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  • Staten Island, NY, USA
    Req #328
    Monday, July 6, 2020
    JOB SUMMARY:   Support strategic planning exercises for all products to determine future growth opportunities; includes researching and data gathering from internal and external data sources and assisting with membership forecasting. Assist with Sales Operations and Business Development projects as needed, including sales lead forecasting and campaign reporting, sales performance tracking, commission processing. For all areas, provide input about data tracking and reporting ... More
  • Staten Island, NY, USA
    Req #327
    Monday, July 6, 2020
    JOB SUMMARY:   At CENTERS PLAN FOR HEALTHY LIVING (CPHL), we are seeking an energetic, highly driven individual to join our Marketing division.  This role is for someone that is people oriented, a great communicator and will thrive in a fast-paced environment.   We are currently looking for a Physician Relations Liaison to manage our providers in our network. Responsibilities include making regular on-site visits as well as expanding our network by having consistent i ... More
  • Staten Island, NY, USA
    Req #108
    Wednesday, July 1, 2020
    JOB SUMMARY:   The Assessment Nurse, works in collaboration with the Care Management team and is responsible for assessing a member’s eligibility for the Centers Plan for Health Living’s  (CPHL all LOB programs.  The Assessment Nurse will conduct a face-to-face comprehensive assessment utilizing NYSDOH approved assessment tool (UASNY) and risk acuity visits with a member in his/her place of residence. The Assessment Nurse is a member of the interdisciplinary care team (IDT). The membe ... More
  • Brooklyn, NY, USA
    Req #107
    Wednesday, July 1, 2020
    JOB SUMMARY:   The Assessment Nurse, works in collaboration with the Care Management team and is responsible for assessing a member’s eligibility for the Centers Plan for Health Living’s  (CPHL all LOB programs.  The Assessment Nurse will conduct a face-to-face comprehensive assessment utilizing NYSDOH approved assessment tool (UASNY) and risk acuity visits with a member in his/her place of residence. The Assessment Nurse is a member of the interdisciplinary care team (IDT). The membe ... More
  • The Bronx, NY, USA
    Req #106
    Wednesday, July 1, 2020
    JOB SUMMARY:   The Assessment Nurse, works in collaboration with the Care Management team and is responsible for assessing a member’s eligibility for the Centers Plan for Health Living’s  (CPHL all LOB programs.  The Assessment Nurse will conduct a face-to-face comprehensive assessment utilizing NYSDOH approved assessment tool (UASNY) and risk acuity visits with a member in his/her place of residence. The Assessment Nurse is a member of the interdisciplinary care team (IDT). The membe ... More
  • Westchester County, NY, USA
    Req #105
    Wednesday, July 1, 2020
    JOB SUMMARY:   The Assessment Nurse, works in collaboration with the Care Management team and is responsible for assessing a member’s eligibility for the Centers Plan for Health Living’s  (CPHL all LOB programs.  The Assessment Nurse will conduct a face-to-face comprehensive assessment utilizing NYSDOH approved assessment tool (UASNY) and risk acuity visits with a member in his/her place of residence. The Assessment Nurse is a member of the interdisciplinary care team (IDT). The membe ... More
  • Manhattan, New York, NY, USA
    Req #70
    Wednesday, July 1, 2020
    JOB SUMMARY:   The Assessment Nurse, works in collaboration with the Care Management team and is responsible for assessing a member’s eligibility for the Centers Plan for Health Living’s  (CPHL all LOB programs.  The Assessment Nurse will conduct a face-to-face comprehensive assessment utilizing NYSDOH approved assessment tool (UASNY) and risk acuity visits with a member in his/her place of residence. The Assessment Nurse is a member of the interdisciplinary care team (IDT). The membe ... More
  • Staten Island, NY, USA
    Req #103
    Wednesday, July 1, 2020
    JOB SUMMARY:   The Field Intake Nurse is responsible for assessing a member’s eligibility for the Managed Long Term Care program. The Intake Nurse will conduct a face-to-face comprehensive assessment utilizing NYSDOH approved assessment tool (UASNY) with a potential member in his/her place of residence. The Intake RN also utilizes CPHL’s database of record, completing all necessary documentation to meet CPHL standards. This position requires thorough knowledge of CPHL’s program and servi ... More
  • Staten Island, NY, USA
    Req #223
    Wednesday, July 1, 2020
