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A&G Weekend Inventory Manager

NY Req ID: R018244 Remote
Duties & Responsibilities:Prepare and plan the weekend staff’s assignments and volume to ensure complianceTriage and assign expedited appeals while helping standardize and optimize how Appeals and Grievances are routedManage inventory to ensure regulatory compliance for appeals processed...
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Clinical Correspondence/Writer-1

NY Req ID: R018266 Remote
Duties and Responsibilities:·       Conduct daily reviews of member and provider correspondence while reviewing clinical system (TruCare) events to ensure compliance with all State and Federal regulations.·       Meet established time frames for completion of assigned correspondence.·      ...
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Clinical Correspondence Writer/Editor-4

NY Req ID: R018265 Remote
Duties and Responsibilities:Conduct daily reviews of member and provider correspondence while reviewing clinical system (TruCare) events to ensure compliance with all State and Federal regulations.Meet established time frames for completion of assigned correspondence.Identify deficiencies and...
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Clinical Pharmacist - Hybrid

NY Req ID: R018335 Remote
Duties & Responsibilities:Support initiatives to resolve gaps in care through direct provider and member outreach, collaboration with provider engagement, and leveraging our pharmacy network capabilitiesEnsure that all recommendations are consistent with the latest guidelines or otherwise...
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Bilingual Spanish Clinical Auditors

FL Req ID: R018322 Remote
This position is RemotePerform routine random/target audits of operational processes (e.g., call centers, enrollment/terminations, invoicing/dunning, member/provider notifications, workforce management, sales/retention, etc.) across multiple lines of business and productsConfirm employee...
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Clinical Support Team Social Worker

NY Req ID: R018351 Remote
Duties and Responsibilities:•        Completes assessment for each member related to their receipt of community based long-term care services.•        Develops a comprehensive care plan for each member based on assessments, counseling, environment, social support and financial status.•       ...
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Support Operations Team Leader

NY Req ID: R018364 Remote
Duties & Responsibilities:  Supervises, evaluates, and coordinates daily team operations and responsibilities to ensure that departmental productivity goals are met in regards to quality, timeliness, accuracy, and consistency.Allocates, monitors, and assigns resources while delegating and...
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Support Coord

NY Req ID: R018355 Remote
Duties and Responsibilities: Provides excellent quality customer service to our members and/or providers relating to questions/issues such as coordinating care, DME outreach, scheduling appointments, and screen assessments to identify risk factors which need closer interventionHandles calls to...
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Mgr Care Mgmt - Disenrollment Team

NY Req ID: R018379 Remote
Duties/Responsibilities:·       Develops and monitors team goals; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; routinely evaluates staff’s clinical skills and technical comprehension; and ensures an atmosphere of open communication, teamwork, and...
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Support Specialist

NY Req ID: R018367 Remote
Duties and Responsibilities: Conduct outreaches for newly enrolled members to review current and approved services, durable medical equipment (DME) and additional requestsReview intake documents for pre-approved services and escalate discrepancies as neededComplete Welcome Onboarding and Consumer...
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QA Ops Auditor

FL Req ID: R018326 Remote
Perform routine random/target audits of operational processes (e.g., call centers, enrollment/terminations, invoicing/dunning, member/provider notifications, workforce management, sales/retention, etc.) across multiple lines of business and productsConfirm employee adherence to company, state and...
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Support Coordinator

FL Req ID: R018391 Remote
Duties and Responsibilities: ·       Provides excellent quality customer service to our members and/or providers relating to questions/issues such as coordinating care, DME outreach, scheduling appointments, and screen assessments to identify risk factors which need closer intervention·      ...
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Per Diem, Assessment RN, Bronx, NY

NY Req ID: R018401 Hybrid
Duties and Responsibilities: ·        Conducts home assessments for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills.  As...
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Care Manager RN/SW - 100% Remote

NY Req ID: R018404 Remote
Duties and Responsibilities:Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.Conducts assessments to identify barriers and opportunities for intervention.Develops care plans that align with the physician’s treatment plans and recommends...
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UM Support Coordinator - 100%

NY Req ID: R018418 Remote
Duties and Responsibilities: Provides excellent quality customer service to our members and/or providers relating to questions/issues such as coordinating care, DME outreach, scheduling appointments, and screen assessments to identify risk factors which need closer interventionHandles calls to...
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Care Manager - 100% Remote

NY Req ID: R018426 Remote
Duties and Responsibilities:The care manager will be responsible for dual eligibility plan.Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.Conducts assessments to identify barriers and opportunities for intervention.Develops care plans...
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Clinical Quality Manager

NY Req ID: R018431 Hybrid
 Job DescriptionInteracts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changesReviews billing codes, medical records, and claims submission processes to ensure accuracyAttends and facilitates any initiative meetings (studies, partnerships)...
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