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Job Description: Summary: Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case assignment. Uses a systematic approach to identify members meeting program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. Participates in a cross functional, multi-disciplinary team to identify and implement member-centric interventions to ensure optimal and cost-effective health outcomes. Collaborates with interdisciplinary care team to develop a comprehensive care plan to identify key strategic interventions to address member's needs, health goals and mitigate health care cost drivers. Essential Accountabilities: Level I • Handles physical health member clinical management programs., • Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the activities as directed by departmental policy and leadership, current NYS DOH, CMS regulations and standards if managing members of Medicare programs, and other regulatory requirements as applicable., • Carries out job responsibilities in accordance with departmental, corporate, state, federal and accreditation standards, as well as licensure, certification and scope of practice requirements for each specific health-related field/specialty,, • Maintains confidentiality and conducts information management procedures per corporate and departmental policy., • Implements the Case Management Process per department policies, procedures and guidelines. The process includes case identification, case opening, member assessment, education and support intervention opportunities, developing care plans, conducting member-centric interventions, measuring member outcomes during re-assessment, case closure, and case reviews., • Screens members that fall within the defined populations served, referred to the department, either by data analysis or by internal or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management services., • Initiates case management, as outlined in the Case Management Program Description. Opens appropriate cases timely and effectively. Using motivational interviewing, assures essential information relating to case management is disclosed to members, thus increasing the opportunity for success in meeting member health goals., • Works in collaboration with members' physicians and other health care providers to assess the needs of the member, facilitate development of an interdisciplinary care plan, coordinates services, evaluates effectiveness of services and modifies the member care plan as necessary. Maintains positive working relationships within this arena., • Assesses member/caregiver knowledge of his/her illness and initiates appropriate education interventions to address knowledge deficits., • Collaborates with member/caregiver to determine specific objectives, goals and actions to address member needs and barriers to meeting health goals identified during assessment., • Provides appropriate resources and assistance to members with regards to managing their health across the continuum of care. Maintains updated information related to appropriate community resources and serves as a source of information for providers and other members of the healthcare team. Acts as a liaison between providers and community resources., • Participates in inter-disciplinary coordination and collaboration to ensure delivery of consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory Therapist, • Accepts responsibility for continuing education relative to professional growth. Meets or exceeds the minimum continuing education requirements as set forth by departmental and corporate policy, and by individual professional certification standards, if applicable., • Participates in and promotes other health plan programs, such as, Preventive Health, use of web-based tools for self-management of conditions and engagement in digital health programs and applications., • Work collaboratively with all Case Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director, Pharmacist, Geriatrics, etc.) to ensure continuity and coordination of care., • May work with internal and external stakeholders for value-based payment programs, such as accountable cost and quality arrangements (ACQA)., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • May participate in the orientation of new staff., • Regular and reliable attendance is expected and required., • Performs other functions as assigned by management. Level II (in addition to Level I Essential Accountabilities) • Handles all member clinical condition management programs., • Offers process improvement suggestions and participates in the solutions of more complex issues/activities., • Mentors junior staff and assists with coaching whenever necessary., • Consistently meets/exceeds all productivity and performance metrics, including positive results of audits., • Works independently in coordinating and collaborating with members and providers, resulting in improving member and community health., • Manages more complex assignments and/or larger caseloads., • Displays leadership skills and serves as a positive role model to others in the department., • Participates in the orientation of new staff. Level III (in addition to Level II Essential Accountabilities) • Process Management and Documentation, • Identifies, recommends, and evaluates new processes as necessary to improve productivity and gain efficiencies., • Assists in updating departmental policies, procedures and desk-top manuals relative to the CM functions., • Identifies and develops processes and guidelines for performance improvement opportunities for the Case Management Department., • Expert and resource for escalations. Serves as subject matter expert and if called upon, works directly with the operation and clinical staff to resolve issues and escalated problems., • Mentors and provides guidance and leadership to the daily activities of the Case Management Department clinical staff. Acts as resource to Case Management staff, members, and providers., • Provides backup for the Supervisor/Manager, whenever necessary by:, • Participating in the orientation of new staff and/training opportunities for all staff. Assists staff to identify opportunities to successfully engage members into care., • Acting as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit (SIU), Provider Relations (PR), or Sales & Marketing., • Ensuring all regulatory requirements are being met, such as NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group., • Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and educational needs to address established policies and procedures and job responsibilities. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels • Associates degree required. Bachelor's degree preferred., • Active NYS RN or Registered Dietician or Physical Therapist licensure required., • Minimum of three years of clinical experience required. Case Management experience preferred., • Must demonstrate proficiency with the Microsoft Office Suite., • Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) and benefits, preferred., • Strong written and verbal communication skills., • Ability to multitask and balance priorities., • Must demonstrate ability to work independently on a daily basis., • Deliver efficient, effective, and seamless care to members., • For incumbents aligned to the Federal Employee Program (FEP) line of business, Case Management Certification required within three (3) years of either hire and/or moving into this role supporting the FEP LOB. Level II (in addition to Level I Qualifications) • A minimum of 2 years in case management position., • Case Management Certification preferred., • Delivers efficient, effective, and seamless care to members., • Demonstrates ability to escalate to management, as necessary., • Demonstrates proficiency in all related technology and documentation requirements., • Consistently meets or exceeds all performance metrics. Level III (in addition to Level II Qualifications) • Must have been in a current Case Management position or similar subject matter expert for at least 5 years., • Case Management Certification required, • Broad understanding of multiple areas (i.e. UM and CM). At this level, incumbent is required to know multiple functional areas and supporting systems., • Expertise in Case Management area and able to handle complex assignments, challenging situations, and highly visible issues., • Ability to lead the training of new staff., • Demonstrated presentation skills. Physical Requirements: • Ability to travel and work long hours on a computer., • May require flexible hours to meet needs of member discussions. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: E2: Minimum: $62,400 - Maximum: $ 96,081 Level II: E3: Minimum: $62,400 - Maximum: $ 106,929 Level III: E4: Minimum: $65,346 - Maximum: $117,622 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description: Summary: Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case assignment. Uses a systematic approach to identify members meeting program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. Participates in a cross functional, multi-disciplinary team to identify and implement member-centric interventions to ensure optimal and cost-effective health outcomes. Collaborates with interdisciplinary care team to develop a comprehensive care plan to identify key strategic interventions to address member's needs, health goals and mitigate health care cost drivers. Essential Accountabilities: Level I • Handles behavioral health member clinical management programs., • Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the activities as directed by departmental policy and leadership, current NYS DOH, CMS regulations and standards if managing members of Medicare programs, and other regulatory requirements as applicable., • Carries out job responsibilities in accordance with departmental, corporate, state, federal and accreditation standards, as well as licensure, certification and scope of practice requirements for each specific health-related field/specialty,, • Maintains confidentiality and conducts information management procedures per corporate and departmental policy., • Implements the Case Management Process per department policies, procedures and guidelines. The process includes case identification, case opening, member assessment, education and support intervention opportunities, developing care plans, conducting member-centric interventions, measuring member outcomes during re-assessment, case closure, and case reviews., • Screens members that fall within the defined populations served, referred to the department, either by data analysis or by internal or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management services., • Initiates case management, as outlined in the Case Management Program Description. Opens appropriate cases timely and effectively. Using motivational interviewing, assures essential information relating to case management is disclosed to members, thus increasing the opportunity for success in meeting member health goals., • Works in collaboration with members' physicians and other health care providers to assess the needs of the member, facilitate development of an interdisciplinary care plan, coordinates services, evaluates effectiveness of services and modifies the member care plan as necessary. Maintains positive working relationships within this arena., • Assesses member/caregiver knowledge of his/her illness and initiates appropriate education interventions to address knowledge deficits., • Collaborates with member/caregiver to determine specific objectives, goals and actions to address member needs and barriers to meeting health goals identified during assessment., • Provides appropriate resources and assistance to members with regards to managing their health across the continuum of care. Maintains updated information related to appropriate community resources and serves as a source of information for providers and other members of the healthcare team. Acts as a liaison between providers and community resources., • Participates in inter-disciplinary coordination and collaboration to ensure delivery of consistent and quality health care services. Examples may include Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory Therapist, • Accepts responsibility for continuing education relative to professional growth. Meets or exceeds the minimum continuing education requirements as set forth by departmental and corporate policy, and by individual professional certification standards, if applicable., • Participates in and promotes other health plan programs, such as, Preventive Health, use of web-based tools for self-management of conditions and engagement in digital health programs and applications., • Work collaboratively with all Case Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director, Pharmacist, Geriatrics, etc.) to ensure continuity and coordination of care., • May work with internal and external stakeholders for value-based payment programs, such as accountable cost and quality arrangements (ACQA)., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • Regular and reliable attendance is expected and required., • Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) • Handles all member clinical condition management programs., • Offers process improvement suggestions and participates in the solutions of more complex issues/activities., • Mentors junior staff and assists with coaching whenever necessary., • Consistently meets/exceeds all productivity and performance metrics, including positive results of audits., • Works independently in coordinating and collaborating with members and providers, resulting in improving member and community health., • Manages more complex assignments and/or larger caseloads., • Displays leadership skills and serves as a positive role model to others in the department., • Participates in the orientation of new staff. Level III (in addition to Level II Accountabilities): • Process Management and Documentation - o Identifies, recommends, and evaluates new processes as necessary to improve productivity and gain efficiencies. o Assists in updating departmental policies, procedures and desk-top manuals relative to the CM functions. o Identifies and develops processes and guidelines for performance improvement opportunities for the Case Management Department. • Expert and resource for escalations. Serves as subject matter expert and if called upon, works directly with the operation and clinical staff to resolve issues and escalated problems., • Mentors and provides guidance and leadership to the daily activities of the Case Management Department clinical staff. Acts as resource to Case Management staff, members, and providers., • Provides backup for the Supervisor/Manager, whenever necessary by: o Participating in the orientation of new staff and/training opportunities for all staff. Assists staff to identify opportunities to successfully engage members into care. o Acting as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit (SIU), Provider Relations (PR), or Sales & Marketing. o Ensuring all regulatory requirements are being met, such as NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group. • Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and educational needs to address established policies and procedures and job responsibilities. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels • Active NYS RN license required with three years' behavioral health experience; or LMSW; or LCSW; or LMHC., • Minimum of three years of clinical experience required. Case Management experience preferred., • Must demonstrate proficiency with the Microsoft Office Suite., • Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) and benefits, preferred., • Strong written and verbal communication skills., • Ability to multitask and balance priorities., • Must demonstrate ability to work independently on a daily basis., • Deliver efficient, effective, and seamless care to members., • For incumbents aligned to the Federal Employee Program (FEP) line of business, Case Management Certification required within three (3) years of either hire and/or moving into this role supporting the FEP LOB. Level II (in addition to Level I Qualifications) • A minimum of 2 years in case management position., • Case Management Certification preferred, • Delivers efficient, effective, and seamless care to members., • Demonstrates ability to escalate to management, as necessary., • Demonstrates proficiency in all related technology and documentation requirements., • Consistently meets or exceeds all performance metrics. Level III (in addition to Level II Qualifications) • Must have been in a current Case Management position or similar subject matter expert for at least 5 years., • Case Management Certification required, • Broad understanding of multiple areas (i.e. UM and CM). At this level, incumbent is required to know multiple functional areas and supporting systems., • Expertise in Case Management area and able to handle complex assignments, challenging situations, and highly visible issues., • Ability to lead the training of new staff., • Demonstrated presentation skills. Physical Requirements: • Ability to travel and work long hours on a computer., • May require flexible hours to meet needs of member discussions. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: E2: Minimum: $62,400 - Maximum: $ 96,081 Level II: E3: Minimum: $62,400 - Maximum: $ 106,929 Level III: E4: Minimum: $65,346 - Maximum: $117,622 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description Are you Ready to Launch Your Career? ???? Join us in our mission as a Youth Specialist & Child Care Worker at Catholic Charities of Community Maternity Services. At Catholic Charities hiring decisions are personal. So personal, in fact, that every application is screened by a member of the HR team or a trained hiring manger! We are hiring Youth Specialists at both the Heery and Farano Centers to support youth in a structured, supportive, and therapeutic environment. These are ongoing openings, and we welcome applicants for full-time, part-time, and per diem roles. Shifts vary and may include days, evenings, overnights, and weekends. As the Youth Specialist & Child Care Worker, you will play a pivotal role in individuals' lives, making a significant impact through: • Provide daily care, supervision, and emotional support to residents and their children (if applicable), • Ensure the health, safety, and welfare of all residents at all times, • Supervise youth during visits with family members or identified visitors, following Family Plans and case plans, • Plan and implement a balanced daily routine and group living experiences, • Provide coverage at any CMS residential program as assigned, • Transport clients to school, medical appointments, court dates, visitation, or other activities Youth Specialist & Child Care Worker Minimum Salary: $ 17.00/hour Youth Specialist & Child Care Worker Maximum Salary: $ 21.00/hour Youth Specialist & Child Care Worker Schedule: Please see below Current Openings Include????Heery Center ????Farano Center Both Programs1 Full-Time Evening (Sunday–Thursday, 3:00 PM – 11:00 PM) 2 Full-Time Evening (Monday–Friday, 2:00 PM – 10:00 PM; includes alternating weekends) Per Diem opportunities available, with preference for evening and/or weekend availability.1 Full-Time Evening (Sunday–Thursday, 3:00 PM – 11:00 PM) 1 Full-Time Overnight (Sunday–Wednesday, 10:00 PM – 8:00 AM) 1 Part-Time Overnight (Thursday–Saturday, 10:00 PM – 8:00 AM) 2 Part-Time Day (Friday–Sunday, 6:00 AM – 2:00 PM) Weekend Warrior Shifts: • Saturday AM (6:00 AM – 2:00 PM), • Sunday AM (6:00 AM – 2:00 PM), • Sunday PM (2:00 PM – 10:00 PM) Note: During the interview process, hiring managers will discuss your availability, experience, and shift preferences to identify the best fit. Candidates new to direct care may start in a per diem role to build experience. Qualifications: • High School Diploma or GED, • 1 - 3 years of experience of working with a diverse population, • Valid driver's license, • Must remain awake and alert during entire shift, including overnight, • Must remain on shift until next shift arrives and is briefed, • Must work holiday and weeks when part of the regular schedule We value work-life balance and offer some stellar benefits: * For benefit-eligible positions: * Health/Dental/Vision/Life Insurance * Retirement planning options * Generous Time Off (as an eligible employee, you will accrue up to 23 days off in your first year, based on your standard work day) * Click here to view our benefits brochure! * A collaborative work environment * Employee Assistance Program * Employee Discounts (movie tickets, hotels, flights, amusement parks, etc.) * Exciting referral bonuses * Ongoing training and development * Recognition and Awards * Career Growth * A collaborative team culture Catholic Charities is proud to be an Equal Opportunity Employer, fostering a workplace where every individual can shine their brightest. Applicants have rights under Federal Employment Law: Family and Medical Leave Act (FMLA) Equal Employment Opportunity (EEO) Know Your Rights Employee Polygraph Protection Act (EPPA)

