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 facilitate access to benefits and healthcare services.
The Advanced Practice Clinician provides primary care to seniors 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 Claims Auditor performs pre-pay and post-pay audits to ensure the accuracy of claims payments and denials. They also maintain regulatory compliance and work closely with other departments to resolve processing errors.
The GAD Coordinator manages a team of Member Services Representatives and oversees the intake process for Part C and D Pre-Service Appeals. They are responsible for ensuring member inquiries are addressed, maintaining accurate databases, and suggesting service improvements based on member feedback.
The Advanced Practice Clinician will provide primary care to members in their residences, including wellness exams, chronic disease management, and diagnostic testing. They will collaborate with case management teams and primary care physicians to ensure continuity of care and optimize clinical outcomes.
Support broker and agency partnerships by responding to inquiries, managing account records, coordinating training and communications, and assisting with recruitment and retention. Help the Broker Sales team meet growth goals by tracking activity, preparing reports, distributing sales materials, and supporting compliance and administrative requirements.
Perform telephonic assessments for dually eligible members to determine care needs and nursing facility level of care. Develop and implement person-centered care plans while providing health education to manage chronic conditions and prevent avoidable hospitalizations.
The Advanced Practice Clinician will provide and coordinate primary care to members in their place of residence, including wellness exams, chronic disease management, and diagnostic testing. They will collaborate with case management teams and primary care physicians to ensure continuity of care and address clinical quality gaps.
The Senior Care Coordinator will assess, plan, and monitor the holistic behavioral and medical needs of SCAN members to support their health and independence. They will act as a primary point of contact to facilitate referrals, resolve access issues, and provide education to members and caregivers.
Oversee the daily operations, productivity, quality, and compliance of a multidisciplinary care management team serving complex members, including telephonic and field-based staff. Coach and develop employees, resolve escalated member and provider issues, maintain accurate procedures and training materials, and lead projects and chronic disease management programs.
The Medical Management Specialist-RN supports utilization management processes by conducting pre-service and concurrent reviews to ensure medical necessity and cost-effectiveness. They also manage complex medical cases, coordinate care transitions, and collaborate with interdisciplinary teams to ensure members receive appropriate services.
Perform telephonic assessments for dually eligible members to determine care needs and nursing facility level of care. Develop and implement person-centered care plans while providing health education and coaching to manage chronic conditions.
The Advanced Practice Clinician will provide primary care to members in their place of residence, including wellness exams, chronic disease management, and care coordination. They will collaborate with case management and primary care physicians to ensure continuity of care and address clinical quality gaps.
The Vice President leads the strategy, performance, and modernization of claims, provider data, and payment integrity operations to ensure accuracy and compliance. They are responsible for driving operational excellence through automation, AI, and cross-functional collaboration to improve provider experience and member outcomes.
The peer advocate will conduct outbound calls to members to provide support, guidance, and advocacy based on health interventions. They will build rapport using personal lived experiences to coach members on health strategies and encourage positive behavior changes.
This role identifies and quantifies total cost of care savings opportunities by applying data science and AI-enabled analytics to claims, clinical, and contract data. The incumbent collaborates with cross-functional stakeholders to translate analytic findings into actionable medical cost management strategies.
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.
