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Now Hiring: Pediatric Physician Assistant (PA) or Nurse Practitioner (NP) In-Office | New Urgent Care Facility | New York Licensed We are partnered with a growing regional healthcare organization opening a new urgent care facility in Manhattan. They are seeking a Pediatric PA or NP to provide high-quality care in a fully in-office setting. This is a strong opportunity to step into a well-supported, fast-paced environment while helping build a pediatric-focused urgent care presence across Manhattan and the surrounding boroughs. Key Responsibilities • Evaluate, diagnose, and treat a wide range of pediatric urgent and primary care conditions, • Perform age-appropriate exams, assessments, and minor procedures, • Prescribe medications in accordance with New York State regulations, • Escalate care or refer to specialists/emergency services as needed, • Deliver compassionate, family-centered care in a high-volume setting, • Maintain accurate, timely clinical documentation, • Active New York Physician Assistant or Nurse Practitioner license, • Active Medicare Provider ID (required at time of hire), • DEA license in good standing, • Experience in pediatric urgent care or high-volume environments, • Brand-new facility with modern systems and workflows, • Stable, fully in-office clinical environment, • Backed by a growing regional healthcare organization, • Supportive leadership and collaborative team, • Opportunity to help build and scale a pediatric urgent care model in a key market

Job Description The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. Even in a non-clinical role, employees have an opportunity to make a positive impact on the quality of our health plan members' lives. Process all requests for services in accordance with Medicare and NYS Medicaid Guidelines as well as departmental criteria and guidelines. Works collaboratively with other disciplines including Care Manager, Assessment Nurse, and Primary Care Physician or other Specialists as necessary to ensure timely provision of services. Coordinates timely completion of UAS NY assessment that accurately reflects current condition of the member. Ensures that the member’s Individualized Person Centered Care Plan has been updated and accurately reflects present status of the member. • Graduate of an accredited nursing program, Bachelor’s preferred, • Knowledge with Utilization management processes preferred, • Current NY RN license and registration required, • CCM preferred, • Minimum three to five years nursing experience in long term care, managed care, home care, geriatrics or hospice, • Prior experience in an interdisciplinary service delivery environment preferred, • Working knowledge of Medicare and Medicaid regulations, • Prior experience in an interdisciplinary service delivery environment preferred, • Working knowledge of Windows, Word and Excel, • Knowledge of current standards of medical practice and healthcare delivery systems, • Strong assessment skills, • Knowledge of Interqual preferred

Job DescriptionEmpower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. POSITION OVERVIEW The HARP Care Manager develops, facilitates, and communicates a plan of care in partnership with the member, his/her assigned Health Home, primary caregiver, the primary and attending physicians, and various Behavioral Health and/or substance use disorder providers. In partnership with these parties, the HARP Care Manager assesses, plans, facilitates, and advocates for options and services to meet a HARP member’s complex health needs through communication and available resources. In addition, the HARP Care Manager is responsible for scheduling aftercare follow-up for members discharging from an acute behavioral health inpatient setting. This position ensures that members have a scheduled appointment in place, completes follow-up and reminder call to member and follows up with providers to ensure member’s compliance with aftercare. This position requires that most case management activities will be performed in field via community and facilities outreach. Work Shifts 9:00 AM- 5:00 PM Duties & Responsibilities • Clinically assess members for acute behavioral and physical health needs. Generating referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement., • Conduct Utilization Review for designated Case Management members for some diversionary levels of care. (CORE/HCBS, ACT)., • Expected to meet with members in their homes, shelters, other residential settings, at community agencies, hospital inpatient units and/or day hospital programs., • Conduct initial and ongoing Behavioral Health clinical assessments., • Develop a formal plan of care for all services needed for the HARP member. Notify physicians for any changes in member’s plan of care., • Assists members and providers in accessing post-discharge aftercare related appointments. Works with inpatient facility team to identify appropriate follow-up care for CORE and HARP BH members., • Responsible for outreaching members regarding adhering to 7-day follow up appointment to offer a 30-day appointment as part of HEDIS measures, • Responsible for mailing discharge aftercare letters with a list of referrals to members not reached by phone., • Collaborate timely follow up with assigned nurses for clinical updates to plans of care., • Document IDT care coordination notes between both internal MetroPlusHealth staff and external Health Home/CMA workers., • Review and Approve submitted Health Home Plans of Care and ensure that CMA’s are conducting timely annual assessments. Review and approve CORE/HCBS requests; educating CMA workers about PROS and IOP options for members who opt out of receiving CORE/HCBS., • Assist providers with achieving pay for performance goals and examine the feasibility of Value Based Payment with high volume providers for HARP line of business., • Educate providers on medication and treatment compliance while also promoting the use of Long Acting Injectables., • Enlist existing provider network in promoting first episode psychosis treatment., • Educate providers to alternate treatment services being promoted by Health + Hospitals in lieu of Inpatient Detox Attends and prepares for bi-Weekly Interdisciplinary Care Team (ICT) meetings which will feature newly enrolled, frequently admitted, high utilizing at risk HARP members., • Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner., • Evaluate housing needs appropriately and assist with housing application process. Collaborating timely with MetroPlusHealth internal housing team for supportive assistance., • Assist members with the coordination of services from various settings as appropriate. Including facilitating discharge from acute setting and alternate settings., • Provides Care Coordination throughout the continuum of care., • Optimizes both the quality of care and the quality of life for the MetroPlusHealth members. Identifies members appropriate for specialty programs., • Documents in a comprehensive manner to ensure that all goals, interventions, and care coordination activities for each member in DCMS (EMR) system, and other applicable software programs, are complaint with professional standards and regulatory guidelines., • Contributes to MetroPlusHealth corporate goals through ongoing execution of member care plans and member goal achievement., • Performs other appropriate HARP Behavioral Health duties and participates in other special projects as assigned, including, but not limited to, audit review and preparation, quality improvement, community health education, facility/provider relations and marketing activities. Minimum Qualifications, • Master’s Degree required, • Overall, 3-5 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience in a managed care and or in a Psychiatric Hospital Inpatient and/or Outpatient experience with both case and utilization management., • One-year HARP experience preferred., • Field based Case Management Experience within the Integrated Collaborative Care Model Approach, • Experience with chronic condition management, particularly Diabetes, HIV, Heart Disease, • Pharmacy, Psyckes, E-Paces, HCS (UAS) MAPP, CORE/HCBS, Microsoft Teams Video knowledge, • Strong interpersonal and assessment skills, the ability to remain calm and poised with challenging members who often present as in a constant state of crisis., • Previous history of conducting home visits to members as well as assessing them bedside during an inpatient hospitalization or at their long-term Substance Abuse Residential setting., • Medical Background & Bilingual preferred., • Integrity and Trust, • Teamwork and Problem-Solving Attitude, • Customer Service Member FIRST Focus, • Superior Technical Computer skills (Microsoft Office, DCMS, Teams Video Application), • Clear and Concise Written/Oral Communications, • Exceptional Organizational and Communication Skills.