Job Description: Summary: Under the direction of the Assigned Management, upon successful completion of all phases of training, and in accordance with established HIPAA regulations the Enrollment Specialist performs enrollment core processing and servicing in accordance with the Health Plan Operation's enrollment regulations, Underwriting Guidelines and applicable government regulations. The focus of this role is to ensure prompt, accurate, and efficient servicing of all broker, member and group administrator inquiries for all product lines. Inquiries are received by the following but not limited to; telephone, email, written inquiries, lobby walk-in customers and through on-site visits with an employer group. The B version of this role will require the individual to be on the phone regularly. Essential Primary Responsibilities/Accountabilities: Level I: • Responsible for Government Programs, Small, Mid, and Large Employer Group Subscriber Enrollment Operations., • Responsible for maintaining communication, including but not limited to; Enrollment Management, Account Services Consultants, Sales, Finance/Underwriting, Claims, Customer Care, as well as interact with external Customers, groups or Brokers as necessary., • Responsible for the enrollment of new groups, renewals, new member and member movement., • Prepares, processes and maintains all member enrollments utilizing multiple Health Plan enrollment systems. Installs and maintains member information, new enrollment, benefit changes/renewal, cancellations, and reinstatements utilizing multiple sales, marketplace, and/or Enrollment systems. Review and assess member enrollment activity and associated documents for accuracy using knowledge and expertise of processing regulations/guidelines., • Researches, interprets and responds to inquiries from internal and external customers, business partners, brokers, consultants, and groups concerning our products, services and policies in accordance with regulatory, corporate policy, association guidelines and productivity measures. Ability to run pre-built reports., • Reviews, validates and updates transaction errors from all member level electronic and paper sources impacting eligibility interfaces., • Identifies issues and responds to all work items brought forward either internally or externally and ensures all inquiries will be responded to within department service level agreements (SLA's)., • Prioritize aged and Performance Guarantee Transactions and takes necessary action to complete timely according to established metrics., • Responsible for knowledge and accuracy on entry level processing within a minimum of 3 inventory areas., • Attends provided/necessary training to support job role/function and share knowledge back with the team., • Attends and participates in meetings as necessary and share information back to the team., • Execution of quality service to our external, as well as internal customers by meeting productivity and accuracy metrics, compliance and member touchpoint measures (MTM) targets, and CMS processing timeframes., • General understanding of the cross functional enrollment process and operating systems., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • Regular and reliable attendance is expected and required., • Prepares, processes and maintains all group enrollment utilizing multiple Health Plan enrollment systems. Installs and maintains group information including new group set up, benefit changes/renewal, cancellations, and reinstatements utilizing multiple sales, marketplace, and/or Enrollment systems. Review and assess enrollment activity and associated documents for accuracy using knowledge and expertise of processing regulations/guidelines., • Handles Designated Record Set (DRS) requests and may serve as a point person for the Account Service team when difficulties arise in obtaining information through normal channels., • Adjusts or triages for adjustment, as situation requires, enrollment for subscriber additions, deletions and changes, and will initiate correspondence requesting additional information or verification., • Acts as a resource to support and or cross train other team members., • Responsible for knowledge and accuracy on at least half of inventory areas., • In depth understanding and working knowledge of the cross functional enrollment process and operating systems., • Identifies issues, patterns and/or trends generated by external and internal action affecting compliance, customer satisfaction and system performance. Consistently and independently recommends and initiates changes and improvement as a result of process review., • Assists in creating and/or updating the operating manuals and/or Desk Level Procedures (DLP's)., • Proficient in most inventory areas, operating systems with expertise in specific job functions., • Mentors and collaborates with others on the team in utilizing tools, sharing best practices, and serving as a role model within a team unit structure., • Serves as subject matter expert for the department. Ability to cross train on any task as demonstrated by comprehension and retention of new skills not limited to a primary line of business. Works continuously toward identifying and removing barriers to increased productivity, quality, cost effectiveness, timeliness of operations, and customer satisfaction., • Process enrollment activities for complex accounts., • Ability to adjust daily assignments to prioritize urgent or complex cases as they arise., • Researches, responds, and resolves eligibility inquires working directly with internal and external customers via multiple communication methods., • Creation of test cases, testing of the process, documents and establishes procedures for the implementation of new products and work efforts. May be asked to participate in end user testing., • Researches complex cases to identify root cause, recommend and execute resolution through completion., • Responsible for complex and/or sensitive cases including but not limited to processing for key brokers, accounts, special arrangements, government programs and/or enrollment resolution cases requiring deep research., • Serves as department representative on corporate projects as well as cross functional work groups as assigned acting as a subject matter expert. Provides advice and counsel to project teams and leadership on implications of requirements on productivity and quality. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. Level I: • Completed High School Diploma or Equivalent., • Minimum of two (2) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position, preferred., • Must have solid written and verbal communication skills., • Proven organizational, analytical, and time management skills., • Basic Computer proficiency, including experience in Microsoft Office Suite., • Attention to detail and accuracy., • Ability to multi-task in order to efficiently resolve customer concerns, by understanding the needs of the customer, navigating screens on the computer, typing inquiry documentation., • Minimum of three (3) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position preferred., • Rating of "Performing" or above for minimally 12 months., • Organizational, reasoning and problem-solving skills., • Takes accountability and ownership of issues and resolution with minimal supervision., • Demonstrates global thinking and takes initiative to recognize opportunities within the team., • Minimum of four (4) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position preferred., • Must have strong written and verbal communication skills., • Strong Computer proficiency, including experience in Microsoft Office Suite (Excel), • Rating of "Performing" or above for minimally 12 months., • Provide mentoring and support to new hires and peer group., • Assist with tasks assigned by management that require advanced problem-solving skills, • Minimum of five (5) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position preferred, • Rating of "Performing" or above for minimally 12 months., • Self Sufficient in ability to efficiently resolve complex & escalated issues., • Lead tasks assigned by management that require advanced problem-solving skills across multiple areas., • B Version: Ability to actively listen to customer while simultaneously taking notes. Ability to be on the phone regularly. Physical Requirements: • Ability to complete work in a traditional office environment under fluorescent lighting., • Ability to arrive on time at work and as scheduled., • Ability to meet minimum performance metrics., • Ability to orally communicate., • Must be able to function while sitting at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time., • Must be able to travel across the enterprise., • Ability to work in a home office for continuous periods of time for business continuity. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: Grade N2: Minimum: $20 .00 - Maximum: $23.89 Level II: Grade N3: Minimum: $20.00 - Maximum: $26.90 Level III: Grade N4: Minimum: $20.00 - Maximum: $30.76 Level IV: Grade N5: Minimum: $20.02 - Maximum: $33.03 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description: Summary: The Health Outcomes Specialist I-II supports the Health Outcomes & Community Impact (HOCI) strategic plan, goals, enterprise-wide measures, and efforts to achieve improvement across our markets and populations. The role supports the design, implementation, and evaluation of initiatives that improve measurable health outcomes across priority member populations. This role ensures that interventions designed to address disparities lead to demonstrable improvements in clinical outcomes, utilization, community impact and member experience. Working within the HOCI team, the Health Outcomes Specialist partners with internal stakeholders including Quality, Healthcare Management, Medical Governance, Provider Network, Pharmacy, Data Analytics, and Marketing to operationalize strategies that improve outcomes for members experiencing disproportionate health risks or barriers to care. This role translates population health insights and equity-informed strategies into actionable interventions, program implementation, and outcome measurement. Essential Accountabilities: Level I • Partners with leadership on sharing and updating a robust health equity and community health training initiative that spans the entire enterprise as well as externally., • Research and maintains sound knowledge of health equity, evidence-based improvement interventions, industry trends, best practices, and benchmarks to deliver innovative and effective solutions for the management of the HOCI strategy., • Consults on the development of the health equity data infrastructure to ensure appropriate creation of downstream clinical interventions to mitigate health disparities., • Facilitates processes needed to analyze and improve processes and workflows. Organizes and facilitates large educational and re-engineering sessions. Facilitates interdepartmental coordination and communication with all Care Management functional areas, such as, but not limited to Case Management, Utilization Management, Behavioral Health, Medical Claim Review and Audit, Health Promotion, Disease Management, to support delivery of high quality, timely customer solutions., • Consults with key internal stakeholders including medical directors, operational and strategic leadership, SMEs, and regional directors as well as external network/other Blues plans regarding the nature of the opportunity identified, potential interventions, and desired and expected outcomes., • Evaluates initiatives and determines key benchmarks in collaboration with health equity stakeholders for its use in subsequent evaluations., • Analyzes, compiles and implements interventions to incorporate into strategic assessments; creates comprehensive strategic proposals to improve health outcomes. Collaborates with other departments early in the initiative development cycle including quality, provider engagement, customer care, VBP programs, corporate communications/marketing, clinical operations, and others, in regard to cross-functional business processes, program development initiatives and timelines., • Collaborates with the Quality department to facilitate health equity accreditation requirements., • Consults with the CIP team to incorporate a community-based approach on projects, processes and initiatives., • Assesses member, provider and other key stakeholders' experience related to new or updated initiatives and plans proactively to address their concerns and needs positively., • Oversees vendor relationships associated with vendor partners as needed, including identification of key vendors, nurturing vendor contacts, RFI/RFP creation and strong oversight, pricing negotiations, contract facilitation with legal and other entities, monitoring vendor SLAs/PGs as needed., • Provides reports and recommendations to the Utilization Management/Case Management (UM/CM) team for action. Responsible for defining, coordinating, and communicating the ongoing monitoring of existing programs in HOCI and other areas as relevant to ensure meaningful intervention outcomes and value are realized and partner with key stakeholders to support strong results. Serves as subject matter expert in maintaining the UM/CM training program for PHE and other key stakeholder roles., • Represents Medical Services on Health Plan-wide cross functional process improvements teams, as requested by manager/director. Coordinates HOCI committees to define, prioritize and facilitate initiatives, as appropriate., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • Regular and reliable attendance is expected and required., • Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) • Participates in, facilitates, and may manage all aspects of meetings within HOCI and in support of program development as needed., • Mentoring and coaching of program development team within the department and others in similar roles as appropriate., • Provides input and recommendations into strategic proposals for program development team., • Acts as an ambassador of the team function throughout the organization to ensure consensus, collaboration, and support., • Provides presentations to key stakeholders to share the vision and mission of the HOCI team and build awareness, support, and participation for the process and team. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels • Minimum of two (2) years' experience working within a health plan related to Health Equity/ Population Health Management or other clinically related program development with Bachelor's degree in related field. In lieu of a degree, minimum of eight (8) years' experience working within a health plan in a role related to population health management/case management interventions/programs or other clinically related program development required., • Five (5) years of clinical experience required (RN, LPN, BH, MPH, etc.), • PMP certification preferred., • Working knowledge of best practices and tools related to project management and process engineering/improvement Working knowledge of Corporate Medical Policies, InterQual and Milliman & Robertson guidelines, NCQA standards, URAC requirements, HEDIS, CMS requirements, and NYSDOH medical management mandates & program requirements., • Demonstrates effective verbal communication skills and strong writing capabilities., • Developing skills in reading, analyzing and understanding analytics reports and documents., • Understands basic concepts of return-on-investment measurement. Exhibits excellent organizational, planning, and project management skills. Makes decisions using solid judgment skills to impact identified problems., • Resourceful and appropriately tenacious in the face of varied opinions to gain consensus., • Exhibits leadership through meeting facilitation., • Subject matter expert on the development of clinical strategic interventions. Level II (in addition to Level I Qualifications) • Minimum of six years' experience working within a health plan in a role related to utilization management/case management interventions/programs or other clinically related program development., • Strong understanding of and preferred experience with Return-on-Investment measurement and concepts., • Experience with process development and refinement, experience leading projects whether formal or informal. Reads, analyzes, and understands complex analytics reports and documents. Able to identify further areas of exploration/opportunity and guide analytic requests to explore targeted opportunities., • Demonstrated strengths with emotional intelligence including keen collaboration, consultative relationship building, and consensus building skills. Physical Requirements: • Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer., • Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time., • Ability to work in a home office for continuous periods of time for business continuity., • Ability to travel across the Health Plan service region for meetings and/or trainings as needed., • Manual dexterity including fine finger motion required., • Repetitive motion required., • The ability to hear, understand, and speak clearly while using a phone, with or without a headset., • Must have a valid Class D license and ability to operate a motor vehicle. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): E2: $62,400 - $96,081 E5: $71,880 - $129,384 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description: Summary: Under the direction of the Assigned Management, upon successful completion of all phases of training, and in accordance with established HIPAA regulations the Enrollment Specialist performs enrollment core processing and servicing in accordance with the Health Plan Operation's enrollment regulations, Underwriting Guidelines and applicable government regulations. The focus of this role is to ensure prompt, accurate, and efficient servicing of all broker, member and group administrator inquiries for all product lines. Inquiries are received by the following but not limited to; telephone, email, written inquiries, lobby walk-in customers and through on-site visits with an employer group. The B version of this role will require the individual to be on the phone regularly. Essential Primary Responsibilities/Accountabilities: Level I: • Responsible for Government Programs, Small, Mid, and Large Employer Group Subscriber Enrollment Operations., • Responsible for maintaining communication, including but not limited to; Enrollment Management, Account Services Consultants, Sales, Finance/Underwriting, Claims, Customer Care, as well as interact with external Customers, groups or Brokers as necessary., • Responsible for the enrollment of new groups, renewals, new member and member movement., • Prepares, processes and maintains all member enrollments utilizing multiple Health Plan enrollment systems. Installs and maintains member information, new enrollment, benefit changes/renewal, cancellations, and reinstatements utilizing multiple sales, marketplace, and/or Enrollment systems. Review and assess member enrollment activity and associated documents for accuracy using knowledge and expertise of processing regulations/guidelines., • Researches, interprets and responds to inquiries from internal and external customers, business partners, brokers, consultants, and groups concerning our products, services and policies in accordance with regulatory, corporate policy, association guidelines and productivity measures. Ability to run pre-built reports., • Reviews, validates and updates transaction errors from all member level electronic and paper sources impacting eligibility interfaces., • Identifies issues and responds to all work items brought forward either internally or externally and ensures all inquiries will be responded to within department service level agreements (SLA's)., • Prioritize aged and Performance Guarantee Transactions and takes necessary action to complete timely according to established metrics., • Responsible for knowledge and accuracy on entry level processing within a minimum of 3 inventory areas., • Attends provided/necessary training to support job role/function and share knowledge back with the team., • Attends and participates in meetings as necessary and share information back to the team., • Execution of quality service to our external, as well as internal customers by meeting productivity and accuracy metrics, compliance and member touchpoint measures (MTM) targets, and CMS processing timeframes., • General understanding of the cross functional enrollment process and operating systems., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • Regular and reliable attendance is expected and required., • Prepares, processes and maintains all group enrollment utilizing multiple Health Plan enrollment systems. Installs and maintains group information including new group set up, benefit changes/renewal, cancellations, and reinstatements utilizing multiple sales, marketplace, and/or Enrollment systems. Review and assess enrollment activity and associated documents for accuracy using knowledge and expertise of processing regulations/guidelines., • Handles Designated Record Set (DRS) requests and may serve as a point person for the Account Service team when difficulties arise in obtaining information through normal channels., • Adjusts or triages for adjustment, as situation requires, enrollment for subscriber additions, deletions and changes, and will initiate correspondence requesting additional information or verification., • Acts as a resource to support and or cross train other team members., • Responsible for knowledge and accuracy on at least half of inventory areas., • In depth understanding and working knowledge of the cross functional enrollment process and operating systems., • Identifies issues, patterns and/or trends generated by external and internal action affecting compliance, customer satisfaction and system performance. Consistently and independently recommends and initiates changes and improvement as a result of process review., • Assists in creating and/or updating the operating manuals and/or Desk Level Procedures (DLP's)., • Proficient in most inventory areas, operating systems with expertise in specific job functions., • Mentors and collaborates with others on the team in utilizing tools, sharing best practices, and serving as a role model within a team unit structure., • Serves as subject matter expert for the department. Ability to cross train on any task as demonstrated by comprehension and retention of new skills not limited to a primary line of business. Works continuously toward identifying and removing barriers to increased productivity, quality, cost effectiveness, timeliness of operations, and customer satisfaction., • Process enrollment activities for complex accounts., • Ability to adjust daily assignments to prioritize urgent or complex cases as they arise., • Researches, responds, and resolves eligibility inquires working directly with internal and external customers via multiple communication methods., • Creation of test cases, testing of the process, documents and establishes procedures for the implementation of new products and work efforts. May be asked to participate in end user testing., • Researches complex cases to identify root cause, recommend and execute resolution through completion., • Responsible for complex and/or sensitive cases including but not limited to processing for key brokers, accounts, special arrangements, government programs and/or enrollment resolution cases requiring deep research., • Serves as department representative on corporate projects as well as cross functional work groups as assigned acting as a subject matter expert. Provides advice and counsel to project teams and leadership on implications of requirements on productivity and quality. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. Level I: • Completed High School Diploma or Equivalent., • Minimum of two (2) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position, preferred., • Must have solid written and verbal communication skills., • Proven organizational, analytical, and time management skills., • Basic Computer proficiency, including experience in Microsoft Office Suite., • Attention to detail and accuracy., • Ability to multi-task in order to efficiently resolve customer concerns, by understanding the needs of the customer, navigating screens on the computer, typing inquiry documentation., • Minimum of three (3) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position preferred., • Rating of "Performing" or above for minimally 12 months., • Organizational, reasoning and problem-solving skills., • Takes accountability and ownership of issues and resolution with minimal supervision., • Demonstrates global thinking and takes initiative to recognize opportunities within the team., • Minimum of four (4) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position preferred., • Must have strong written and verbal communication skills., • Strong Computer proficiency, including experience in Microsoft Office Suite (Excel), • Rating of "Performing" or above for minimally 12 months., • Provide mentoring and support to new hires and peer group., • Assist with tasks assigned by management that require advanced problem-solving skills, • Minimum of five (5) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position preferred, • Rating of "Performing" or above for minimally 12 months., • Self Sufficient in ability to efficiently resolve complex & escalated issues., • Lead tasks assigned by management that require advanced problem-solving skills across multiple areas., • B Version: Ability to actively listen to customer while simultaneously taking notes. Ability to be on the phone regularly. Physical Requirements: • Ability to complete work in a traditional office environment under fluorescent lighting., • Ability to arrive on time at work and as scheduled., • Ability to meet minimum performance metrics., • Ability to orally communicate., • Must be able to function while sitting at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time., • Must be able to travel across the enterprise., • Ability to work in a home office for continuous periods of time for business continuity. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: Grade N2: Minimum: $20 .00 - Maximum: $23.89 Level II: Grade N3: Minimum: $20.00 - Maximum: $26.90 Level III: Grade N4: Minimum: $20.00 - Maximum: $30.76 Level IV: Grade N5: Minimum: $20.02 - Maximum: $33.03 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description: Summary: The Customer Care Advocate (CCA) resolves customer inquiries via telephone, walk in, mail, fax, web chat, off-phone work, and email concerning, but not limited to, contract benefits, claim payments, and enrollment in accordance with LOS, Corporate Service strategy, NCQA, and legislative requirements. The Customer Care Advocate provides service for customers and business partners while responding in a professional, efficient, and timely manner to resolve issues and enhance member & provider satisfaction/retention. The B version of this role requires the individual to speak Spanish fluently. Essential Responsibilities/Accountabilities: All Levels • Provides service among the customers and business partners while responding in a professional, efficient, and timely manner to enhance member and provider satisfaction and retention. Must exercise tact, patience, and professionalism at all times in responding to internal/external customers., • Documents, researches, interprets and responds to inquiries from internal and external customers, business partners and special groups concerning our products, services and policies in accordance with LOS, NCQA, HIPAA, NYSDOH, CMS and other legislative requirements., • Utilizes appropriate resources, resolves customer inquiries accurately & efficiently resulting in acceptable quality, first contact resolution/provider satisfaction, and performance., • Provides outreach related to claims, onboarding, effectuation, retention, provider inquiries, and any other complex inquiry., • Demonstrates willingness to adapt and be flexible to changes and business needs while taking ownership and accountability for issue identification and resolution., • Participates in meetings, training, and skill development to support career path and individual development plans., • Is knowledgeable and enthusiastic about the company and our products and/or services., • Identifies and follows through on issues impacting the Health Plan and customer experience., • Develops effective internal working relationships for improved communication and collaboration., • Shares ideas and solutions to improve processes, procedures, and systems., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • Regular reliable attendance is expected and required., • Performs other functions as assigned by management. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. Level I: • High School diploma or equivalent, customer service experience preferred., • Entry level position. Duties performed under close supervision., • B Version: Bi-lingual English/Spanish required (must have ability to speak Spanish fluently)., • Ability to multi-task to efficiently resolve customer concerns, by actively listening to the customer, navigating screens on the computer, typing call documentation, and speaking to the customer simultaneously., • Computer skills required, including the ability to navigate in a Windows environment. Skillful at working between multiple programs and applications at the same time., • Organizational skills, reasoning, problem solving skills, effective and diplomatic communication, ability to prioritize, multitask, and work in fast paced environment and remain professional and focused under multiple pressures and demands., • Successfully attends and completes all training as defined by the business unit. Level Il - in addition to Level I requirements: • Rating of "Performing" or above on the Agent Dashboard and Competencies for a minimum of 9 out of 12 months., • Successfully complete training as required by the business unit., • Ability to efficiently resolve complex & escalated issues with minimal direction., • Advanced system and navigational skills., • Expanded communication skills across multiple channels including, but not limited to, voicemail, email, web chat, outbound calls, membership growth, retention, etc., • Takes accountability and ownership of issues and resolution with minimal supervision. Level III - in addition to Level II requirements: • Rating of "Performing" or above on the Agent Dashboard and Competencies for a minimum 10 out of 12 additional months., • Successfully complete training as required by the business unit., • Self-sufficient in resolving complex & escalated issues., • Provide mentoring and support to new hires and peer group., • Assist with tasks assigned by management that require advanced problem-solving skills., • Demonstrates functional global thinking and takes initiative to recognize opportunities within the team. Physical Requirements • Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time., • The ability to hear, understand, and speak clearly while using a phone, with or without a headset., • Ability to travel across the Health Plan service region for meetings and/or trainings as needed. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Please note: There may be opportunity for remote work within all jobs posted by the Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Compensation Range(s): Grade N2: Minimum $20.00 Maximum $20.00 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description: Based on the scope of the role & business needs, we're exclusively seeking candidates who reside in the Albany/Capital Region. Summary: The Medicare Broker Account Executive will be responsible for building and maintaining strong relationships with Medicare brokers to drive the sales and growth of our Medicare products This involves close collaboration with Field Marketing Organizations (FMO), General Agents, and Individual Agents to ensure compliance with all relevant policies and procedures. This role will require a strategic approach to broker engagement, sales support, and market development. The ideal candidate will have a deep understanding of Medicare products, comprehensive understanding of Medicare sales dynamics, excellent interpersonal skills, and the ability to foster positive broker relationships. Essential Accountabilities: Broker Relationship Management: • Develops and maintains strong relationships with all levels of the Medicare brokers distribution hierarchy to enhance their engagement and productivity., • Acts as the primary point of contact for brokers, addressing inquiries, resolving issues, and providing ongoing support., • Conducts regular in-person and virtual meetings with brokers to ensure optimal external agent effectiveness through coaching, performance review, addressing concerns, and discussing strategies for growth and retention objectives. Sales Support and Training: • Develops professional presentations related to proposals and projects for both internal and external audiences., • Delivers comprehensive training and support to brokers on our Medicare products, sales techniques, and compliance requirements so that selling methods conform to our brands directed approach to consultative selling and always support the optimal matching of products to the needs of beneficiaries through a proper suitability assessment., • Assists brokers in developing effective sales strategies and marketing plans to drive enrollment and retention., • Ensures brokers are well-equipped with the latest product information, marketing materials, and regulatory updates., • Constructs and implement processes to manage and track agent resources, productivity, and quality. Market Development: • Identifies and recruits new brokers to expand our market presence and drive sales growth., • Analyzes market trends and competitor activities to identify opportunities for product development and market expansion., • Collaborates with internal teams to develop and implement targeted marketing campaigns and initiatives., • Attends conferences and reviews marketplace trends to identify sales and growth opportunities. Compliance and Reporting: • Ensures all broker activities comply with CMS regulations and company policies and procedures., • Prevents, detects, and resolves the instances of conduct that do not conform to federal (CMS) and state law, and federal and state health care program requirements, as well as ethical and business policies of the organization., • Prepares and presents regular reports on broker activities, sales performance, and market insights., • Monitors and reports on broker performance, sales metrics, and market trends to senior management., • Develops corrective action plans for performance and process management improvement., • Ensures that all appointed Agents have approved selling materials and that all Agents have thorough understanding of CMS Medicare Marketing Guidelines. Collaboration and Communication: • Work closely with internal teams, including retail sales, marketing, compliance, and product development, to support broker needs and drive business goals., • Communicate effectively with brokers to ensure alignment on objectives, expectations, and performance goals., • Facilitates recurring meetings to review account status and operational effectiveness., • Foster a collaborative environment that promotes knowledge sharing and continuous improvement., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • Regular and reliable attendance is expected and required., • Performs other functions as assigned by management. Minimum Qualifications: • Bachelor's Degree in business, Marketing, Healthcare Administration, or a relevant field with five or more years of experience in sales, account management, or broker relations preferably within the Medicare or health insurance industry. In lieu of degree, a minimum of ten years' Medicare/Insurance Sales experience., • Valid NYS Accident and Health License within six months of employment required. Employees without a license are not eligible for any sales incentive awards or contests. Any sales made while not licensed are not eligible for incentive compensation., • In-depth knowledge of Medicare products, regulations, and market dynamics., • Strong analytical skills with the ability to interpret sales data and market trends., • Self -motivated and highly organized with a proven track record of building and maintaining strong relationships with brokers or sales partners., • Excellent communication, presentation, and negotiation skills., • Ability to work independently and manage multiple priorities in a fast-paced environment., • Demonstrated training skills., • Proficiency in Microsoft Office Suite and CRM software., • Ability to travel at least 60% of the time. Physical Requirements: • Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer., • Ability to travel across the Health Plan service region for meetings and/or trainings as needed. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Minimum: $71,880 - Maximum: $129,384 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description: Summary: This role serves as a Regional Chief Medical Officer within the health plan, providing senior clinical leadership, community representation, and strategic oversight of medical operations. This highly visible role leads a team of Medical Directors and provides matrixed clinical influence across key Medical Services functions in the region. The role is the primary clinical executive for the region and brand, collaborating closely with the enterprise Chief Medical Officer to ensure alignment of clinical strategy, quality initiatives, and operational excellence in accordance with regulatory, accreditation, and corporate objectives. This leader builds trusted relationships with providers, hospital systems, regulators, and community partners to advance member outcomes, promote value-based care, and strengthen the organization's reputation in the market. This role blends clinical credibility with strong business acumen, ensuring clinical excellence, regulatory compliance, and financial stewardship across the organization. Essential Accountabilities: • Serve as the regional and brand Chief Medical Officer, shaping and executing the clinical strategy for the market. Oversee and participate in the strategic planning, program development, and implementation for Medical Services related activities in partnership with executive leadership., • Lead, coach, and develop a team of Medical Directors, fostering high performance, and member centered clinical culture. Provide clinical guidance, feedback, and professional development to physicians and clinical leaders., • Represent the brand externally as the senior clinical voice in community forums, provider engagements, regulatory meetings, and public health partnerships. Serve as a liaison with our physician network to advance the mission of the plan for the benefit of its members., • Partner with enterprise Chief Medical Officer to translate enterprise clinical priorities into regional programs and measurable outcomes. Support defined focus area by leveraging clinical expertise in alignment with corporate objectives and determined in partnership with enterprise Chief Medical Officer., • Collaborate closely with Marketing & Growth and Provider Network & Contracting, to align clinical strategy with market strategies, jointly participating in regular engagement and alignment with key customers and groups., • Contribute to the regional and enterprise strategy development. Collaborate with Finance, Operations and across the organization on budgeting, forecasting and performance metrics., • Provide strategic clinical matrixed leadership and regional medical oversight to utilization management, case management, care management, quality, provider network, physician engagement, behavioral health, and health outcomes initiatives., • Partners closely with CCP TASS and health care delivery support in alignment with organizational health care delivery goals., • Champion regional quality strategy in partnership with Quality Leadership, including HEDIS, Stars, CAHPS, NCQA, and meeting state/regional quality requirements., • Educate providers on clinical guidelines, quality metrics and population health strategies. Act as regional clinical representative in engagements with state regulators, CMS, and accreditation bodies., • Ensure clinical operations comply with federal, state, and contractual requirements. Support enterprise risk management, audit processes, and corrective action plans., • Ensure compliance with US Department of Labor, NYS regulatory and corporate appeals/grievance policy., • Promote collaboration and alignment across multidisciplinary teams, ensuring clear accountability and clinical excellence. Influence cross functional teams using strong communication, relationship building, and executive presence without reliance on direct reporting lines., • Oversee and monitor the administration of the division's employment related activities in accordance with CDPHP's policies and in a consistent and legally responsible manner including the principles of equal employment and affirmative action. Includes, but is not limited to the following: recruitment, selection, and hiring, training, development, retention, setting and monitoring standards of performance, promotions, transfers and terminations., • The employee agrees to comply with CDPHP's Corporate Compliance Policy and all laws, rules, regulations and standards of conduct relating to the Corporate Compliance Policy and has a duty and obligation to report any suspected violations of any law, the standards of conduct or Corporate Compliance Policy to his or her immediate Supervisor, the fraud and abuse hotline, the Compliance Officer, the Compliance Director, Human Capital Management or the Chief Executive Officer., • Performs other duties as assigned. Minimum Qualifications: • Degree in medicine, either M.D. or D.O., board certification, and an unrestricted active NYS medical license required., • 10+ years of clinical practice experience required., • Previous experience leading physicians, medical practices and/or managerial experience required., • 5+ years in senior medical leadership within a health plan, health system or population health organization preferred., • Ability to understand and communicate a region & brand's unique value proposition to physicians, members, government, employer groups, and the larger communities we serve., • Strong communication skills both oral and written., • Deep expertise in healthcare quality, utilization management, clinical operations, and value-based care. Demonstrated ability to establish, develop, recommend, implement, and oversee utilization and quality policies requires., • Demonstrated ability to lead physicians and influence cross functional teams in a matrixed environment., • Excellent public speaking and relationship building skills; comfortable as the community facing clinical representative., • Strong commitment to health equity and culturally responsive care., • Demonstrated ability to serve as a patient and physician advocate for the Plan and the community., • Ability to understand and communicate CDPHP's unique value proposition to physicians, members, government, employer groups and the community in general. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): SL1: $304,800 - $450,000 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description: Summary: The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical documentation, and/or inpatient coding and has a high level of understanding of the current MS-DRG, and APR-DRG payment systems. This position is responsible for reviewing medical records for appropriate provider documentation to support the principal diagnosis, co-morbidities, complications, secondary diagnosis, surgical procedures, POA indicators to validate coding and DRG assignment accuracy, insuring the physician documentation supports the hospital coded data. Essential Accountabilities: Level I • Analyzes and audits acute inpatient claims. Integrates medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise. Clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently., • Adheres to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge - DRG &ICD 10., • Establishes national and best practice benchmarks and measures performance against benchmarks., • Ensures accurate payment by independently utilizing DRG grouper, encoder, and claims processing platform., • Manages case volumes and review/audit schedules, prioritizing case load as assigned by Management., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • Regular and reliable attendance is expected and required., • Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) • Performs complex audits or projects with minimal direction or oversight., • Acts as an expert in reviewing medical coding and medical record review with ability to oversee complex assignments, challenging customers, and highly visible issues., • Supports leadership in projects related to divisional/departmental strategies and initiatives., • Participates and represents in audits, payment methodologies, contractual agreements, with cross functional teams or with business partners as needed., • Serves as a mentor to new hires., • Demonstrates ability to participate and represent department on interna/external committees. Level III (in addition to Level II Accountabilities) • Provides expertise in developing data criteria for audits., • Acts as a Lead and provides training, guidance, consultation, complex performance analysis, and coaching expertise to team members around methods of continuous quality improvement., • Serves as an expert and resource for escalations and works directly with Payment Integrity staff to resolve issues and escalation problems., • Provides backup support for Management as necessary. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels • Associate or bachelor's degree in health information management (RHIA or RHIT) or a Nursing Degree., • Three (3) years' experience in claims auditing, quality assurance, or recovery auditing, of (MS/APR) DRG coding for hospital or other acute facility setting., • Three (3) years of working experience with ICD 10CM, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines, medical necessity criteria, and coding terminology., • Coding Certification is to be maintained as a condition of employment of one of the following: RHIA or RHIT, Inpatient Coding Credential - CCS or CIC., • Intermediate analytical and problem-solving skills; as well as keeps abreast of latest trends related to business analysis., • Intermediate knowledge of PC, software, auditing tools and claims processing systems. Level II (in addition to Level I Qualifications) • Five (5) years' experience in claims auditing, quality assurance, or recovery auditing, of (MS/APR) DRG coding for hospital or other acute facility setting., • Five (5) years of working experience with ICD 10CM, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines, medical necessity criteria, and coding terminology., • Demonstrated ability across multiple skills, products, processes, and systems with the Division., • Demonstrated ability to lead initiatives with occasional guidance and assistance from management and/or others., • Advanced analytical, problem solving, and judgement skills., • Advanced knowledge of PC, software, auditing tools and claims processing systems. Level III (in addition to Level II Qualifications) • Eight (8) years' experience in claims auditing, quality assurance, or recovery auditing, of (MS/APR) DRG coding for hospital or other acute facility setting., • Eight (8) years of working experience with ICD 10CM, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines, medical necessity criteria, and coding terminology., • Demonstrated leadership skills., • Demonstrated ability as a subject matter expert or consultant to other departments., • Demonstrated ability to work independently and assumes lead role in key business initiatives., • Expert proficiency in analytical skills, auditing skillset and ability to manage complex assignments, challenging situations, and highly visible issues., • Demonstrated expert proficiency in project management and presentation skills. Physical Requirements: • Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer., • Ability to travel across the Health Plan service region for meetings and/or trainings as needed. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: Grade E4: Minimum: $65,346- Maximum: $117,622 Level II: Grade E5: Minimum: $71,880 - Maximum: $129,384 Level III: Grade E6: Minimum: $79,068 - Maximum: $142,322 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description Are you Ready to Launch Your Career? ???? Join us in our mission as a Youth Specialist & Child Care Worker at Catholic Charities of Community Maternity Services. At Catholic Charities hiring decisions are personal. So personal, in fact, that every application is screened by a member of the HR team or a trained hiring manger! We are hiring Youth Specialists at the Branson Center to support youth in a structured, supportive, and therapeutic environment. These are ongoing openings, and we welcome applicants for part-time, weekend, and per diem roles. Shifts vary. As the Youth Specialist & Child Care Worker, you will play a pivotal role in individuals' lives, making a significant impact through: • Provide daily care, supervision, and emotional support to residents and their children (if applicable), • Ensure the health, safety, and welfare of all residents at all times, • Supervise youth during visits with family members or identified visitors, following Family Plans and case plans, • Plan and implement a balanced daily routine and group living experiences, • Provide coverage at any CMS residential program as assigned, • Transport clients to school, medical appointments, court dates, visitation, or other activities Youth Specialist & Child Care Worker Minimum Salary: $ 17.00/hour Youth Specialist & Child Care Worker Maximum Salary: $ 21.00/hour Youth Specialist & Child Care Worker Schedule: Please see below Note: During the interview process, hiring managers will discuss your availability, experience, and shift preferences to identify the best fit. Candidates new to direct care may start in a per diem role to build experience. Please have at least one professional/supervisor reference available Qualifications: • High School Diploma or GED, • 1 - 3 years of experience of working with a diverse population, • Valid driver's license, • Must remain awake and alert during entire shift, including overnight, • Must remain on shift until next shift arrives and is briefed, • Must work holiday and weeks when part of the regular schedule We value work-life balance and offer some stellar benefits: * For benefit-eligible positions: * Health/Dental/Vision/Life Insurance * Retirement planning options * Generous Time Off (as an eligible employee, you will accrue up to 23 days off in your first year, based on your standard work day) * Take a look at our Benefits Brochure * A collaborative work environment * Employee Assistance Program * Employee Discounts (movie tickets, hotels, flights, amusement parks, etc.) * Exciting referral bonuses * Ongoing training and development * Recognition and Awards * Career Growth * A collaborative team culture Catholic Charities is proud to be an Equal Opportunity Employer, fostering a workplace where every individual can shine their brightest. Applicants have rights under Federal Employment Law: Family and Medical Leave Act (FMLA) Equal Employment Opportunity (EEO) Know Your Rights Employee Polygraph Protection Act (EPPA)

