WELCOME TO CONNEXUS SOLUTIONS
Connexus Solutions is a managed care advisory firm that provides risk bearing organizations with turn-key solutions for addressing health plan compliance issues and other delegated functions.
These functions include
- updating managed care policy & procedures
- providing comprehensive corrective action plan for health plan deficiency audits
- assessment of managed care delegated programs
- managed care systems implementation
- provider network development and contracting
Connexus Solutions will incorporate a tailored approach by conducting a forensic review of risk bearing organizations that are under health plan and/or Department of Managed Care Corrective Action Plan. Our advisor team will develop and incorporate a detailed business plan to address the structural and technical deficiencies as identified in the health plan compliance audit.
Managed Care Services
Policies and Procedures
Our advisor team has decades of experience in the development of Managed Care Policies and Procedures across all product lines including Commercial, Medi-Cal, Medicare. Our Managed Care Programs can be tailored for the health plan delegated functional areas such as Claims, Medical Management and Credentialing.
Health Plan Corrective Action Plan
Connexus has developed industry audit tools for risk bearing organizations that are under health plan corrective action plan and/or compliance monitoring by the Department of Managed Care (DMHC). Our advisors have extensive experience working with health plan auditors to develop a corrective action plan that is based upon industry benchmarks and regulatory guidelines.
Managed Care Delegation Program Evaluation
Connexus advisors can perform detailed analysis of the risk bearing organization delegated departments including work-flow assessment, technical program review and baseline metrics evaluation.
Managed Care Systems Implementation
Connexus advisors have experience in project management with implementation managed care technology platforms utilizing industry applications to create seamless data transfer and operational efficiency.
Provider Network Development
Connexus has experience with building a Provider Network for risk bearing organizations that will encompass contracting with specialists, ancillary providers, hospitals and health plans.