Job Description Job Title: Medical Office Manager Location: Brooklyn Heights, NY Job Type: Full-Time Salary: $66,000 – $96,000 per year (DOE) About the Opportunity A busy and well-established medical practice in Brooklyn Heights, NY is seeking an experienced Medical Office Manager to lead the administrative and operational functions of the office. This role is ideal for a highly organized professional with strong leadership skills and experience managing healthcare office operations, staff, and patient workflows. The Medical Office Manager will ensure efficient daily operations, maintain regulatory compliance, support staff development, and deliver an exceptional patient experience. Key Responsibilities • Oversee day-to-day operations of a single-site medical office, • Manage office workflow including patient scheduling, records management, and front desk operations, • Ensure compliance with HIPAA, OSHA, labor laws, and healthcare regulations, • Supervise and support administrative staff, including performance evaluations, coaching, and training, • Address patient concerns and implement improvements to enhance patient satisfaction, • Oversee reception, patient intake, scheduling, and chart preparation, • Manage medical billing processes and insurance workflows, • Coordinate surgical authorizations, scheduling, and billing, • Maintain office supplies, medical inventory, and equipment, • Support additional administrative and operational tasks as needed Qualifications • Bachelor’s degree in business administration, Public Health Administration, Healthcare Management, or related field, • 5–7 years of experience in medical office administration or healthcare operations, • 3+ years of supervisory experience managing teams of five or more employees, • Strong knowledge of healthcare office operations and regulatory compliance Required Experience • Medical billing and insurance processing, • Medicare, Medicaid, and commercial insurance regulations, • Human resources processes including hiring, onboarding, and performance management, • Workers’ Compensation and No-Fault claims, • Surgical authorization and scheduling coordination Skills • Strong leadership and organizational skills, • Excellent communication with physicians, staff, and patients, • Experience with electronic medical records (EMR) and healthcare software, • Strong attention to detail and ability to manage multiple priorities, • Commitment to providing excellent patient service Additional Requirements • Bilingual in Spanish and English (Required) Physical Requirements • Prolonged periods of sitting and working on a computer, • Ability to occasionally lift up to 25 pounds Benefits • Competitive Salary, • Paid Time Off (PTO), • Medical, Dental & Vision Insurance, • 401(k) Retirement Plan, • Legal Insurance, • Pet InsuranceCompany DescriptionLanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.

Job Description Job Title: Office Manager – Medical Practice Location: Brooklyn Heights, NY Employment Type: Full-Time Schedule: Full-Time | Monday–Friday Salary: $66,000 - $70,000 annually (DOE)*** Position Overview: We are seeking an experienced Office Manager to oversee the business operations of a medical practice site in Brooklyn Heights. This role ensures smooth daily operations, strong staff engagement, regulatory compliance, and excellent patient service. Key Responsibilities: • Manage day-to-day operations of a single-site medical office, • Maintain efficient patient flow including reception, scheduling, records, and chart preparation, • Ensure compliance with HIPAA, OSHA, labor laws, and healthcare regulations, • Supervise staff performance, including reviews, recognition, and discipline, • Address patient concerns and implement process improvements, • Oversee billing processes and insurance workflows, • Assist with surgical authorizations, scheduling, and billing, • Bachelor’s degree in Public Health Administration, Business, or related field, • 5–7 years of medical office administration management experience, • Medical billing and insurance processes, • Medicare, Medicaid, and commercial insurance regulations, • Workers’ Compensation and No-Fault claims, • Strong leadership and organizational skills, • Professional communication with staff, clinicians, and patients, • Experience with healthcare software systems, • High attention to detail and customer service focus Competitive Salary, Paid Time Off Medical Dental Vision 401(k) Legal Insurance Pet Insurance. Company DescriptionLanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.

