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  • Margate, FL, USA
    Req #252
    Friday, February 21, 2020
    We are seeking Full Time Call Center Representatives for our recently opened office in Margate, Florida. This role provides an opportunity for someone who thrives in a logistics environment with a solid customer centric approach. Responsibilities Respond to inquiries and requests via telephone and email in a timely fashion Document inquiries, requests, resolutions, and follow-up tasks Escalate inquires and requests to appropriate channels where ... More
  • Margate, FL, USA
    Req #245
    Friday, February 14, 2020
    One of the fastest growing Managed Long-Term Care company in New York, Centers Plan For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience.   Our Registered Nurse is responsible for reviewing the assessments completed by Field RNs, insuring consistency, quality and accuracy of documentation in compliance with NYDOH MLTC regulations and CPHL policies. Responsibilities: Review all pre-enrollment documentations, i ... More
  • Farmingdale, NY 11735, USA
    Req #208
    Friday, February 14, 2020
    Opportunity Summary:   Fulfills member needs and sends correspondences to ensure member satisfaction. Has knowledge of commonly-used concepts, practices, and procedures. Has knowledge of all LOBs, scripts, and workflows- or is able to obtain information rapidly as needed. Relies on instructions and pre-established guidelines to perform the functions of the job. Works under immediate supervision. Primary job functions do not typically require exercising independent judgment. Repo ... More
  • Staten Island, NY, USA
    Req #241
    Thursday, February 13, 2020
    JOB SUMMARY:   The Provider Services Phone Representative will provide outstanding service acting as the primary point of contact for Providers regarding products and services related to CPHL programs. Representative will provide callers with thorough service that builds relationships, resolves issues and increases overall trust and satisfaction.    PRIMARY RESPONSIBILITIES:    Professionally handle incoming inquiries from providers regarding Medic ... More
  • Staten Island, NY, USA
    Req #237
    Thursday, February 13, 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
  • Staten Island, NY, USA
    Req #244
    Thursday, February 13, 2020
    JOB SUMMARY:   Centers Plan for Healthy Living is seeking a Configuration Analyst. This individual will serve as the primary resource to our Claims, Provider Services and Authorizations departments. The role will aid in configuration design, analysis, testing, and documentation related to the QNXT software platform regarding, but not limited to, benefits, sponsors, contracts, and authorizations. The Configuration Analyst will coordinate various aspects of planning, development, im ... More
  • Staten Island, NY, USA
    Req #242
    Thursday, February 13, 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
  • Staten Island, NY, USA
    Req #236
    Tuesday, February 11, 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 #239
    Monday, February 10, 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 #210
    Monday, February 3, 2020
    JOB SUMMARY: The Account Liaison (Field) is responsible for enrolling members who are interested in our plan.  The Account Liaison 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 Licensed Home Care Services Agencies      PRIMARY RESPONSIBILITIES:   Maintain appointments, develop community marketing sites, establish relationship with community-based ... More
  • Jamaica, Queens, NY, USA
    Req #225
    Thursday, January 30, 2020
    JOB SUMMARY: The Care Coordinator works within a multidisciplinary care team to help assist with the care of members enrolled in CPHL Managed Long Term Care program and other LOBs to facilitate, schedule and arrange a variety of treatments and healthcare related activities. REPORTING RELATIONSHIPS: Reports to Care Coordination Manager and shares a collaborative relationship with the Care Management Team and other departments involved in member’s care.   PRIMARY RESPONSIBILITIES: ... More
  • Staten Island, NY, USA
    Req #223
    Tuesday, January 28, 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 #221
    Tuesday, January 28, 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 professiona ... More
  • Margate, FL, USA
    Req #220
    Tuesday, January 28, 2020
    One of the fastest growing Managed Long-Term Care company in New York, Centers Plan For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management nurse works within a multidisciplinary team to help identify and manage members who are in need of additional care or support in their home to improve their quality of life. The Utilization Management nurse will assess and process all authorization requests to determine medi ... More
  • Staten Island, NY, USA
    Req #215
    Tuesday, January 28, 2020