Job Description Are you Ready to Launch Your Career? ???? Join us in our mission as a Youth Specialist & Child Care Worker at Catholic Charities of Community Maternity Services. At Catholic Charities hiring decisions are personal. So personal, in fact, that every application is screened by a member of the HR team or a trained hiring manger! We are hiring Youth Specialists at the Branson Center to support youth in a structured, supportive, and therapeutic environment. These are ongoing openings, and we welcome applicants for full-time (Evenings & Overnights). As the Youth Specialist & Child Care Worker, you will play a pivotal role in individuals' lives, making a significant impact through: • Provide daily care, supervision, and emotional support to residents and their children (if applicable), • Ensure the health, safety, and welfare of all residents at all times, • Supervise youth during visits with family members or identified visitors, following Family Plans and case plans, • Plan and implement a balanced daily routine and group living experiences, • Provide coverage at any CMS residential program as assigned, • Transport clients to school, medical appointments, court dates, visitation, or other activities Youth Specialist & Child Care Worker Minimum Salary: $ 17.00/hour Youth Specialist & Child Care Worker Maximum Salary: $ 21.00/hour Youth Specialist & Child Care Worker Schedule: Please see below Note: During the interview process, hiring managers will discuss your availability, experience, and shift preferences to identify the best fit. Please have at least one professional/supervisor reference available Qualifications: • High School Diploma or GED, • 1 - 3 years of experience of working with a diverse population, • Valid driver's license, • Must remain awake and alert during entire shift, including overnight, • Must remain on shift until next shift arrives and is briefed, • Must work holiday and weeks when part of the regular schedule We value work-life balance and offer some stellar benefits: * For benefit-eligible positions: * Health/Dental/Vision/Life Insurance * Retirement planning options * Generous Time Off (as an eligible employee, you will accrue up to 23 days off in your first year, based on your standard work day) * Take a look at our Benefits Brochure * A collaborative work environment * Employee Assistance Program * Employee Discounts (movie tickets, hotels, flights, amusement parks, etc.) * Exciting referral bonuses * Ongoing training and development * Recognition and Awards * Career Growth * A collaborative team culture Catholic Charities is proud to be an Equal Opportunity Employer, fostering a workplace where every individual can shine their brightest. Applicants have rights under Federal Employment Law: Family and Medical Leave Act (FMLA) Equal Employment Opportunity (EEO) Know Your Rights Employee Polygraph Protection Act (EPPA)