Job DescriptionAbout NYLAG: Founded in 1990, NYLAG is a leading civil legal services organization combatting economic, racial, and social injustice by advocating for people experiencing poverty or in crisis. Our services include comprehensive, free civil legal services, financial empowerment, impact litigation, policy advocacy, and community partnerships. NYLAG exists because wealth should not determine who has access to justice. We aim to disrupt systemic racism by serving individuals and families whose legal and financial crises are often rooted in racial inequality. NYLAG goes to where the need is, providing services in more than 150 community sites (e.g. courts, hospitals, libraries) and on our Mobile Legal Help Center. NYLAG’s staff of 410 impacted the lives of nearly 129,000 people last year. Job description NYLAG seeks a highly motivated temporary staff attorney to join its staff from end of April 2026 to end of October 2026 to provide elder law and special needs legal services to older adults and individuals with disabilities. The temporary staff attorney will work on matters related to Medicaid planning and appeals, Medicare, homecare appeals, Social Security, Supplemental Security Income (SSI), and advance directives and Wills, as well as other legal issues related to older adults and people with disabilities. In terms of Medicaid, the attorney will assist clients with navigating the Medicaid landscape, including eligibility and representation on complex fair hearings and external appeals relating to homecare. This attorney will also provide community and professional trainings on these topics. Duties and Responsibilities This attorney’s primary responsibilities include: • Providing direct representation, advice and consultation on elder law matters., • Counseling, drafting and supervising the execution of advance planning documents;, • Representing clients at complex administrative fair hearings and external appeals related to Medicaid homecare;, • Meeting with clients at community-based sites and making home, hospital and nursing home visits for homebound, hospitalized and nursing home clients throughout Brooklyn., • Conducting trainings for community-based organizations, local agencies, and other advocates in the related substantive matters;, • Admission to NYS Bar is required;, • NYS notary license is required;, • Excellent communication, research and writing skills are required;, • Civil legal services, clinical, and/or fellowship experience in elder law and health law is preferred;, • Strong organizational and administrative skills are required;, • Experience working with diverse populations is preferred;, • Demonstrated ability to take initiative and work independently. Employment type: ☒ Full-time ☒ Temporary – from May 4, 2026 to October 30, 2026 Professional Level: ☒ Professional Salary Range: NYLAG is a unionized workplace, and salaries are set pursuant to a collective bargaining agreement. The current salary range for this position is between $88,265 - $101,009 depending on experience. Benefits: Medical, dental, vision, 401k, life insurance, long term disability, commuter benefits, flexible spending accounts (FSA) for Medical and Dependent care. Application Instructions: Please save resume and cover letter on one pdf. NYLAG is committed to a hybrid work policy for staff whose work does not require their full-time presence in the office. NYLAG’s current policy is that most staff are required to work in NYLAG’s offices or do other in-person work at least two days each week. This policy is subject to change. Powered by JazzHR ZVPSc7Nwht

Under the supervision of the Senior Director of Integrated Care Management (ICM), the Director of ICM (Medicare) provides clinical and administrative oversight for the Medicare Advantage and Integrated Benefits for Dually Eligible (IB-Dual) populations, also known as the Medicare dual eligible speci

Position Summary: The Senior Analyst, Government Programs Operations - Analysis & Efficiencies will play a pivotal role in supporting the operational success of Medicare, Medicaid, and the Exchange programs. This analyst develops data-driven solutions that enhance efficiency and reduce manual effor

Job Description Job Details: Title: LMSW / LCSW – Child Care Location: Bronx, NY (Hybrid) (Once a week on-site) Job Type: Full time Permanent Salary: LMSW - $65,000 to $70,000 Annually (Depends on the years of experience) + Full-time Benefits / LCSW - $85,000 to $95,000 Annually (Depends on the years of experience) + Full-time Benefits Job Summary The Licensed Social Worker will be responsible to perform daily social work operations Responsibilities • Assessment of patients referred by Primary Care Provider (PCP) using evidenced based assessment tools., • Treatment of behavioral health conditions using evidenced based approaches (CBT, Motivational Interviewing, crisis intervention, Interpersonal Psychotherapy, and behavioral activation)., • Make treatment recommendations during collaborative care team meetings, • Monitor treatment through care planning and coordination of care with clinical team and health homes., • Provide crisis intervention services and risk assessment of patients as needed., • Engage clients with limited utilization of behavioral health service through outreach efforts., • Document services in a timely fashion., • Engage in weekly clinical supervision, • New York state LMSW / LCSW License, • Master of Social Work Degree from accredited institution, • Must see patients age of 6 or above., • Ability to utilize behavioral health screening tools and perform biopsychosocial assessments, • Utilize DSM-V diagnostic criteria to diagnoses and treat behavioral health conditions, • Assess for risk and collaborate with psychiatric and clinical team around risk management, • Ability to utilize electronic health records for documentation of clinical services and review of relevant health data., • Communicate clinical information in a succinct and comprehensive way to integrated care teams, inclusive of PCP, NP/MD, and Health Home Care Management staff., • Bilingual in Spanish required., • Already enrolled in Medicare or Medicaid program for LCSW.Company DescriptionLanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.

