseling of patients within West Virginia Medicine Hospitals, and University Medical labs to ensure the financial viability of the clinical and business enterprise
• Maintain internal controls over accounts receivable records and collection of cash
• Establish and implement controls for submission, billing and payment cycles to ensure integrity of accounts receivable and patient information as well as supervising and controlling cash collected directly from patients
• Negotiate special discount arrangements, using sound financial practices, within the guidelines of State and Federal regulations
• Assures department compliance relating to the extension of credit, billing, and allowable follow-up
• Monitors daily operations to help ensure adherence to documented administrative and departmental policies and procedures
• Coordinates billing operations (including late charge issues, charge issues, coding issues) with other departments and/or outside referral sources/agencies/facilities to ensure continuity of care timely communication and accurate revenue cycle operations
• Identifies on-going continuing education needs of existing employees as well as new employees
• Complete annual reviews as well as 90 day review
• Keeps staff informed of process, policy and other changes through presentation at regular staff meetings, face to face communication and email correspondence
• Provides coaching and counseling to staff based upon performance management principals
• Efficiently and assertively coordinates resolution of problems with other departments as monitored by Manager or Director
• Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability, and efficiency
• Handles patient/family or staff complaints, investigates complaints, and makes recommendations of appropriate resolution
• Works with Manager or Director to develop and attain quarterly objectives
• Maintains confidentiality according to policy when interacting with patients, physicians, families, coworkers and the public regarding demographic/clinical/financial information
• Demonstrates flexibility to meet the needs of the department or hospital in regard to changes in work volume, planned change, scheduling changes, and emergency call – backs (i.e. weather or disaster)
• Maintains currently knowledge of major payor payment provisions
• Displays and understanding of third-party payor regulations related to managed care, denials, and reimbursement issues
• Able to inform patients of hospital and clinic billing practices/polices and their rights and responsibilities regarding payments

Graphic Designer – Marketing Specialist

Care Manager, RN

Manager, Utilization Management, RN

Supervisor, Customer Service