Job Locations US-NY-ALBANY ID 2026-189932 Line of Business PharMerica Position Type Full-Time Pay Min USD $124,800.00/Yr. Pay Max USD $124,800.00/Yr. PharMerica PharMerica is hiring a full-time Overnight Pharmacist inAlbany,NY ! Join our closed-door pharmacy team where you'll work in a non-retail environment, dedicated to meeting the pharmaceutical needs of long-term care and senior living clients. If you're passionate about delivering exceptional service and high-quality care, we want to hear from you. Apply today and become part of a team committed to making a difference! Schedule: M-F: 8pm-7am ( 7 days on, 7days off) Sa-Su: 8pm-8am Benefits and perks for you! Medical, Dental, Vision insurance • Health Savings & Flexible Spending Accounts (up to $5,000 for childcare), • Tuition discounts & reimbursement, • 401(k), • Company Paid Time Off, • Shift Differential, • DailyPay, • Pet Insurance, • Employee wellness and discount programs *Benefits may vary by employment status How YOU will benefit: • Supportive team with room to work independently, • Ongoing training and career growth, • Advancement opportunities in a growing company, • Referral bonuses As a Pharmacist you will: • Evaluate physician medication orders for drug appropriateness, correct dosage, potential drug interactions, and proper route of administration., • Provide clinical recommendations to physicians and healthcare staff regarding medication therapy changes and optimizations., • Maintain up-to-date patient/resident profiles, including medical history, lab results, and current medications (prescription, OTC, and home remedies)., • Ensure laboratory tests required for monitoring high-risk medications are appropriately ordered, reviewed, and communicated to the healthcare team., • Collaborate with physicians, nurses, and other healthcare professionals to provide clinical and technical support., • Document all communications and clinical interventions in the patient's medical record, including interactions with families and caregivers., • Implement and enforce policies and procedures for the safe handling, dispensing, and clinical oversight/management of medications., • Ensure compliance with all state and federal regulatory requirements related to pharmacy practice and medication management., • Report medication-related errors and adverse drug events to the Pharmacy Manager as required., • Educate and support clinical team and healthcare agency staff on safe and effective medication handling procedures. Required: • Bachelor's Degree in Pharmacy, Pharm D preferred, • One year experience in long term care desired, • License/Certification(s): current and valid pharmacist license in the state of practice, • Knowledge of drug therapy guidelines, medication safety practices, and regulatory standards (CMS, DEA, FDA)., • Proficiency in electronic medical records and pharmacy information systems, • Strong clinical judgement, and effective written and verbal communication *Position will be posted for a minimum of 7 business day PharMerica, an affiliate of BrightSpring Health Services, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. We also cater to individuals with behavioral needs, infusion therapy needs, seniors receiving in-home care, and patients with cancer. Operating long-term care, home infusion, and specialty pharmacies across the nation, we combine the personal touch of a neighborhood pharmacy with the resources of a national network. Our comprehensive solutions, backed by industry-leading technology and regulatory expertise, ensure accurate medication access, cost control, and compliance with best-in-class clinical standards. We are committed to enhancing resident health, reducing staff burdens, and supporting our clients' success. For more information, visit . Follow us on Facebook, Twitter, and LinkedIn. USD $124,800.00 / Year

