Location: REMOTE in OH State Work Schedule: Schedule is Monday – Friday, 8am-5pm, standard business hours. No required holidays or weekends This role serves as the "Front desk" to the plan. This individual will work on a variety of administrative tasks to assist the Care Coordination department that may include but are not limited to, the inbound care management queue line, responding to questions and inquiries from both members/guardians or parties assisting with services. They will be responsible for taking referrals, confirming their Medicaid eligibility and processing the referral. This role will also complete Health Risk Assessments for all members assigned. It is imperative that the CMA must be able to practice both a high level of professionalism and compassion at all times when interacting with various departments or member representatives. The CMA will also support administrative needs that involve comfortability with working in complex data systems, an Electronic Record System and/or Excel at any given time. Tasks can change with little notice to meet the demands of the health plan requiring flexibility.

Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.

Location: Grosse Pointe, MI 48230. Work Schedule: Will work in clinic a rotation of 10-hour weekdays and every other weekend. Nurse Practitioners will work in collaboration with a dedicated clinical care team to provide evidenced-based care to a panel of patients. The clinical care team will work with the provider daily to drive better outcomes for entire panel of patients. This will include accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning. This role will be reported to the practice manager.

Nurse Practitioners will work in collaboration with a dedicated clinical care team to provide evidence-based care to a panel of patients. The clinical care team will work with the provider daily to drive better outcomes for entire panel of patients. This will include accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning. This role will be reported to the practice manager.

This position requires up to 50-75% travel to complete Face to Face visits in the state of NJ in various settings including, but not limited to, homes, hospitals, provider settings, etc. Travel requirements are subject to change based upon business need.

Case management experience required long term care experience preferred Microsoft Office including Excel competent

The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license

The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

Location: Arlington and surrounding areas & SE Dallas and surrounding areas in TEXAS This role is working remotely; this position will require travel to meet in person with members around Service Delivery Area 75% of the time. Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes

Participates in the collection and review of medical records to abstract clinical information for HEDIS quality reporting. Training will be provided prior to the start of the assignment. Assist the HEDIS department with outreach calls to our Social Risk Factors population to close gaps in care.

Participates in the audit/overead of the medical record collection and review process for HEDIS quality reporting. Training will be provided prior to the start of the assignment. This position audits and interprets relevant clinical criteria through review of medical records, annotates via Adobe PDF and audits data populated within a data collection tool to support compliance with HEDIS and CMS performance measures. Ensures accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements. The candidate must be proficient with databases and with conducting 100% of work activities on the computer.

Nurse Practitioners will work in collaboration with a dedicated clinical care team to provide evidence-based care to a panel of patients. The clinical care team will work with the provider daily to drive better outcomes for entire panel of patients. This will include accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning. This role will be reported to the PRACTICE MANAGER.