Our mission-driven organization is focused on the “Triple Aim” - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.
The Culinary Health Fund serves over 100,000+ workers and 220,000 covered lives in the hospitality and gaming industry. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!
Integrity – Must be trustworthy and principled when faced with complex situations
Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required
Communication – Ability to generate concise, compelling, objective and data-driven reports
Teamwork – Working well with others is required in the Fund’s collaborative environment
Diversity – Must be capable of working in a culturally diverse environment
Continuous Learning – Must be open to learning and skill development. As the Fund’s needs evolve, must be proactive about developing new areas of expertise
Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect)
A purpose of this position is to analyze medical charts, trend lines, and applicable transparency websites, to determine whether there are adverse trends and peer review cases comply with standards. Build quality standards into Network panel. To ensure negotiated hospital contracts contain measureable, consistent, contemporary quality measurement language. Provide site visits of new providers and providers for whom the Fund has received complaints.
ESSENTIAL JOB FUNCTIONS AND DUTIES
Performs Essential Job Functions and Duties with or without reasonable accommodation
Skills and Abilities
Years of Experience and Knowledge
Education, Licenses, and Certifications