Job Description Social Workers establish and maintain a therapeutic relationship with individuals and their families by effectively utilizing professional social work skills. They may review the individuals psychiatric, medical and other case records and discuss issues with families and other members of the treatment team. Complete admission screening; conduct psychosocial assessments; make treatment recommendations; participate in treatment planning; provide social casework services; provide individual, group, and family therapy; assess availability of services; serve as consumer advocate; develop and implement discharge plans; and coordinate services with community providers. Incumbents advocate ensures individuals receive appropriate treatment/services that their legal and human rights are protected and promote effective and consistent utilization of services and resources. We are offering the maximum salary range for qualified Spanish-bilingual candidates! ESSENTIAL JOB FUNCTIONS: List all essential job duties. (To perform this job successfully, an individual must be able to perform each essential duty listed satisfactorily with or without a reasonable accommodation. Reasonable accommodations may be made to enable qualified individuals with a disability to perform the essential duties unless this causes undue hardship to the agency.) • Interviews individual after a thorough review of the record to construct the psychosocial assessment., • Obtains psychosocial history by interviewing the individual, the family, significant others, and former service providers to formulate clinical recommendations for therapeutic interventions., • Assesses individuals' treatment needs., • Prioritizes the individual's treatment needs; assesses impact of treatment on the individual and the family; assesses ability of significant others to assist in the treatment planning process; and involves the individual and significant others in a comprehensive treatment plan; and in some settings, determines which individuals are appropriate for other levels of care., • Participates in the development of a written comprehensive individualized treatment plan that is based on the assessment of the individuals clinical needs; determines need for services and ensures that referrals for ancillary, support and consultative services are noted and made; reviews and updates individual treatment plan according to all applicable guidelines and in response to clinical change; and ensures that arrangements are made and documented for continuation of care well in advance of individuals planned departure., • Provides individual therapy to enhance social, emotional, and behavioral functioning., • Advises the individual and family about the nature of the illness, needed and available services and how to access them., • May identify, coordinate and plan for the individuals' financial needs., • May identify and provide intervention to individuals in crisis in a range of settings; or provides consultation to others to enable them to appropriately intervene., • Assesses the individual's readiness for discharge; identifies needed resources; works with consumers/patients, families and providers to link him/her with appropriate resources; may conduct follow-up visits., • Prepares required progress notes, treatment team recommendations, written and verbal reports, discharge plans and other documents within required timeframes., • As an integral member of the treatment team, ensures that all relevant clinicians are kept informed of the individuals clinical needs, family social adjustment, services needed and their availability through clear documentation of the record. 15. May supervise social work students. Meets with staff on caseload and identified issues. Prepares performance program and discusses these duties with staff; prepares and completes a written performance program according to agency guidelines; monitors and evaluates performance. Establishes work schedules; monitors time and attendance taking corrective action where necessary; approves and disapproves requests for time off. If supervising social work students, maintains liaison with sponsoring institutions and ensures that facility policies are followed; applications are properly reviewed; orientation is thorough; a supervisor is clearly designated; and a high-quality clinical experience is provided to the social work student. ESSENTIAL KNOWLEDGE, SKILLS AND ABILITIES: • Ability to work with clients, families, and staff in a caring and respectful manner, and with due understanding of and consideration for cultural differences., • Ability to develop, evaluate, implement and modify a treatment plan, meeting all deadlines and productivity standards., • Ability to communicate effectively with staff, clients, families, and the public., • Ability to prepare accurate and timely documentation, reports and other written material as assigned. using computers and computer software assigned (e.g., IMA, Word, Anasazi, etc.), • Ability to understand and adhere to internal and external laws, rules, and policies., • Ability to secure the cooperation of and work effectively with others., • Licensed by New York State as a Master Licensed Social Worker or as a Licensed Clinical Social Worker; current, valid registration certificate. Experience with the type of clientele served by the particular clinic very helpful., • Must be eligible for full and unconditional participation in the Medicaid and Medicare programs, • May be required to possess a valid NYS driving license and a clear driving record., • FOR ALL POSITIONS: Continued employment is based on the ability to maintain professional licensure, current registration and participation in the Medicaid and Medicare programs. #ICLRN

Job Description Join a Company That Puts People First! Licensed Practical / Vocational Nurse – LPN/LVN We are one of the largest private duty nursing companies in the nation and growing! At Aveanna, we’re proud to foster a workplace culture that celebrates diversity, encourages connection, and supports our team members every step of the way. Here’s what sets us apart: Award-Winning Culture • Indeed’s Work Wellbeing Top 100 Company in 2024, • Paid Time Off Available, • Flexible scheduling- full-time, part-time, or PRN. Days, nights, and weekend shifts— we will work with your availability!, • 24/7 Local support from operators and clinicians, • Aveanna has a tablet in each patient’s home allowing for electronic documentation, • Career Pathing with opportunities for skill advancement, • Weekly and/or Daily Pay, • Employee Stock Purchase Plan with 15% discount, • Employee Relief Fund We consider it both a privilege and an honor when we welcome a new patient into our Aveanna family. Our homecare is always delivered from a place of heartfelt compassion and empathy, and every one of our Licensed Practical / Vocational Nurses (LPN/LVN)s works together to make sure we achieve outstanding clinical outcomes. Aveanna isn’t just a provider of compassionate homecare to children and adults. We are a national leader. Qualifications • Must have and maintain an active, unencumbered license (LPN/LVN) in the state in which the clinician will practice, • Compact licenses must be transferred to your state of residence within 90 days, • Current CPR certification (with hands-on component)- Aveanna can assist in obtaining this requirement after hire, if necessary., • TB skin test (current within last 12 months), • Six months prior hands-on nursing experience preferred but not required As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate. Notice for Job Applicants Residing in California Notice for Job Applicants Residing in Florida

Job Description Provides appropriate and clinically indicated services to children, adolescents, parents and families in an on-site school-based satellite clinic in addition providing support at HPC. Provides in-service training, collateral contact, and support to teachers and school personnel. Maintains clinical records within all Federal, State, and City regulations documenting all services provided. ESSENTIAL JOB FUNCTIONS: List all essential job duties. (To perform this job successfully, an individual must be able to perform each essential duty listed satisfactorily with or without a reasonable accommodation. Reasonable accommodations may be made to enable qualified individuals with a disability to perform the essential duties unless this causes undue hardship to the agency.) • Provides trauma- Informed, recovery-oriented, integrated, person-centered care to individuals with severe and persistent mental health diagnoses., • Utilizes clinical modalities such as CBT, MI, REBT, DBT and SFBT to support Clients, • Effectively and empathically provides direct clinical services including individual, family, and crisis intervention as clinically indicated., • Conduct intakes in schools and HPC as needed; hold a caseload of 50+, • Collaborates with an interdisciplinary team and consults with supervisor as clinically indicated., • Maintains clinical records in compliance with all City, State, and Federal regulations as per the State Office of Mental Health, and the State of New York Department of Health., • Complies with managed care requirements including consulting with care coordinators, obtaining treatment authorization, and providing necessary documentation in a thorough and timely manner., • Committed to equity, anti-racism and active promotion of the ICL equity goals and action steps., • Strong clinical writing skills; ability to accurately document counseling sessions demonstrating an understanding of mental health status, recovery-oriented treatment planning and psychiatric and substance harm reduction techniques, • Computer proficiency. Ability to master electronic health record software, use word processing programs, and computer programs and applications to provide telehealth as required, • Cultural competency is essential., • Ability to work effectively in high pressure mental health crisis environment, • Ability to maintain composure and demonstrate trauma -informed Person-Centered care to clients in a crisis Ability to meet deadlines., • Ability to follow procedures and instructions; prioritize, think logically and advocate professionally., • Demonstrates knowledge of, and supports, clinic mission, vision, and values, standards, and the code of ethical behavior. Education: LMSW, LMHC or LCSW; current, valid registration certificate. Must be eligible for full and unconditional participation in the Medicaid and Medicare programs Experience with children and families and/or a school-based setting is preferred but not required

