Our contingent workforce plays a critical role in working with our new and existing Medicare clients to process enrollments and various other requests. The position will work in accordance with the Center for Medicare/Medicaid Services (CMS) guidelines to ensure regulatory compliance takes place. This position requires a strong focus on accurate and timely customer support to ensure member enrollment o Identifying and processing different types of documents and routing them to the correct area for processing. o Processing returned mail and updating members’ addresses o Meet monthly established quality and productivity goals on a consistent basis o Follow work instructions regarding enrollment tasks

The Contractual Eligibility Consultant is responsible to research and validate enrollment information, processing enrollment transactions, make outbound calls to enrollees and members to obtain required enrollment information, handle member inquiries and participate in enrollment projects. The Contractual Eligibility Consultant will support training initiatives and work to resolve member inquiries or concerns

Location: Remote in EST Time zone. •Works with internal staff across multiple departments to assist with data sources, processes and activities required to meet regulatory compliance requirements with a key focus on Utilization Review (UR) /Utilization Management (UM) • 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. •Data gathering requires navigation through multiple system applications. •Prior experience in performing data collection is preferred.

Location: Miami Dade, FL (ZIP CODES: 33010, 33012, 33013). Must be fluent in speaking Spanish, be able to have a full conversation The Case Management Coordinator is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. The Case Management Coordinator will effectively manage a caseload that includes supportive and complex members. Develop a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration. Case Management Coordinators will determine appropriate services and support due to members’ health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and support.

Location: Franklin, TN (Hybrid). Responsibility for taking about 50 to 75 calls a day. Work with a team of specialists dedicated to one of our manufacturers to provide reimbursement support services. Have direct interaction with the manufacturer client to provide case statuses and updates.

Provides technical support for all food product development activities. High emphasis on documentation, record keeping, reporting, sample storage, and sample demonstration preparation. Function allows staff to focus on broad strategic work.

Profee coders who must know how to code ortho (with surgeries), cardio (with surgeries), ENT, primary care, and podiatry. E/M leveling & Injections/Infusions. A well rounded profee coder so they can pivot specialties as needed This type of coding involves evaluating and managing services provided in outpatient settings like physician offices, clinics, and other healthcare facilities. It focuses on services like office visits, consultations, preventive care, and follow-up appointments.

This position requires a bachelor's degree and 2-4 years of experience in healthcare administration, nursing, public health or in a related area. Managed care experience preferred. In collaboration with clinical and quality leaders, the Program Manager manages the implementation and administration of population health programs development, supports the state strategic pillars, drives improvements in health outcomes, and strengthens operational initiatives that are required under state contract, RFP, or other state/national standards. Reporting to Population Health Officer, the successful candidate will work directly with cross functional teams to ensure deliverables fall within the applicable scope, timeline and budget; coordinate with state, national and internal partners to ensure all programs are designed and delivered to meet goals, measures and outcomes with defined policies, procedures, workflow, training materials and reporting in accordance with corporate, state or other requirements.

Small Description: • Work from Home. Candidates must reside in Osceola County, FL. specifically in St. Cloud/Kissimmee, to include zipcodes 34769, 34744, 34743, 34741, possibly 34771/34772 • Training will be conducted remotely via Microsoft Teams. • Candidate will travel approximately 75% of the time within the region seeing Members at home, in assisted living facilities and nursing homes.