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 concierge advocate acts as a primary point of contact for members, resolving healthcare administrative issues through inbound and outbound calls. They manage member relationships, perform research to resolve concerns, and coordinate with internal and external stakeholders to ensure effective service delivery.
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 peer advocate will conduct outbound calls to members to provide support, guidance, and health education based on personal lived experience. They will also coach members on risk-minimization strategies and assist in overcoming obstacles to accessing care.
The Member Experience Guide acts as a primary point of contact for members, managing inquiries from start to finish with empathy and accountability. They are responsible for resolving member issues, explaining complex benefits, and identifying opportunities to improve service delivery.
The RN will provide person-centered care management to frail seniors, including telephonic assessments and the development of care plans to manage chronic conditions. They will work within an interdisciplinary team to prevent avoidable hospitalizations and support members in navigating the healthcare system.
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 Advanced Practice Clinician provides primary care to members in their residences, including wellness exams, chronic disease management, and coordination with healthcare teams. They also participate in on-call programs and collaborate with specialists to ensure continuity of care and hospital avoidance.
The Social Worker will provide person-centered interventions for high-risk members, focusing on behavioral health, substance use, and psychosocial needs. They will collaborate with interdisciplinary teams to develop care plans and conduct assessments to prevent unnecessary healthcare utilization.
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.
The Member Experience Guide acts as a primary point of contact for members, managing inquiries from start to finish with empathy and accountability. They are responsible for resolving complex issues, providing clear guidance on benefits, and advocating for process improvements to enhance the overall member experience.
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.
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.
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 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.