Job Description PRIMARY FUNCTION/PURPOSE: Supervise the delivery of services provided by Client Care Coordinators (Social Workers) to enhance existing services to homeless families. This includes the completion of a thorough assessment, and the development and completion of a bio-psychosocial for each family upon intake, crisis intervention, counseling, client advocacy, and referrals to government and/or community-based resources. If needed, this individual will ensure that recommendations of achievable goals be implemented on each family’s service plan, leading to permanent housing, and strengthening the overall permanency outcome for clients in shelter. MINIMUM QUALIFICATIONS: • Must be a Licensed Clinical Social Worker (LCSW) in the state of New York, • Minimum of 3-5 years of experience in social services, counseling, crisis intervention, family services, preventive services, housing services, or homeless services, • At least two years of supervisory experience in social services, counseling, crisis intervention, family services, preventive services, housing services, or homeless services, • Knowledge in three or more of the following areas:, • Experience in supervision of social workers, • Experience in client assessment, service plan development, and case management, • Child and adolescent development, • Parent-child relationships, family dynamics, and diagnostic classifications, • Mental health and Emotional/Behavior health, • Child Welfare policies and procedures, • Government Entitlements: TANF, Social Security, Medicare etc., • Knowledge and experience working with diverse cultures and ethnicities, • Expertise in strengths-based, solution-focused, and family-centered practice, • Experience facilitating groups for adults, • Proficiency in Spanish a plus, • Excellent oral and written communication skills coupled with strong interpersonal skills, • Proficient in MS Office, Outlook, Excel, PowerPoint, and Adobe PRIMARY RESPONSIBILITIES: • Manage and supervise a team of Client Care Coordinators to develop a team of skilled professional staff, including recruitment, training, supervision, evaluation, and staff scheduling to achieve the objectives of both CRF and Agency Funders, • Guide client care coordinators in the development, implementation, and achievement of program goals, • Handle administrative, operational, and programmatic issues that might affect client care coordinator staff, • Assign cases to client care coordinators for newly admitted clients to be assessed immediately upon admission and managed throughout shelter stay, • Ensure the timely completion of comprehensive bio psychosocial assessments for each client to understand strengths and service needs, • Work effectively as a part of a multi-disciplinary team to enhance client engagement and the delivery of quality service, • Enhance the delivery and coordination of mental health and related services to clients in shelter, • Ensure that Client Care Coordinator reports are clearly written and capture assessment findings and recommendations, • Confer and consult with professional and technical personnel in implementing a multidisciplinary approach to client care and well-being, • Ensure that Client Care Coordinators are providing short-term counseling, outreach services, crisis intervention, risk assessment, safety planning, and psycho-education for clients, • Collaborate with ACS and/or prevention services agencies, and participate in conferences to advocate on behalf of clients as needed, • Ensure that Client Care Coordinators are providing clients with appropriate referrals and linkages between mental health providers, government agencies, and other related community-based services as needed, • Serve as agency/program liaison between DHS, government agencies, community-based organizations and/or groups, • Develop and Implement group work to be facilitated by Client Care Coordinators to address family issues, enhance life skills etc., • Ensure that Client Care Coordinators are completing all documentation in a timely manner, • Ensure that Client Care Coordinators assess each client/family for supportive housing, complete supportive housing applications when applicable, and accompany residents to supportive housing interviews when needed, • Ensure that Client Care Coordinators complete and discuss exit summaries with each client, and provide clients/families with referrals and supportive services identified in their new community, • Participate in family meetings with case work and housing teams to discuss planning efforts and progress, • Networking and establishing successful linkages with government and community-based organizations to create resources for both families and staff, • Work in collaboration with the Director of Social Services and the Housing Coordinator to ensure that all services lead to permanent housing placement, • Complete special projects and assignments as needed or identified by leadership, • Must work one late a week from 11 am -7 pm to accommodate both staff and families, • Provide on-call crisis intervention support to Client Care Coordinators, • Perform other duties as assigned CLIENT CHARTS / STAFF COMPLIANCE: • Manages, reviews, and monitors Client Care Coordinators’ maintenance of client records (paper and electronic) by conducting case audits, ensuring both internal and external quality assurance standards are being met in accordance with CRF and DHS standards, • Provides training to new staff and existing Client Care Coordinator staff, • Provide individual and group supervision to Care Coordinators to provide coaching, guidance, and support on service delivery and work performance, • Ensure that high-risk cases are monitored closely and serviced effectively, • Provide Client Care Coordination team with support and guidance on high-risk and challenging cases, • Collects and analyzes data provided on client services to evaluate team success in service delivery, • Provides Client Care Coordination services in the absence or vacancy of Client Care Coordinator staff MEASURABLE AREAS: • Ability to team lead and provide effective supervision, guidance, and oversight of subordinates, • Timely reporting of critical/priority one incidents to DHS, • Ability to respond and troubleshoot crisis situations, • Comply with and promote compliance with all agency policies, helping to strengthen and maintain an ethical organizational culture Completion of DHS Monthly Metrics. • Number of biopsychosocials completed, • Number of mental health referrals, • Number of successful referrals (3 MH referrals kept), • Number of substance use referrals, • Number of successful referrals (3 SU referrals kept), • Number of other referrals, • Number of successful other referrals, • Number of linkage agreements finalized, • Number of training sessions conducted, • Number of client groups/workshops facilitated, • Timely completion and submission of CCC Unit DHS Monthly Metrics Report SECONDARY RESPONSIBILITIES: • Facilitate effective communication with other staff within an interdisciplinary context, participate in and contribute to staff meetings and the development of policies and procedures, • Participate in trainings and staff-development activities to acquire and maintain both the interpersonal and operational skills necessary for successful job performance, • Provide professional development to Client Care Coordinators to enhance skill-sets as it relates to appropriately assessing the needs of clients in shelter, • Work in collaboration with site leadership to provide training and consultation to shelter-based case management team, and to increase the ability of shelter staff to address mental health issues, • Ensure that staff attend CORE trainings within (6) months of employment, such as the mandated Reporter Training, CARES Getting Started, CARES Incident Reporting, CARES Intimate Partner Violence 101, Bio-Psychosocial & Engagement 101, Bio-Psychosocial & Engagement 102, Risk & Safety Assessment, Motivational Interviewing, and CPR/First Aid PRINCIPAL RELATIONSHIPS: • Frequent interaction with diverse clients to assess and respond to their needs, • Collaborative working relationships with and volunteers who aid in the facility, • Regular contact with other program and Social Services staff to ensure team delivery of consistent high-quality services EEO Statement – Children’s Rescue Fund is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, sexual orientation or protected veteran status. #IND1