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: The Vice President (VP), Cardiovascular Medicine is a key clinical executive responsible for leading cardiology- and vascular-related utilization management, quality improvement, and clinical operations across Evolent's value-based care platform. This role ensures consistent, high-quality adjudication of cardiology decisions and serves as a strategic liaison between clinical teams and clients. The VP will serve as a key strategic thought-partner in shaping Evolent's cardiovascular medicine programs. The VP must be able to incorporate clinical, operational, and business inputs in designing and refining our programs to achieve healthcare value creation. In addition, the VP will be able to rapidly scale our cardiovascular programs across all current and future clients to drive Evolent's business success. The VP will also partner closely with Evolent's Growth and Strategic Accounts teams for executive partnership with cardiovascular physician executives from all Evolent's clients. Such relationships are expected to deepen Evolent's business partnerships and provide key insights to evolve how we continue to deliver better clinical outcomes, provider experience, and client value. Des i red Skill Set * Experience driving innovation in cardiovascular care to ensure quality and manage costs * Demonstrated ability to engage,inspireand galvanize teams around mission and impact with ability to operationalize and scale business-critical, clinical programs * Ability to lead nationalcardiovascular medicineprograms with deep regulatoryexpertisein Medicare, Medicaid, and Commercial * Experience in health plan operations and/or managed care highly desirable * 7+ years managing teams to drive performance across physician, nursing, and shared services teams * 3+ yearsworking with clinical operations in a provider or health plan environment * Supervision ofclinical reviewerstoensure consistentclinical decision making * Comfort and skill in leading and managing significant and fast-paced organizational change and clinical integration * Clinicalsubject matterexpertiseand credibility to serve as keythought partner to support Growth,Customer, and Performance Suite,andProductteams * Proficiencycreating and leading presentations to key stakeholders inside and outside of the organization, including health plan executives, investors, physiciangroupsand trade associations * Authentic voice used to center patient and provider experience internally and externally * Growth mindset willing to test new interventions alongside other teamsas well as current and future clients * Ability to work within national coalitions to effectively advocate for payment reform,qualityand health equity at CMS/CMMI, within professional organizations and guilds, and across health plan partners. Experience we look for: * MD, DOboard certification incardiologyorvascular surgery * Active/unrestricted Medical License in one or more states * Board Certified (ABMS or Specialty Board) * 7+ years managing clinical/physician teams * 5+ clinical practice experience * Skilled communicator with executive presence and stakeholder engagement experience * Position is remote with 20% travel expected. To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. Technical Requirements: We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact for further assistance. The expected base salary/wage range for this position is $-. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!