    JOB SUMMARY:  Looking for a temporary Coordinator to assist Managed Care Pharmacy Department in daily operations. Work closely with pharmacists to improve the plan’s CMS star ratings. Must have excellent communication skills. Bi-lingual Spanish/English preferred. PRIMARY RESPONSIBILITIES: Assist pharmacist in daily operations Contact physicians’ offices through fax and phone calls Call members to remind them to refill their medications on time ... More
  • Margate, FL, USA
    Req #185
    Friday, January 24, 2020
    JOB SUMMARY:The Quality Assurance Specialist (QAS) is responsible for monitoring and assessing the quality of the performance of our Member Services Representatives and the performance by representatives at our delegated vendor call centers. The QAS will monitor inbound and outbound calls to assess representative’s demeanor, customer service performance, conformity to company policies and procedures and compliance with regulatory requirements. This individual will assist in developing and imple ... More
  • Margate, FL, USA
    Req #183
    Friday, January 24, 2020
    JOB SUMMARY:   The Member Services Supervisor assists the department in monitoring, coaching and developing member services representative on a daily basis. Expected to be subject matter expert in at least one of the following health options MLTC, FIDA, Medicare, Advantage. Supervisor will lead a team of member service agents and also assist in the development, implementation, coordination, and supervision required to maintain an efficient call center operation. Works under general supe ... More
  • Staten Island, NY, USA
    Req #76
    Wednesday, January 22, 2020
    JOB SUMMARY:   The Assistant Director of Information Systems is responsible for overseeing and managing the configuration, development, support and maintenance of all core applications.       PRIMARY RESPONSIBILITIES:   Assist in the development of a strategic plan demonstrating ways in which systems/technology and related processes can be used to improve upon the effectiveness and efficiency of our organization’s operations. Collaborate with operational areas on ... More
  • Staten Island, NY, USA
    Req #213
    Tuesday, January 21, 2020
    JOB SUMMARY:   The Intake Field Coordinator is responsible for obtaining any outstanding documents needed by the Intake department, ensuring productivity, quality and compliance with all CPHL policies. The position entails reaching out to CPHL Managed Long Term Care Plan (MLTCP) referrals by phone as well as conducting home visits as needed; carefully explaining plan benefits and enrollment procedures; determining patient’s current services and understanding what they are looking for tod ... More
  • Margate, FL, USA
    Req #15
    Thursday, January 16, 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 #206
    Friday, January 10, 2020
    JOB SUMMARY:   The Care Coordinator works within a multidisciplinary care team to help assist with the care of members enrolled in CPHL Managed Long Term Care program and other LOBs to facilitate, schedule and arrange a variety of treatments and healthcare related activities. REPORTING RELATIONSHIPS:   Reports to Care Coordination Manager and shares a collaborative relationship with the Care Management Team and other departments involved in member’s care.   PRIMARY RESPONS ... More
  • Garden City, NY, USA; Staten Island, NY, USA
    Req #203
    Thursday, January 9, 2020
    JOB SUMMARY:   Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims. Collaborates with other Health plan departments and Management to ensure claims are processed in accordance with Federal, State and CPHL established guidelines and/or policies and procedures. Provides feedback or suggestions to enhance current processes and/or systems; works under general supervision.     PRIMARY RESPONSIBILITIES:    Conducts monthly audits of CPHL clai ... More
  • Staten Island, NY, USA
    Req #201
    Wednesday, January 8, 2020
    JOB SUMMARY:   The Intake Coordinator position is responsible for the multiple administrative tasks for which the Intake department is responsible. This includes tracking visit outcomes, submitting prospects for enrollments, responding to rejected submissions, completing authorizations, monitoring and producing operational reports as needed, reaching out to vendors as needed, reconciling UAS and membership lists, pulling information from UAS into the membership database, and other duties ... More
  • Staten Island, NY, USA
    Req #176
    Friday, December 20, 2019
    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
  • Garden City, NY, USA; Staten Island, NY, USA
    Req #88
    Thursday, December 12, 2019
    JOB SUMMARY:   Responsible for assisting in auditing functions of Centers Plan for Healthy Living (CPHL) claims. Collaborates with other Health Plan departments and Delegated Vendors to ensure claims are processed in accordance with Federal, State and CPHL established guidelines and/or policies and procedures. Assists in and/or participates in compliance reviews of Delegated Vendor’s claims processing policies and procedures. Provides feedback or suggestions to enhance current processes ... More