    JOB SUMMARY: The Intake Representative position is responsible for reaching out to CPHL Managed Long Term Care Plan (MLTCP) referrals by phone; carefully explaining plan benefits and enrollment procedures; determining patient’s current services and what they are looking for today; and appropriately scheduling Intake RNs for in-home assessments. The Intake Representative acts as in-house liaison for RNs working in the field, insures that UAS’ (New York State’s clinical assessment tool) are a ... More
  • Staten Island, NY, USA
    Req #280
    Wednesday, July 1, 2020
    Position Details:  Professionally handle incoming inquiries via telephone, email or fax from providers (i.e. physician offices, clinics, social day cares, home care agencies, DME suppliers) regarding claim decision and payments across all Centers Plan for Healthy Living (CPHL) product offerings. Thoroughly and efficiently gather claim information, assess and fulfill the caller’s needs and educate the caller where applicable regarding claim submission procedures. Focus on r ... More
  • Farmingdale, NY 11735, USA
    Req #279
    Wednesday, July 1, 2020
    JOB SUMMARY:  Responsible for the timely and accurate adjudication of all claims for Centers Plan for Healthy Living (CPHL) products. Reviews and resolves pended and corrected claims. Analyzes claim resubmissions to determine areas for provider education or system re-configuration. Serve as the primary point of contact for claim issues raised by Providers and internal CPHL departments. Provides feedback on department workflows and identifies opportunities for redesign.  Performs claims testi ... More
  • Garden City, NY, USA
    Req #269
    Wednesday, July 1, 2020
    JOB SUMMARY:                        This Claims Business Analyst works collaboratively with the Director of Claims in supporting the department to deliver timely and accurate payment of claims and first call resolution. This role will also provide analysis related to the identification of improved claim system configuration and call flows that would positively impact quality performance, reduce claim inventory and improve the customer experience.     PRIMARY RESPONSIB ... More
  • The Bronx, NY, USA
    Req #8
    Wednesday, July 1, 2020
    JOB SUMMARY:   The nurse practitioner treats acute and chronic conditions in place while maintaining the highest level of daily function possible for CPHL members.  Scope of responsibilities include building connections with members, designated representative and the interdisciplinary care team (ICT) through assessing needs, creating individualized care plans, coordination of care to ensure smooth transitions across settings.   PRIMARY RESPONSIBILITIES:    Provide proacti ... More
  • Staten Island, NY, USA
    Req #124
    Wednesday, July 1, 2020
    JOB SUMMARY:   Responsible for the timely and accurate adjudication of all provider disputes (reconsiderations) or claims for Centers Plan for Healthy Living (CPHL) products. Reviews and resolves pended and corrected claims. Analyzes claim resubmissions to determine areas for provider education or system re-configuration. Serve as the primary point of contact for claim issues raised by Providers and internal CPHL departments. Provides feedback on department workflows and identifies oppor ... More
  • Staten Island, NY, USA
    Req #176
    Wednesday, July 1, 2020
    JOB SUMMARY:   The Supervisor of Network Data Management oversees the Network Data Management team, promotes problem solving, communication, excellent service, process improvement and quality control, and education/development. The position requires inter-department collaboration on projects, business development, network expansion and fortification including knowledge of contracting and credentialing.      PRIMARY RESPONSIBILITIES:    Supervise a team of Data Analysts Sp ... More
  • Margate, FL, USA
    Req #15
    Wednesday, July 1, 2020
    JOB SUMMARY:   As an integral part of the Grievance and Appeals (G&A) Department, the G&A Coordinator lends their support in processing member-related grievances and appeals across CPHL’s various lines of business. Process includes gathering, documenting, tracking, and pursuing resolution of complaints in accordance with regulatory and organizational guidelines to the member’s satisfaction.     PRIMARY RESPONSIBILITIES:    Logs and tracks verbal or written member grievan ... More
  • Staten Island, NY, USA
    Req #239
    Wednesday, July 1, 2020