About The Job Arcadis is the world's leading company delivering sustainable design, engineering, and consultancy solutions for natural and built assets. We are more than 36,000 people, in over 70 countries, dedicated to improving quality of life. Everyone has an important role to play. With the power of many curious minds, together we can solve the world’s most complex challenges and deliver more impact together. Role description: The Project Administrator I assists in the preparation of Arcadis DPS project deliverables and provides administrative project support for Arcadis DPS project managers under the supervision of the Manager of Project Administration and Document Control. Role accountabilities: • Provide support for project set up including updating the New York Deliverables Calendar and setting up file transfer sites on Procore and other FTS., • Organize permit sets by assembling electronic and hard copies and assuring inclusion of appropriate A/E stamped drawings, affidavits, and other documents as required., • Proof, edit, format and brand documents, presentations, and spreadsheets in adherence to industry and company standards and guidelines., • Submit small packages to clients through Procore., • Coordinate with Construction Managers (CM) on issue of construction deliverables coordinated with A/E design teams and serve as CM liaison for the PADC team., • Meet with PMs (and CMs, as needed) to review package composition and deadlines of client deliverables, and check files for formatting errors and consistencies, • Assemble and prepare A/E reports and deliverable packages including combining multiple documents in Bluebeam., • Use Excel to build and proof deliverable lists, reconcile discrepancies, and prepare Architectural drawing lists of files issued with deliverable packages., • Utilize conferencing technology and Microsoft Teams to project, review, and edit electronic documents and presentations during team meetings., • Attend and take notes at meetings and prepare minutes. Qualifications & Experience: • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions., • Fifth year college or university certificate; or one to two years related experience and/or training; or equivalent combination of education and experience., • Read and comprehend simple instructions, short correspondence and memos. Write simple correspondence. Effectively present information in one-on-one and small group situations to customers, clients and other employees., • Calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference and volume. Apply concepts of basic algebra and geometry. Perform these operations using units of American money and weight measurement, volume and distance., • Solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Interpret a variety of instructions furnished in written, oral, diagram, or schedule Form. Dealing problems involving several concrete variables in standardized situations., • Proficient in Microsoft Suite, Procore, Bluebeam, or other File Transfer Platforms. Why Arcadis? We can only achieve our goals when everyone is empowered to be their best. We believe everyone's contribution matters. It’s why we are pioneering a skills-based approach, where you can harness your unique experience and expertise to carve your career path and maximize the impact we can make together. You’ll do meaningful work, and no matter what role, you’ll be helping to deliver sustainable solutions for a more prosperous planet. Make your mark, on your career, your colleagues, your clients, your life and the world around you. Together, we can create a lasting legacy. Join Arcadis. Create a Legacy. Our Commitment to Equality, Diversity, Inclusion & Belonging We want you to be able to bring your best self to work every day which is why we take equality and inclusion seriously and hold ourselves to account for our actions. Our ambition is to be an employer of choice and provide a great place to work for all our people. We are an equal opportunity and affirmative action employer. Women, minorities, people with disabilities and veterans are strongly encouraged to apply. We are dedicated to a policy of non-discrimination in employment on any basis including race, creed, color, religion, national origin, sex, age, disability, marital status, sexual orientation, gender identity, citizenship status, disability, veteran status, or any other basis prohibited by law. Arcadis offers benefits for full time and part time positions. These benefits include medical, dental, and vision, EAP, 401K, STD, LTD, AD&D, life insurance, paid parental leave, reward & recognition program and optional benefits including wellbeing benefits, adoption assistance and tuition reimbursement. We offer nine paid holidays and 15 days PTO that accrue per year. Salaries will vary and are based on several factors, such as experience, education, budget, internal equity, project and location. Salary range will vary from $60,000 to $70,000 depending on experience.

