Job Search

Loading...
  • Jamaica, Queens, NY, USA
    Req #160
    Thursday, December 5, 2019
    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 #156
    Monday, December 2, 2019
    JOB SUMMARY: The Home Care Relations Liaison position is responsible for working with internal departments regarding existing members request for provider change.       PRIMARY RESPONSIBILITIES:    Point person for Utilization Management, Case Management and G&A regarding resolution to members request for a change in provider Communicate with current provider regarding stabilizing services Communicate with providers regarding staffing new cases Document ... More
  • Staten Island, NY, USA
    Req #149
    Monday, December 2, 2019
    JOB SUMMARY:   Under the direction of the AVP of Business Development, and Internal Support Manager MLTC; the Benefit Navigator will be responsible for providing PROACTIVE support and advocacy for current and future Centers Plan for Healthy Living MLTC members. The Benefit Navigator will make members aware of services and benefits available both directly through Centers Plan for Healthy Living (covered MLTC benefits, MAPD Plan benefits, etc.) and through outside vendors and organizations ... More
  • Farmingdale, NY 11735, USA
    Req #150
    Wednesday, November 27, 2019
    JOB SUMMARY:   The Intake Representative Supervisor is responsible for the education, training and oversight of the Intake Representatives.  The Supervisor ensures Intake Representative productivity, quality and compliance with all CPHL policies and intake workflows; also serving as a resource to the department representatives.       PRIMARY RESPONSIBILITIES:    Oversight of Intake Referral queue in Case Trakker, ensuring referrals are assigned timely for outreach ... More
  • Staten Island, NY, USA
    Req #148
    Monday, November 25, 2019
    JOB SUMMARY:  Under general supervision, this position is responsible for performing general cleaning of assigned building   ESSENTIAL RESPONSIBILITIES: • Vacuuming, sweeping, and mopping of flooring and stairs • Floor care tasks • Clean and Restock supplies in bathrooms, break rooms, and common areas • Empty all trash cans and replace liners, clean receptacles as necessary • Dusting and cleaning office desks and furniture  • Dust all image frames, charts, graphs, and wall hangings • Cleaning wi ... More
  • Staten Island, NY, USA
    Req #131
    Monday, November 25, 2019
    JOB SUMMARY: This role supports the Data and Systems Manager,Member Services and Member Satisfaction Teams in evaluating data and collaborating on business needs to support short and long-term business strategies of the department and organization.Through collecting and analyzing data and business needs the Business Analyst will play a key role in ensuring department reporting needs are met, assist in streamlining information, promote cost-effective business decisions and supporting conti ... More
  • Staten Island, NY, USA
    Req #132
    Thursday, November 21, 2019
    JOB SUMMARY: This role supports the Member Service and Member Satisfaction Teams through leadership in data management, administration and analysis. Responsibilities include developing reporting, analyzing data for efficiency opportunities, maintaining various systems administratively. This role will assist the Director to design and implement technology solutions, improve business processes, define maintenance processes and implement efficiencies throughout the teams.   PRIMARY RES ... More
  • Margate, FL, USA
    Req #147
    Thursday, November 21, 2019
    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 Entry Level Registered Nurse in our Margate, FL office. 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. Qualifications: Active and unrestricted NYS RN license Exce ... More
  • Farmingdale, NY 11735, USA
    Req #130
    Thursday, November 21, 2019
    JOB SUMMARY:   The Resource & Quality Manager will be responsible for leading the efforts of Training & Quality Assurance teams to ensure department staff have the necessary resources to perform their respective roles at optimum levels delivering the highest quality of care to our members. The Manager in this position will proactively respond to the resource and training needs identified through call monitoring trends, direct observation, internal and external compliance audits, manag ... More
  • Garden City, NY, USA
    Req #143
    Thursday, November 21, 2019
    JOB SUMMARY:   The Field Assessment Coordinator works within the field assessment department to help assist with the multiple administrative tasks for the Field Assessment Department. The field assessment coordinator is detailed orientated with strong critical thinking and problem solving skills.   PRIMARY RESPONSIBILITIES:   Assists with scheduling and communication with the UAS coordinatorsTracking visit outcomesGenerates daily operational reports Reconciling UAS and membership list ... More
