Lead day-to-day census, enrollment, eligibility, and Medicaid re-eligibility operations.
Develop, maintain, and enforce department policies, procedures, workflows, and monitoring routines.
Supervise, mentor, and develop staff while setting clear expectations and maintaining accountability for performance and quality.
Habitat Health aims to help older adults experience an independent and joyful aging journey. They provide clinical and social care through the Program of All-Inclusive Care for the Elderly (“PACE”) in collaboration with healthcare partners like Kaiser Permanente.
Manage the full enrollment process for Medicare and Medicaid across applicable states.
Prepare, complete, and submit all required enrollment applications and documentation.
Track application status and follow up with agencies to drive timely approvals.
BetterHelp aims to improve mental health and make mental healthcare accessible. They are the world’s largest online therapy service with over 30,000 licensed therapists, and they value employee mental health, investing in their team’s well-being and professional development.
Administer day-to-day health and welfare benefits including new hire enrollments and terminations.
Manage leave administration lifecycle and ensure compliance with federal regulations.
Partner with HRBPs on leave planning and return-to-work strategies.
Jobgether uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Final hiring decisions are ultimately made by humans.
Administer and organize various types of projects within the Healthcare Development team.
Support project teams on meetings and logistics coordinating virtual and in-person meetings and education.
Assist with preparing reports and deliverables per project requirements.
The American Heart Association's mission is to be a relentless force for a world of longer, healthier lives. They have cut cardiovascular disease deaths in half since 1924, and they continue to strive for progress with a team of passionate individuals.
Gather, validate, and prepare data from multiple sources.
Identify missing or inconsistent fields and partner with Operations to resolve issues.
Zócalo Health is the first tech-driven provider built specifically for Latinos, by Latinos, developing a new approach to care designed around shared and lived experiences. Founded in 2021, they are backed by leading healthcare and social impact investors.
Relaying participant eligibility information to insurance carriers via email, fax or mail following standard operating practices.
Performing day-to-day data entry tasks and other clerical support tasks to facilitate the capture, transfer and maintenance of accurate and timely data/records.
Answering questions or explaining information to clients and participants, reviewing files, records and other documents to obtain information for a response to requests regarding a benefit plan or personal participant account status/activity.
HealthEquity's mission is to SAVE AND IMPROVE LIVES BY EMPOWERING HEALTHCARE CONSUMERS. They aim to make HSAs as widespread and popular as retirement accounts, providing solutions that allow American families to connect health and wealth.
Oversees day-to-day adjudication operations and ensures a compliant operational environment.
Establishes and maintains reports that support the efficacy of each service authorization process activity.
Monitors encounter data submissions for accuracy and maintains documentation and troubleshooting processes to support data quality.
Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of All-Inclusive Care for the Elderly (“PACE”) in collaboration with our leading healthcare partners, including Kaiser Permanente. They are redefining aging in place and building engaged, fulfilled care teams to deliver personalized care.
Oversees daily operations of the Care Management unit and ensures process implementation.
Facilitates staff development, provides regular performance feedback, and identifies areas of improvement.
Evaluates performance metrics, supports staff in care planning, and promotes interdisciplinary collaboration.
Capital Blue Cross promises to go the extra mile for our team and our community. They offer a caring team of supportive colleagues and invest heavily in training and continuing education. Employees consistently vote them one of the “Best Places to Work in PA.”
Administer the day-to-day operations of benefit programs in accordance with plan documents and regulations.
Manage leaves of absence in coordination with external vendors and the payroll team.
Provide guidance and support to People & Culture Partners and employees on benefits-related matters.
Bounteous is an end-to-end digital transformation consultancy dedicated to partnering with ambitious brands to create digital solutions. They have over 4,000 expert team members across the Americas, APAC, and EMEA and an engagement model designed to align interests and accelerate value creation.
Provides policy expertise related to systems or products.
Communicates Medicaid program insight to UX researchers and designers.
Analyzes laws and policy documents and explains their impact.