The Fresh Market - - Responsibilities: Handle production for key items to support Meat-Seafood, Deli-CMS, and other departments as needed; Maintain knowledge of products/weekly ad items throughout the store and work across departments to assist guests in finding products and complete meal solutions

Become a part of our caring community The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Become a part of our caring community and help us put health first The Behavioral Health Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs within a context of regulatory compliance and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, Medicaid state contracts, clinical reference materials, internal teaching conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare, Medicare Advantage and Medicaid requirements, and will understand how to operationalize this knowledge in their daily work. The Behavioral Health Medical Director will attend and participate in meetings involving care management, provider relations, quality of care, audit, grievance and appeal and policy review. The Behavioral Health Medical Director will develop and present educational seminars on various behavioral health topics to the clinical operations team and healthcare organization. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management. Has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances these may require conflict resolution skills. The Behavioral Health Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value-based care, quality metrics, population health, and disease or care management. The Behavioral Health Medical Director may develop procedures, processes, productivity targets and new delivery models maintaining efficient operations while ensuring attainment of quality of care and financial goals. The Behavioral Health Medical Directors support Humana values, and Humana's Bold Goal mission, throughout all activities. Use your skills to make an impact Use your skills to make an impact Required Qualifications * MD or DO degree * Must be board certified in Psychiatry * 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare or Medicaid type population * Current and ongoing Board Certification in an approved ABMS Medical or ABPN Specialty * A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required * No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements * Excellent verbal and written communication skills * Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation * Fully remote schedule Mon-Fri 9am-6pm EST (nationwide) w/weekends as needed Preferred Qualifications * Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid products, or other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management * Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid * Experience with national guidelines such as MCG, ASAM or InterQual * Advanced degree such as an MBA, MHA, MPH- Exposure to Public Health, Population Health, analytics, and use of business metrics * Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health * The curiosity to learn, the flexibility to adapt and the courage to innovate Additional Information Typically reports to an Associate Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. Work at Home Guidance To ensure Home or Hybrid Home/Office associates have the self-provided internet service you must meet the following criteria: * At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested * Leadership approves satellite, cellular and microwave connection for use only if they give approval. * Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. * Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet our requirements for their position/job. * Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 09-12-2026 About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. ? Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our .

Job Description Job Description Overview Ansible Government Solutions, LLC (Ansible) is currently recruiting Primary Care Physicians to provide onsite primary care services to eligible beneficiaries of the Stratton VA Medical Center (VAMC) located at 113 Holland Avenue, Albany, NY 12208. On occasion, Physicians may also be asked to provide services at Community Based Outpatient Centers (CBOC) in Bainbridge, Clifton Park, Fonda, Catskill, and/or Saranac Lake. Physician may be requested to work up to four (4) Saturdays per year. This is a PRN position currently. Ansible Government Solutions, LLC (Ansible) is a Service-Disabled Veteran-Owned Small Business (SDVOSB) providing Federal customers with solutions in many arenas. Our customers face wide-ranging challenges in the fields of national security, health care, and information technology. To address these challenges, we employ intelligent and committed staff who take care of our customers' success as if it is their own. Responsibilities • Provide comprehensive primary care services, including women's health to a defined panel of patients, • Work with clinic staff to schedule new and follow-up patients, • Order and monitor appropriate medications for patients using VA Formulary; Physicians shall also query State Prescription Drug Monitoring Programs (PDMPs) before prescribing controlled substances per VHA Directive 1306 Querying State Prescription Drug Monitoring Programs (PDMP); Physicians shall also obtain IMED consents prior to prescribing or dispensing medications requiring consent including prescriptions for controlled substances, • Become familiar with VA Formulary and use the computer system as needed for efficient practice., • Refer patients to specialty care services as appropriate, admission to hospital care when indicated, and patient education and counseling, • Complete all patient documentation in a timely manner utilizing the CPRS system; Progress Notes shall be entered into the VA EMR the same day as the visit/encounter and must meet CMS guidelines for documentation which include the 3 key components to determine the level of evaluation and management (E/M); these components include: (1) History; (2) Exam; and (3) Medical decision making. Progress Notes associated with each visit/encounter will include pertinent medical treatment, test results, a treatment plan, teaching that was provided to the patient and/or the patient's family, the date of appointment, and the electronic signature of the treating clinician; all progress notes must be linked to the correct visit/encounter and location; a patient problem list must be present on the patient's record by the third clinic visit and will be entered via the EMR on the Problem List tab; this list will include all diagnoses, medications and procedures and will be updated as the patient's condition changes; Physicians are also responsible for proper documentation and completion of all clinical reminders as they appear during a patient's visit, • Ensure the patient's care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient's needs, • Provides consultation with and instruction to referring physician regarding appropriate indications for procedures so that the most expeditious and clinically appropriate work-up can be completed, • Determines the appropriate course of treatment and communicate in person or by phone with the referring clinicians, • Initiates appropriate social work referrals for all identified homeless, • Board Certified or Board Eligible in Internal Medicine, • Active, full, and unrestricted license to practice medicine in any U.S. State or Territory, • Active NPI report, • Active DEA license, • Must be able to pass a Federal background investigation, • Sit, stand, walk, lift, squat, bend, twist, and reach above shoulders during the work shift, • Lift up to 50 lbs from floor to waist, • Lift up to 20 lbs, • Carry up to 40 lbs a reasonable distance Powered by JazzHR it1rt9VSW1

Company : Highmark Inc. Job Description : JOB SUMMARY This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members ESSENTIAL RESPONSIBILITIES * Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. * Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise. * Participate in protocol and guidelines development to ensure consistency in the review process. * Actively manage projects and/or participate on project teams that require a physician subject matter expert. * Other duties as assigned. EDUCATION Required Required Required * Medical Doctor or Doctor of Osteopathic Medicine (DO) * Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards * Active medical state licensure required. Additional specific state licensure(s) may be required based on business need. Preferred Critical Thinking * Case Management * Customer Service * Oral & Written Communication Skills * Collaboration * Listening * Telephone Skills * General Computer Skills * Clinical Software * Managed Care Language (Other than English) None Travel Required 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $227,600.00 Pay Range Maximum: $385,000.00 Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J270842

Become a part of our caring community The Medical Director National OP Medicare relies on medical background and reviews preauthorization requests for services. You will work assignments that involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make determinations. Whether requested services, requested level of care, and/or requested site of service should be authorized, all work occurs with a context of regulatory compliance. Work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise. You will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient or post-acute care environments. You will have discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances, these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities. This may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value-based care, population health, or disease or care management. Use your skills to make an impact Responsibilities * Use clinical expertise, medical judgment, and experience to determine authorization for requested services, level of care, and site of service. * Perform medical necessity reviews in compliance with regulatory standards, CMS requirements, Humana policies, clinical guidelines, and applicable contractual obligations. * Apply knowledge of Medicare and Medicare Advantage requirements in daily utilization management and coverage determination activities. * Conduct computer-based review of moderately complex to complex clinical cases, primarily involving inpatient and post-acute care scenarios. * Review all submitted clinical documentation and records to support accurate, evidence-based determinations. * Interpret whether services rendered by other healthcare professionals align with national guidelines, clinical standards, CMS requirements, and internal policies. * Prioritize daily case review workload to ensure timely completion and adherence to compliance-driven turnaround times. * Communicate utilization review decisions and clinical determinations to internal associates and relevant stakeholders. * Speak regularly with external physicians to obtain additional clinical information, discuss determinations, and support peer-to-peer review processes. * Use conflict resolution skills when needed during physician discussions related to adverse determinations or clinical review outcomes. * Participate in care management activities when applicable to support quality, coordination, and appropriate resource utilization. * Provide oversight or input, as applicable, regarding coding practices, clinical documentation, grievance and appeals processes, and outpatient services and equipment reviews. * Collaborate with internal team members, cross-functional departments, Humana colleagues, and regional health services leadership to support organizational and market goals. * Engage with contracted physicians, physician groups, facilities, and community organizations to support regional priorities and strengthen collaborative business relationships. * Contribute to initiatives related to value-based care, population health, disease management, and care management strategies. * Work effectively in a structured environment with strong expectations for consistency in clinical reasoning, written determinations, and documentation. * Perform daily responsibilities independently after mentored training, exercising sound judgment with minimal direction. * Meet departmental expectations for quality, consistency, productivity, and compliance timelines. Required Qualifications * MD or DO degree * 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). * Current and ongoing Board Certification in an approved ABMS Medical Specialty * A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required. * No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. * Excellent verbal and written communication skills. * Evidence of analytic and interpretation skills * The curiosity to learn, the flexibility to adapt and the courage to innovate. Preferred Qualifications * Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. * Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. * Experience with national guidelines such as MCG or InterQual * Advanced degree such as an MBA, MHA, MPH * Exposure to Public Health, Population Health, analytics, and use of business metrics. * Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. * The curiosity to learn, the flexibility to adapt and the courage to innovate. Additional Information Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees. Work at Home Guidance To ensure Home or Hybrid Home/Office associates have the self-provided internet service you must meet the following criteria: * At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested * Leadership approves satellite, cellular and microwave connection for use only if they give approval. * Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. * Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet our requirements for their position/job. * Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information #physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $223,800 - $313,100 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 08-14-2026 About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our .

Responsible for staff orientation and continued development. Assists in the development of policies and procedures, standards of care and practice, and in the monitoring processes in relations to those standard • Demonstrates advanced knowledge and expertise in CMS, DOH, OMH, OPWDD laws and regula

Fresenius Medical Care - 16 North Greenbush Road - Responsibilities: High School diploma or GED; CMS-approved state and/or national certification; State licensure, education, and training as required; CPR certification; Previous patient care experience preferred.

Albany, NY, is seeking a Director for the CMS & Provider Direct Channel. This role involves leading the connectivity strategy across CMS compliance APIs and driving provider adoption.