Job DescriptionPOSITION SUMMARYSupports the VP of Revenue Cycle Operations and Optimization in managing aspects of revenue cycle optimization, including maintaining relationship and monitoring of third-party billing organization and EPIC hosting organization, identifying and implementing revenue optimization strategies, regulatory compliance with third-party insurers (Medicaid, Blue Cross/Blue Shield, etc.), and maintenance of billing and reporting systems. Supports fee schedule, contract review and credentialing activities for managed care contracts. ESSENTIAL JOB DUTIES AND RESPONSIBILITIES Management (10%) · Recruits, retains and develops a diverse and highly qualified staff; provides ongoing performance feedback and maintains a safe and professional work environment.· Trains or assists in training staff in other departments on revenue cycle related areas (both administrative and program) as needed.· Evaluates staff in a timely manner in accordance with PPGNY’s policies.· Performs other training and mentoring related duties as required. Revenue Cycle Optimization and Revenue Cycle Liaison (55%)· Performs analysis of revenue cycle trends and identifies areas of focus to reduce denials and increase overall collections.· Performs root cause analysis for areas identified, proposes solutions to achieve overall enhancement of revenue and implements changes.· Develops workplans to address billing corrections needed, works closely with EPIC hosting organization to implement automated solutions· Collaborates with third party RCM vendor and health center operations to implement process changes.· Collaborates with cross functional teams to ensure alignment between clinical operations and PPGNY billing practices· Tracks adherence to process changes implemented and quantify financial impact.· Monitor health centers’ adherence to charge reconciliation processes and metrics measured by key performance indicators and work with HC leadership to address issues/ trends identified· Ensure changes within the charge description master (CDM) coincide and are implemented with clinical systems· Review changes in CPT®, HCPCS, and revenue codes for accuracy, compliance with applicable billing guidelines, and optimization of reimbursement· Develop, deliver, and revise integrity education and training programs in coordination with clinical operations and leadership· Perform revenue integrity reviews and present findings for corrective actions Monitoring tools (25%)· Develops and implements reporting tools to identify revenue cycle trends, including root cause of denials.· Builds reporting tools to monitor productivity and quality of work performed by staff that impacts RCM results, including front desk, financial counselors, and third-party RCM vendor.· Creates reports to monitor the impact of RCM enhancements and ensure compliance with new processes.· Works closely with Data Analytics team to develop dashboards, scorecards and other tools to monitor performance. Monitoring tools (25%)· Develops and implements reporting tools to identify revenue cycle trends, including root cause of denials.· Builds reporting tools to monitor productivity and quality of work performed by staff that impacts RCM results, including front desk, financial counselors, and third-party RCM vendor.· Creates reports to monitor the impact of RCM enhancements and ensure compliance with new processes.· Works closely with Data Analytics team to develop dashboards, scorecards and other tools to monitor performance. Education and Training (10%) · Evaluates the results of the periodic coding audits conducted by an outside agency, and partners with the VP of Revenue Cycle Operations and Optimization and clinical services leadership to provide training and feedback to the clinical providers on their performance and areas for improvement.· Actively maintains an up-to-date knowledge base of developments in third-party billing, such as changes in Medicaid reporting requirements. Identifies changes required to department procedures in response to such developments.· Responsible for identification of training needs for all registration areas and provide training material working in conjunction with RDO of operations. · Maintain up to date knowledge of CMS billing rules and payer requirements to proactively identify policy changes· Remain current on payer billing requirements· Remain current on Epic reporting tools CORE COMPETENCIES· A demonstrated commitment to PPGNY’s mission related to bodily autonomy, health equity, gender and racial justice · A demonstrated commitment to learning about and enhancing practices related to racial equity and its impact on healthcare systems. · Strong relationship building and communication skills, including an ability to work and build trust across cultural differences related to related to race, class, age, gender, gender identity and expression, sexual orientation, religion, ethnicity, national origin or ability; and to reflect on one’s personal identity with humility. · Strong knowledge of data and analytics to ensure good decision making, performance measurement and financial analysis.· Ability to work collaboratively in cross-organization workgroups.· Customer service and interpersonal skills and the ability to coordinate work with others, both internally and externally, to accomplish tasks. · Engages in mutual problem solving · Facilitates continuous process improvements · Strong time management skills, including ability to work in a high distraction environment and to juggle multiple deliverables at one time · Strong project management skills, identifying all steps required to meet a deliverable, key stakeholders, deliverables by other units in order to achieve goals, and barriers to success. REQUIRED SKILLS/ABILITIES:Interpersonal · Excellent customer service and communication skills · Ability to remain focused and calm in stressful situations · Excellent interpersonal, written and verbal skills · Ability to develop and maintain effective, professional relationships with internal and external stakeholders · Ability to work effectively as part of team Technical · Proficient with Microsoft Office Suite; Advanced Excel skills including Pivot Tables and V Look Ups· Deep understanding of EMR systems; Experience in an EPIC environment· Strong data management and data analysis skills; research oriented with the ability to critically analyze large data sets Subject Matter Knowledge · In-depth knowledge of Medicare/Medicaid regulations, including billing, coding, and documentation requirements. · Strong experience in revenue cycle management and optimization· Previous experience with Charge Master Management· Experience with principles of process improvement Work Habits/Attributes · Excellent organizational skills · Outstanding time management skills, including the ability to work under deadline · The ability to produce high quality work in a fast-paced environment with changing and/or competing priorities · Ability to exercise sound judgment and independent decision-making skills · Ability to produce reliable, high-quality work with minimal direct supervision · Ability to exercise discretion in the handling of confidential information · Possess strong work ethic REQUIRED QUALIFICATIONS • Minimum of an associate degree in business administration, accounting, healthcare administration, or other related degree., • 10 years of experience related to billing, coding, denial management and underpayment analysis, • Demonstrated leadership skills, • Two years’ experience with EPIC Reporting. Preferred Qualifications:, • Bachelor's degree in Finance or IT related areas of focus, • EPIC related certifications and reporting experience, • Coding certification (e.g. CCS, RHIA, RHIT) or applicable experienceTYPICAL PHYSICAL DEMANDS, • Requires prolonged sitting and repetitive tasks including use of a computer. Periodic standing, walking, bending. Requires lifting or moving of up to 15 pounds. Visual acuity sufficient to perform frequent work on a computer screen and review printed reports and other materials. Requires the ability to hear and to communicate orally with others. This role routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets, and will require reaching, grasping, pushing and pulling.TYPICAL WORKING CONDITIONS