  • Staten Island, NY, USA
    Req #145
    Thursday, November 21, 2019
    JOB SUMMARY:   The Utilization Management Care Coordinator works within a multidisciplinary care team to assist with the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members.       PRIMARY RESPONSIBILITIES:   Assists in the prior authorization of services and ongoing authorization requests Assists in completing authorization updates as needed based on the care plan of the member Coordinat ... More
  • Margate, FL, USA
    Req #111
    Tuesday, November 19, 2019
    JOB SUMMARY:   The Utilization Management Care Coordinator works within a multidisciplinary care team to assist with the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members.       PRIMARY RESPONSIBILITIES:   Assists in the prior authorization of services and ongoing authorization requests Assists in completing authorization updates as needed based on the care plan of the member Coordinat ... More
  • Staten Island, NY, USA
    Req #144
    Tuesday, November 19, 2019
    JOB SUMMARY: Looking for a Project Manager who will manage multiple and varied projects with the goal of meeting their objectives in the most effective manner possible, on time, within budget and within scope.   Responsibilities PRIMARY RESPONSIBILITIES:  Assist in the definition of project scope and objectives, involving all relevant stakeholders and ensuring technical feasibility Coordinate internal resources and third parties/vendors for the flawless execution of p ... More
  • Staten Island, NY, USA
    Req #142
    Thursday, November 14, 2019
    JOB SUMMARY:   The Director of Complex Care oversees Medicare and Medicaid-Medicare programs including Medicaid Advantage Plus (MAP), Fully Integrated Duals Advantage (FIDA), Medicare Advantage Prescription Drug plan (MAPD), Dual Eligible Special Needs Plans (D-SNP). The Director of Complex Care will be responsible for ensuring appropriate Care Management operations by overseeing a team consisting of Clinical Team Manager, Care Managers, Social Workers and Care Coordinators.  This role a ... More
  • Staten Island, NY, USA
    Req #124
    Thursday, November 14, 2019
    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 #135
    Monday, November 11, 2019
    JOB SUMMARY:   The Delegated Care Management Coordinator is responsible to manage incoming correspondences related to CHHA referrals, PRI assessment/screen requests as well as provide updates to all appropriate parties. Utilize Computer skills to assist management with reporting and auditing. Participate in Care Management related projects. Communicate and Collaborate with CPHL Care Management Vendors providing direction in accordance with regulatory and organizational Care Management gu ... More
  • Staten Island, NY, USA
    Req #103
    Thursday, November 7, 2019
    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
  • Garden City, NY, USA
    Req #118
    Monday, November 4, 2019
    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 ... More
  • Garden City, NY, USA
    Req #123
    Friday, November 1, 2019
    JOB SUMMARY:                        This position provides support for the reporting and analysis needs of the Claims Department which is responsible for the timely processing of claims and Provider customer service. Responsibilities include development of reports that will enable more efficient workflows and processes for department staff, as well as those which will assist management in monitoring, assessing, and evaluating departmental performance. Additionally, this role will provid ... More
  • Staten Island, NY, USA
    Req #19
    Thursday, October 31, 2019
    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
    Tuesday, October 29, 2019
    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
  • Farmingdale, NY 11735, USA
    Req #73
    Thursday, October 24, 2019
    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
  • Farmingdale, NY 11735, USA
    Req #79
    Thursday, October 24, 2019
    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
  • Jamaica, Queens, NY, USA
    Req #110
    Thursday, October 17, 2019
    JOB SUMMARY:   The Utilization Management Care Coordinator works within a multidisciplinary care team to assist with the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members.       PRIMARY RESPONSIBILITIES:   Assists in the prior authorization of services and ongoing authorization requests Assists in completing authorization updates as needed based on the care plan of the member Coordinat ... More
  • Manhattan, New York, NY, USA
    Req #70
    Tuesday, October 15, 2019
    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