The Supervisor oversees a multi-disciplinary team providing care management to members with intellectual or developmental disabilities and traumatic brain injuries. They ensure staff implement evidence-based practices and maintain compliance with NCQA procedures while managing whole-person care needs.
The Nurse Manager leads daily utilization management operations, overseeing teams responsible for authorization and clinical review workflows. They are accountable for performance monitoring, staff guidance, and ensuring the consistent application of clinical criteria and policies.
The Population Health Nurse provides clinical care management and population health support by analyzing data to identify member health needs and care gaps. They develop and implement care plans while coordinating services across providers to improve wellness outcomes and reduce reliance on episodic care.
The Care Transitions Specialist II coordinates and manages care transition activities to ensure successful discharges and service changes for individuals with complex needs. They develop transition plans, collaborate with community partners, and intervene to resolve barriers to service continuity.
The Care Manager provides complex care coordination and monitoring for members with intellectual or developmental disabilities, mental health needs, or substance use disorders. They utilize person-centered planning to assess needs, educate members on service options, and facilitate multi-disciplinary collaboration.
The Executive Assistant provides high-level administrative support to executive leadership and serves as a key liaison for internal and external stakeholders. Responsibilities include managing executive calendars, preparing reports and presentations, and coordinating board activities and leadership events.
The Care Manager serves as the primary point of contact for members, facilitating comprehensive assessments and developing integrated care plans to address physical, mental, and social needs. They collaborate with a multidisciplinary team and providers to ensure continuity of care and quality support for individuals with complex health requirements.
The Manager, Agile Integrations leads the delivery of integration services and manages the performance and development of the integration team. They are responsible for directing integration development, implementing standards, and coordinating cross-functional efforts to ensure reliable enterprise technology solutions.
Conduct prospective, concurrent, and retrospective clinical reviews to assess medical necessity, level of care, and ongoing care needs. Collaborate with providers and facilities on treatment planning and discharge coordination, and identify cases requiring physician review.
Assess members’ behavioral health, psychosocial needs, risks, and barriers, and use clinical judgment to connect them with appropriate services. Coordinate care among providers, multidisciplinary teams, and community resources, monitor member progress, and adjust coordination efforts to improve outcomes.
The Peer Support Specialist provides peer-based support to individuals navigating care transitions by using lived experience to build trust and promote engagement. They also facilitate group activities and connect individuals to community resources to promote recovery and independence.
The Care Manager provides complex care coordination and monitoring for members with intellectual or developmental disabilities, mental health needs, or substance use disorders. They utilize person-centered planning strategies to assess needs, educate members on their rights, and facilitate access to appropriate services and providers.
The Care Manager provides complex care coordination and monitoring for members with intellectual or developmental disabilities, mental health needs, or substance use disorders. They utilize person-centered planning strategies to assess needs, educate members on their rights, and facilitate access to community services.
The Senior Manager, IT Project Management oversees complex, enterprise-wide technology projects and programs to ensure alignment between business needs and IT capabilities. This role also leads and supervises a team of Project Managers and Analysts while managing project governance and strategic roadmaps.
The Care Manager provides tailored care management to members on the Registry of Unmet Needs by assessing their physical, behavioral, and resource requirements. They also educate families on available services and assist members in navigating Medicaid or disability determination processes.