Job Description Benefits Pulled from the full job description • Paid training, • Parental leave, • Health insurance, • Paid time off, • Vision insurance, • Dental insurance, • Paid sick time Full job description Position Summary The Receptionist/ Patient Care Coordinator will strive to deliver five-star concierge-level customer service to every patient from their initial evaluation through each subsequent contact until discharge. This includes fielding and responding to patient questions and requests and providing prompt, thorough follow-up. The ability to travel between offices and flexibility (with notice) to cover additional shifts or work extended ours is required Accountabilities The Receptionist / Patient Care Coordinator is the face of the practice and must make an excellent first impression. Friendly, outgoing, engaging, with a positive, can-do attitude, commitment to delivering an excellent patient experience, and the highest standards of professionalism and courtesy are required. This position reports to the Office Manager who may at times not be onsite and therefore requires confidence, resourcefulness, an entrepreneurial spirit, and superior problem-solving capabilities, as well as the ability to work independently without direct day-to-day supervision. Success will be measured based upon the following: • Displaying top notch professional etiquette in all interactions with both patients and H&D staff., • Articulate and strong communication skills both written and verbal, including use of correct grammar, spelling, and punctuation., • Attention to details and consistent follow-up to ensure accuracy and process completion., • Crisis management skills; the ability to triage unexpected events to help mitigate any adverse effects on the practice or patient., • Discretion when handling confidential information., • Check in patients for their appointments and collect copays., • Cancel and/or reschedule patients as needed., • Assist new patients in completion of intake paperwork., • Respond to all phone and email queries., • Monitor and follow-up on needed referrals., • Fill last minute cancellations from the clinic’s waitlist., • Close-out and reconciliation of daily receipts., • Run copay reports daily to ensure optimal collection rates., • Daily quality assurance checks., • Basic office technology skills including Microsoft Office Suite (Outlook, Word, Excel, Teams), PDF, Scanners, copy machines and fax machines, Telephone, • Electronic Medical Records (EMR) systems and online scheduling (we use PromptEMR), • High School Diploma (associate degree or higher preferred), • Minimum of 1-year front desk experience in a healthcare setting (required) H&D Physical Therapy is a therapist-owned, family-oriented practice that prioritizes personalized, one-on-one care over the pressures of large-scale, high-volume settings. With locations across Manhattan and Brooklyn and onsite partnerships at top firms, we foster a supportive, collaborative environment for both our patients and our team. We specialize in: • Orthopedics and sports rehab, • Pelvic floor therapy (all genders), • Vestibular and balance disorders Better Begins Here. With us—and with you. Job Type: Full-time Pay: $20.00 - $24.00 per hour Expected hours: 40 per week Benefits: • Dental insurance, • Health insurance, • Paid sick time, • Paid time off, • Paid training, • Parental leave, • 8 hour shift

