The LTSS Provider Representative serves as the primary liaison between the health plan and the provider network to resolve operational issues and ensure quality care. Responsibilities include conducting site visits, managing provider relationships, and supporting recruitment and compliance efforts.
The Grievance and Appeals Nurse investigates and processes complex medical necessity appeals for members and providers. They prepare recommendations for medical directors and ensure all resolutions meet regulatory timeframes.
Manage a caseload of pregnant members by providing telephonic support, care coordination, and education throughout pregnancy and postpartum. Collaborate with healthcare providers to develop care plans, monitor progress, and ensure members have access to necessary resources.
The Medicaid Housing Coordinator will design and oversee housing programs to support members experiencing homelessness or housing instability. They will collaborate with community partners and healthcare providers to ensure integrated service delivery and sustainable housing solutions.
