The Advanced Practice Clinician provides primary care to members in their residences, including wellness exams, chronic disease management, and diagnostic testing. They collaborate with case management and primary care physicians to ensure continuity of care and address clinical quality gaps.
The Care Coordinator will assess, plan, and monitor the holistic needs of members to support their health and independence. They will act as a primary point of contact for members and providers to troubleshoot access issues and coordinate care services.
The Broker Account Executive is responsible for overseeing, training, and servicing the broker distribution channel to achieve sales targets for Medicare Advantage plans. This role involves managing relationships with agencies, conducting broker education, and ensuring compliance with federal and state regulations.
The Concierge Advocate acts as a primary point of contact for members, resolving healthcare administrative questions and issues through inbound and outbound calls. They also manage member records, perform proactive outreach, and coordinate with internal and external stakeholders to ensure effective issue resolution.
The representative will facilitate telephonic enrollment for health plans and manage prospect requests while adhering to CMS regulatory guidelines. They are also responsible for scheduling sales appointments and maintaining accurate records within the CRM system.
The Senior Accountant manages financial transactions, reconciliations, and regulatory compliance for the Medicare Part D pharmacy program. They collaborate with internal and external stakeholders to provide accurate financial reporting and support operational decision-making.
Coordinate high-quality care for members by managing authorizations, conducting utilization reviews, and facilitating discharge needs from acute and skilled nursing settings. Serve as the primary point of contact for patients, families, and providers to ensure timely delivery of services and medical supplies.
Leads end-to-end provider data operations to ensure a single source of truth for provider intelligence across the enterprise. Drives strategy for data accuracy, governance, and AI-enabled automation to support regulatory compliance and operational efficiency.
Acts as a primary point of contact for members to resolve questions regarding benefits, eligibility, claims, and referrals. Ensures high member satisfaction by providing professional support and coordinating solutions across various departments.
Supports the Medical Management department by processing provider calls, faxes, and inpatient data into the case management system. Responsible for authorizing services and verifying member eligibility and benefits to ensure quality care delivery.
The role manages the end-to-end sales commission process and provides analytics on incentive compensation plans. It involves auditing data for accuracy, resolving payment discrepancies, and partnering with Finance and HR to optimize sales performance.
Oversee the design and implementation of the Part D program, ensuring CMS compliance and operational excellence for a senior-focused Medicare Advantage Plan. Manage the contracted pharmacy benefit manager (PBM) and lead the Pharmacy Experience & Access team to optimize member experience and clinical operations.
Lead the development and execution of the Special Investigations Unit (SIU) infrastructure to manage fraud, waste, and abuse (FWA) programs. Oversee complex investigative cases, ensure regulatory compliance, and collaborate with legal and internal audit teams to implement recovery efforts.
Serve as the primary point of contact for members regarding benefits, eligibility, claims, and referrals. Ensure member satisfaction by providing quality customer service and resolving issues efficiently while adhering to regulatory guidelines.
Acts as a primary point of contact for members to resolve questions regarding benefits, eligibility, claims, and referrals. Ensures member satisfaction by providing high-quality customer service and coordinating resolutions with providers and internal departments.
Lead the pharmacy operations team to ensure regulatory compliance with CMS and other state requirements regarding prescription drug benefits. Oversee PBM operations, manage Part D reporting, and drive departmental goals through cross-functional collaboration.
The Broker Account Executive is responsible for overseeing, training, and servicing the broker distribution channel to achieve sales targets for Medicare Advantage plans. This role involves maintaining relationships with agencies, ensuring regulatory compliance, and coordinating broker education and marketing campaigns.