Job Description The Senior NOC Technician will provide 2nd level technical support to all managed and unmanaged networks controlled from the FirstLight Core NOC. This position provides technical leadership and guidance for the NOC in proactive alarm management, network analysis, maintenance and health checks as well as being an escalation point for the customer and NOC peers. When the system malfunctions, the Senior NOC Technician troubleshoots the network across multiple vendor platforms, makes repairs or refers to the next level of technical hierarchy (Engineering) to restore services as quick as possible. There are three main roles in the Network Operation Center (NOC). Surveillance, Repair, and Communications/Documentation. This is to quickly recognize network anomalies, ensure maximum possible service availability and performance, and to communication and document the actions of the NOC. This position is responsible for providing technical guidance and training to the NOC Technician along with the FirstLight customer base. The individual will be responsible for working closely with all Network Operations teams ensuring customer satisfaction and ticket resolution. Perform the roles/responsibilities of the NOC Technician I and Senior NOC Technician positions as required. The position also includes some queue, workload, and team lead responsibilities. The Senior NOC Technician is expected to be a technical focal point within the team, validating escalations into 2nd & 3rd level Technical Support, and overseeing Core Network Events that impact multiple customers and systems. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES • Resolution and diagnosis of network and system faults at a 2nd line support level through proactive alarm management and technically escalated network faults., • Management of technically escalated issues that may require hands-on management of 3rd party vendor activities and customer liaison., • Monitoring network performance, highlighting any deficiencies through the appropriate channels via network health checks and identification of activities that present risk to the live networks. Action and resolve using the correct processes and procedures., • Provide operational assistance to all areas of Network Operations, mentor, and train members of the NOC., • Manage Major Service outages. Lead conference bridge directing activities. Update notifications in a timely manner. Work with OSP, GIS, and field teams as required. Direct NOC team to update customers and internal mail groups., • New Hire Training, • Job role will involve potential on call duties. Recommended SKILLS • Associate degree or Technical school is highly recommended with a strong knowledge of computer functionality., • Word, Microsoft Excel, Microsoft Outlook., • Excellent written and verbal communication skills are required., • Must be detail oriented and highly organized., • Strong detail-oriented and organized project management skills., • Ability to build and foster collaborative relationships., • Capable of working and learning independently with minimal supervision., • Strong problem-solving skills, and the ability to make decisions independently., • Good communication skills with ability to converse technical information to all audiences., • Cisco certifications, • Four to Six years Network Operations experience or equivalent, • Experience working on Core Transport, Data/IP networks completing 1st/2nd level diagnostics across multiple technologies and Vendors preferred., • Advanced 2nd line technical competency level that spans all deployed equipment technologies., • Willingness and ability to train NOC staff on technical, functional, and procedural items., • Experience with Network Edge, Transport and Access technologies such as DSL, GPON, SONET, and ROADM., • In depth knowledge of MEF and CE2.0 Ethernet products and standards, including y.1731 statistics collection, y.1564 testing., • Advanced knowledge of Ethernet and IP required. Successful candidate will have the skills necessary to troubleshoot layers 1-4 of the OSI Model., • In depth knowledge of connection-oriented Ethernet standards including MPLS-TP, G.8032, PBB-TE., • In depth knowledge of industry protocols including IP, MPLS, OSPF, ISIS, BGP, VRRP, VLANs, Spanning tree, and 802.1q., • Solid optical troubleshooting skills using OTDR, OSA, BERT and optical power meters., • Experience with passive and active OADM & ROADM DWDM systems. REQUIRED SKILLSETS Expert knowledge of the operations and repair of telecommunications systems to include, but not limited to, the following hardware platforms: • CYAN(Ciena) Z33/77., • Telco Sys 71xx / EdgeGenie, • Ciena 6500/One Control, • Huawei SONET, • Adva, • Calix / CMS, • Cisco (CCNA / CCDA Level), • Cisco SONET (ONS 15454)

Job DescriptionCardiology Nurse Practitioner/ Physician Assistant Location: Albany, NY Schedule: Part-Time (1 day per week) Total Annual Compensation: $30,000.00 - $60,000.00 About Infinite Medical P.C. Infinite Medical P.C. is a nationwide network of advanced practice providers and specialty clinicians committed to delivering high-quality, proactive care directly to residents in skilled nursing and long-term care facilities. Our partnership with MedElite Healthcare Management Group empowers us to focus on what matters most: providing compassionate, personalized care that meets the unique needs of each resident. Together, we champion continuous innovation and collaboration in our shared mission to redefine senior care across the country. Job Summary We are seeking a friendly and compassionate Cardiology Nurse Practitioner or Physician Assistant to join our team. As a Cardiology Nurse Practitioner/Physician Assistant, you will play a crucial role in providing comprehensive care to patients with heart-related conditions. This is an exciting opportunity to make a difference in the lives of patients while working alongside a dedicated team of healthcare professionals. . Responsibilities • Perform comprehensive patient assessments, including physical examinations, medical histories, and diagnostic tests, • Collaborate with cardiologists to develop and implement treatment plans for patients with cardiovascular conditions, • Administer medications, monitor patient responses, and adjust treatment plans as necessary, • Conduct cardiac stress tests, electrocardiograms (EKGs), and other diagnostic procedures, • Educate patients and their families about cardiovascular health, preventive measures, and the importance of medication adherence, • Provide counseling and emotional support to patients and their families, • Knowledge of CMS Regulations and NCQA HEDIS Guidelines, • Document accurate medical records to ensure compliance with OSHA and Government regulations and perform duties in accordance with site quality and safety systems, • Collaborate with the interdisciplinary team, • Analyze and organize the care of critically complex patientsRequirements, • Minimum 6 months of experience in long-term care or a skilled nursing facility, • Active and unrestricted Nurse Practitioner, Physician Assistant, or Physician license, • DEA License, • CPR BCLS/BLS certified, • Must hold a Master's Degree in Nursing, • Completed a degree from an accredited Nurse Practitioner program, • Preferred experience in cardiology: training provided, • Preferred experience in Documenting EMR (Sigma, Visual, PCC, etc.): training provided, • Must have great organizational and time management skills., • Competitive compensation per annum: $30,000.00 - $60,000.00, • Malpractice Insurance, • Paid subscription to Up-to-dateWhy Work With Us?, • Make a meaningful impact on the lives of seniors, • Work in a collaborative, mission-driven environment The above-noted job description is not intended to describe, in detail, the multitude of tasks that may be assigned but rather to give the applicant a general sense of the responsibilities and expectations of this position. As the nature of business demands change so, too, may the essential functions of the position. Ready to Make a Difference? Apply today and help us deliver compassionate, personalized care where it matters most.

Job DescriptionWe are actively seeking a Clinical Post Acute Care (PAC) Subject Matter Expert (SME) to join our growing healthcare team. If you have deep expertise in post-acute care workflows and clinical processes, this is a great opportunity! Experience Required: 10+ Years (preferred) Location: Remote Role Type: Contract Key Responsibilities: • Provide SME expertise in Post-Acute Care (PAC) workflows and operations, • Collaborate with clinical, technical, and business teams, • Support implementation and optimization of PAC solutions, • Ensure compliance with healthcare regulations and standards, • Analyze clinical data and improve patient care processes, • Work with EHR/EMR systems and healthcare data integrationImportant Skills (Must Have):, • Strong knowledge of Post-Acute Care (Skilled Nursing, Home Health, Rehab, LTAC), • Experience with clinical workflows & care coordination, • Hands-on experience with EHR/EMR systems (Epic, Cerner, etc.), • Understanding of CMS guidelines, HIPAA compliance, • Knowledge of HL7, FHIR, healthcare data standards, • Strong analytical and problem-solving skills, • Excellent communication with clinical & non-clinical stakeholders, • Experience in healthcare IT or digital transformation projectsPreferred Qualifications:, • Clinical background (RN, PT, OT, or related), • Experience in PAC consulting or healthcare systems implementation, • Certifications in healthcare/clinical informatics are a plus This is a remote position.

Job DescriptionSenior AuditorEmployment Type: Full-Time, ExperiencedDepartment: Financial CGS is seeking a highly skilled Senior Auditor to provide general auditing and accounting services in support of fraud investigations involving potentially complex financial transactions and complex organizations attempting to evade detection. The ideal candidate will develop, coordinate, and draft technical audit guidelines, is proficient in a variety of accounting systems, and practices excellent cross-functional communication throughout investigations. CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities. Skills and attributes for success:-Management experience helpful; experience in litigation environment, experience working with automated litigation support helpful. -Conduct financial analysis by reviewing bank records, wire transfers, ledgers, and other financial documentation.-Conduct open-source intelligence and database research on individuals, business entities, and assets.-Analyze large and complex healthcare claims datasets to identify fraud, waste, and abuse patterns.-Design and run SQL queries, models, and data algorithms to detect anomalous billing trends and patterns.-Extract and manipulate federal health claims data using CMS tools such as OnePI, STARS, Business Objects, and other related platforms.-Prepare analytical summaries, memoranda, charts, and data visualizations to support case development and litigation.-Summarize transaction histories and flag suspicious activities for follow-up.-Evaluate allegations of fraud and provide recommendations to [assistant client attorneys] for determination.-Based on fraud data, assist with development of investigative plans including identifying areas of investigative focus.-Work collaboratively with attorneys and investigators to refine leads and develop investigative strategies.-Deliver oral briefings and written reports to [assistant client attorneys] on findings from healthcare data analytics.-Support development of internal best practices and workflows for healthcare fraud detection." Required Skills: -Undergraduate degree minimum, CPA/MBA equivalent.-Must be a Certified Public Accountant. -MBA or equivalent in accounting or directly related field. -Thorough knowledge of generally accepted accounting principles and generally accepted auditing standards. -Minimum of five years’ experience as an auditor; minimum three years specialized experience in the specific subject matter area involved - for example, Medicare billing and claims systems, or DoD inventory systems. -Extensive working knowledge of appropriate accounting and financial analysis ADP systems and applications. -Excellent oral and written communication skills. -Must be a United States citizenMust be able to obtain a Public Trust security clearance Our Commitment:Contact Government Services (CGS) strives to simplify and enhance government bureaucracy through the optimization of human, technical, and financial resources. We combine cutting-edge technology with world-class personnel to deliver customized solutions that fit our client’s specific needs. We are committed to solving the most challenging and dynamic problems. For the past seven years, we’ve been growing our government-contracting portfolio, and along the way, we’ve created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work. Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come. We care about our employees. Therefore, we offer a comprehensive benefits package.- Health, Dental, and Vision- Life Insurance- 401k- Flexible Spending Account (Health, Dependent Care, and Commuter)- Paid Time Off and Observance of State/Federal Holidays Contact Government Services, LLC is an Equal Opportunity Employer. Applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Join our team and become part of government innovation! Explore additional job opportunities with CGS on our Job Board: For more information about CGS please visit: or contact:Email: #CJ We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

Job DescriptionJob Title: Epic Tapestry Analyst Job Summary: The Epic Tapestry Analyst is responsible for the build, configuration, implementation, and support of the Epic Tapestry (Managed Care/Payer) module. This role partners with payer operations, revenue cycle, contracting, and IT teams to ensure accurate benefits, authorizations, claims adjudication, and payer workflows. Key Responsibilities: • Configure and maintain Epic Tapestry (Payer/Managed Care) application components., • Build and support benefit plans, products, packages, coverage rules, and authorizations., • Configure claims adjudication logic, reimbursement rules, and payment policies., • Support payer contracts, fee schedules, and coordination of benefits (COB)., • Analyze payer requirements and translate them into Epic system build and workflows., • Perform unit, integrated, and user acceptance testing (UAT); resolve defects., • Collaborate with Revenue Cycle, Enrollment, Claims, and Provider Contracting teams., • Support integrations with Epic HB, PB, Clearinghouses, and external payer systems., • Monitor adjudication errors, work queues, and reports; recommend system improvements., • Provide go-live, postgo-live, and production support., • Create and maintain build, workflow, test scripts, and training documentation., • Ensure compliance with CMS, Medicaid, Medicare, and HIPAA regulations. Required Skills & Qualifications: • Epic Tapestry certification or proficiency (required or strongly preferred)., • 3+ years of experience working with Epic Tapestry or payer systems., • Strong knowledge of payer operations, benefits, claims processing, and authorizations., • Experience with Medicare, Medicaid, and commercial insurance plans., • Understanding of reimbursement methodologies and provider payment models., • Strong analytical, troubleshooting, and communication skills. Preferred Qualifications: • Experience with Epic Resolute HB/PB integrations., • Knowledge of reporting tools such as Clarity, Caboodle, or Reporting Workbench., • Previous Epic implementation or payer-system optimization experience., • Healthcare payer or managed care organization background.