    Position Summary The Sales Account Manager will responsible for enrolling NH residents who are interested in our I-SNP HMO plan.  The SAM will also be responsible for generating leads, qualifying and educating prospects/accounts on the plan.  They should be able to identify viable prospects and be able to establish relationships with stakeholders/accounts.  Reports to VP of Strategic Partnerships   Essential Duties and Responsibilities The essential functions include, but are n ... More
  • Staten Island, NY, USA
    Req #236
    Wednesday, July 1, 2020
    JOB SUMMARY:   The Enrollment Associate position is responsible for processing referrals/applications in an accurate and timely manner, entering all information into Case Trakker, communicating with appropriate departments as needed, maintaining accurate records, and appropriately escalating any issues that arise. The Enrollment Associate understands and easily communicates the eligibility criteria for the line of business they work under, and utilizes those programs and software neces ... More
  • Staten Island, NY, USA
    Req #242
    Wednesday, July 1, 2020
    JOB SUMMARY:   Reports directly to the Assistant Director of Business Development Support, the Provider Support Coordinator will be based in Staten Island office providing updates and working on several reports for our Referral Sources and Account Representatives. This position will communicate directly with Account Representatives and Referral Sources.       PRIMARY RESPONSIBILITIES:    Responsible for bi-monthly Disenrollment Report. To combin ... More
  • Farmingdale, NY 11735, USA
    Req #248
    Wednesday, July 1, 2020
    JOB SUMMARY: This position tracks and maintains members Medicaid/Medicare coverage within the various CPHL lines of business by productive communication with members, assigned vendors engaged by CPHL, state and city contacts and inter-departmental communication within CPHL to successfully sustain members appropriate coverage. PRIMARY RESPONSIBILITIES: Up-to-date knowledge of the guidelines and regulations that affect members eligibility and coverage. Effective and profe ... More
  • Staten Island, NY, USA
    Req #263
    Wednesday, July 1, 2020
    SUMMARY:   Assesses, formulates plans and provides assistance to members and their families in conjunction with the interdisciplinary team. Provides social services support to the member and/or caregiver as identified.  Provides support to members who are transitioning from an acute care facility back to the community.  Provides support to Complex Care Managers and other departments in day-to-day care management activities as needed.   REPORTING RELATIONSHIPS: ... More
  • Staten Island, NY, USA
    Req #256
    Wednesday, July 1, 2020
    JOB SUMMARY:   Centers Plan for Healthy Living is seeking a Jr. Configuration Analyst. The role will aid in configuration design, analysis, testing, and documentation related to the QNXT software platform regarding, but not limited to, code sets, fee schedules, benefits, sponsors, contracts, and authorizations. The Jr. Configuration Analyst will assist in coordination of various aspects of planning, development, implementation, communication and evaluation of existing or new funct ... More
  • Staten Island, NY, USA
    Req #265
    Wednesday, July 1, 2020
    JOB SUMMARY:  Support the Business Development Department goals, objectives and initiatives by driving and maintaining vehicles in a safe and effective manner. Support Business Development by dispersing marketing materials in the various communities and ensure the Centers Plan For Healthy Living signature events are properly equipped to support Health Benefit Advisors. PRIMARY RESPONSIBILITIES:   Pick up and drive vehicles to locations predetermined by management Set up lo ... More
  • Staten Island, NY, USA
    Req #255
    Wednesday, July 1, 2020
    JOB SUMMARY:   The Utilization Management Manager oversees and monitors the authorization process for service requests for members in CPHL.     PRIMARY RESPONSIBILITIES:              Responsible for effective communication and administration of company policies and procedures and ensuring compliance with these policies, as well as State and Federal regulations Hires, supervises and manages a team of nursing professionals Develops ... More
  • Staten Island, NY, USA
    Req #237
    Wednesday, July 1, 2020
    JOB SUMMARY The Quality Assurance Specialist (QAS) isresponsible for monitoring and assessing the quality of the performance of ourClaims Reconsideration Representatives. The QAS will monitor inbound andoutbound calls to assess representative’s demeanor, customer serviceperformance, conformity to company policies and procedures and compliance withregulatory requirements. This individual will assist in developing andimplementing call center quality processes and procedures; as well as makere ... More