A1M Solutions is a woman-owned small business focused on providing value to customers, employees, partners, and the community, while remaining aligned to its guiding principles. A1M’s mission is to preserve and improve government healthcare programs for underserved people in the United States, focusing on projects with nation-wide impact at the intersection of policy, data, and user experience design.
Maintain oversight over a specified panel of members by performing ongoing assessments.
Create comprehensive care plans addressing members' needs and conducting regular follow-ups.
Ensure achievement of targeted goals related to patient outcomes and care plan realization.
Jobgether is a company that uses an AI-powered matching process to ensure applications are reviewed quickly, objectively, and fairly against the role's core requirements. Their system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
Monitor real-time demand and key performance metrics.
Deploy resources according to plan and manage service levels.
Communicate workforce deployment and schedules updates.
Transcarent and Accolade have come together to create the One Place for Health and Care, the leading personalized health and care experience that delivers unmatched choice, quality, and outcomes. Together, more than 20 million people have access to the combined company’s offerings and they are looking for teammates to join them in building their company and culture.
Establish and maintain licensing processes for Physicians, Nurses, and Licensed Mental Health providers.
Monitor progress and approval of submitted licenses ensuring timely completion.
Serve as the primary point of contact for all matters related to licensing.
TimelyCare provides virtual medical and mental health support. They foster a supportive team culture with a mission-driven purpose and are an equal opportunity employer.
Lead and manage a team of revenue cycle and/or eligibility specialists.
Serve as the primary subject matter expert for insurance eligibility verification and billing requirements.
Oversee day-to-day revenue cycle operations, including patient billing support and claim resolution.
Midi Health is focused on scaling billing operations. They have a fast-paced, growth-focused environment that supports teamwork and continuous improvement.
Manages client denials and concerns through analytic review of clinical documentation.
Delivers final determination based on skillsets and partnerships with Humana parties.
Investigates and resolves member and practitioner issues via phone or face to face to support quality goals.
Humana Inc. is committed to putting health first for teammates, customers, and the company. Through Humana insurance services and CenterWell healthcare services, they strive to make it easier for millions to achieve their best health, delivering needed care and service.
Work with Transportation Providers and resolve service issues.
Coordinate and conduct monthly provider performance evaluations.
Manage day-to-day vendor interactions and ensure satisfaction.
Jobgether uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Their system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
Independently resolve a broad range of member inquiries across Maven Managed Benefits, fertility programs, and Maven Wallet workflows.
Interpret and clearly explain benefits design, eligibility, and coverage to members, identifying edge cases and ensuring alignment with plan rules.
Manage end-to-end reimbursement and payment workflows, including reviewing documentation, identifying discrepancies, guiding members on next steps.
Maven Clinic is the world's largest virtual clinic for women and families on a mission to make healthcare work for all. More than 2,000 employers and health plans trust Maven's end-to-end platform to improve clinical outcomes, reduce healthcare costs, and provide equity in benefits programs. Maven Clinic is a recipient of over 30 workplace and innovation awards.
Navigate the Medicare system for patients and caregivers.
Manage care coordination and logistics, including specialist visits.
Advocate for patients by identifying billing errors and cost-saving programs.
Carewell is dedicated to providing a trusted retail source for caregiving products, offering expert-vetted items like incontinence supplies and mobility aids. They are recognized as one of the fastest-growing companies in the US, committed to improving teams, partnerships, and solutions.
Submit, track, and manage all Community Supports, Enhanced Care Management and Community Health Worker authorizations/reauthorizations/referrals
Update Athena with authorization information and For Community Supports: add members to the outreach assignment tracker and ensure compliance with the 24-hour assignment standard
Ensure workflow alignment with referral/authorization processes and Conduct internal checks for compliance, quality assurance, and clinical alignment
Zócalo Health is a tech-driven provider built specifically for Latinos, by Latinos, developing a new approach to care designed around shared and lived experiences. Founded in 2021, they are backed by leading healthcare and social impact investors, aiming to improve the lives of communities that have dealt with generations of poor experiences.