Job DescriptionOur mission: to eliminate every barrier to mental health. At Spring Health, we're on a mission to revolutionize mental healthcare by removing every barrier that prevents people from getting the help they need, when they need it. Our clinically validated technology, Precision Mental Healthcare, empowers us to deliver the right care at the right time—whether it's therapy, coaching, medication, or beyond—tailored to each individual's needs. We proudly partner with over 450 companies, from startups to multinational Fortune 500 corporations, as a leading provider of mental health service, providing care for 10 million people. Our clients include brands you use and know like Microsoft, Target, and Delta Airlines, all of whom trust us to deliver best-in-class outcomes for their employees globally. With our innovative platform, we've been able to generate a net positive ROI for employers and we are the only company in our category to earn external validation of net savings for customers. We have raised capital from prominent investors including Generation Investment, Kinnevik, Tiger Global, Northzone, RRE Ventures, and many more. Thanks to their partnership and our latest Series E Funding, our current valuation has reached $3.3 billion. We're just getting started—join us on our journey to make mental healthcare accessible to everyone, everywhere. Reporting to the Senior Director of Product Management, the Lead Product Manager, Claims and Insurance Eligibility will own the development of systems and experiences that support eligibility verification, claims generation, and reimbursement. This role is part of the Care Foundations Product team and is critical to scaling our healthcare infrastructure and optimizing financial outcomes for members, Providers, and Spring. Please note that this is a hybrid role based in New York City, with an expectation to be in office 2-3 days a week. Our office is located at 60 Madison Avenue. What you'll do: • Define and drive the product roadmap for eligibility verification, claims processing, EDI integrations, and payer reimbursement workflows., • Partner with engineering, revenue cycle operations, data, and compliance teams to deliver reliable, accurate, and scalable systems., • Improve real-time eligibility checks and automate claims submission processes to reduce administrative overhead., • Ensure products meet HIPAA and other regulatory requirements while optimizing for user experience and operational efficiency., • Identify and resolve pain points that lead to claim denials, slow reimbursements, or friction for members and providers., • Measure and enhance the success of claims workflows through product analytics, stakeholder feedback, and A/B testing., • Strategically leverage AI and other technologies to gain large efficiencies, • High level of accuracy for eligibility checks, • Lower processing cost per appointment, • 90%+ claims auto-submitted, • Significant increase in "clean claims"/reduction in claim denial rates, • Improve revenue cycle automation to reduce manual interventions, • 5+ years of product management experience, including experience in healthcare tech, • Experience developing and delivering on strategic roadmaps tied to longer term company objectives, • Deep familiarity with claims workflows, eligibility checks, and healthcare billing standards (e.g., EDI, X12), • Demonstrated ability to lead cross-functional teams across operations, engineering, and compliance, • Strong technical acumen and systems thinking, especially with complex data workflows and the ability to improve them with AI and automation, • Experience with payer-provider systems or clearinghouses, • Familiarity with Medicare, Medicaid, or commercial insurance billing nuances, • Health, Dental, Vision benefits start on your first day at Spring. You and your dependents also receive access to One Medical accounts HSA and FSA plans are also available, with Spring contributing up to $1K for HSAs, depending on your plan type., • Employer sponsored 401(k) match of up to 2% for retirement planning, • A yearly allotment of no cost visits to the Spring Health network of therapists, coaches, and medication management providers for you and your dependents., • We offer competitive paid time off policies including vacation, sick leave and company holidays., • At 6 months tenure with Spring, we offer parental leave of 18 weeks for birthing parents and 16 weeks for non-birthing parents., • Access to Noom, a weight management program—based in psychology, that's tailored to your unique needs and goals., • Access to fertility care support through Carrot, in addition to $4,000 reimbursement for related fertility expenses., • Access to Wellhub, which connects employees to the best options for fitness, mindfulness, nutrition, and sleep in one subscription, • Access to BrightHorizons, which provides sponsored child care, back-up care, and elder care, • Up to $1,000 Professional Development Reimbursement a year. Ready to do the most impactful work of your life? Learn more about our values, what it's like to work here, and how hypergrowth meets impact at Spring Health: Our Values Our privacy policy: Spring Health is proud to be an equal opportunity employer. We do not discriminate in hiring or any employment decision based on race, color, religion, national origin, age, sex, marital status, ancestry, disability, genetic information, veteran status, gender identity or expression, sexual orientation, pregnancy, or other applicable legally protected characteristic. We also consider qualified applicants regardless of criminal histories, consistent with applicable legal requirements. Spring Health is also committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. If you have a disability or special need that requires accommodation, please let us know.

Job DescriptionManager of Credentialing (Healthcare) Location: Remote (US) or Hybrid (City, State) Type: Full-time Reports to: Head of Operations / Director of Provider Operations (or similar) Comp: Competitive base + equity + benefits About the Company Our client is a venture-backed healthcare startup building a modern platform that makes it easier for patients to access high-quality care and for clinicians to practice at the top of their license. The team is scaling quickly, operating in multiple states, and credentialing is core to the ability to grow safely and compliantly. The Role Our client is hiring a Manager of Credentialing to own and scale the credentialing function. You’ll lead day-to-day credentialing operations, build repeatable systems, and partner cross-functionally with Operations, Clinical, Legal/Compliance, and Product to reduce time-to-credential while maintaining rigorous quality standards. This is a high-ownership role for someone who can execute in the details and improve the system. What You’ll Do * Own end-to-end credentialing for clinicians/providers across multiple states and payers (as applicable), including new credentialing, recredentialing, and ongoing maintenance. * Manage a small team and/or vendors (CVOs) and drive clear KPIs (time-to-credential, first-pass yield, aging, rework rate). * Create and maintain SOPs, checklists, and QA processes to ensure accuracy, completeness, and audit readiness. * Partner with Provider Operations to forecast pipeline needs and proactively manage throughput/capacity. * Serve as escalation point for complex cases (sanctions queries, gaps in work history, adverse actions, board issues, expiring coverage, etc.). * Build strong relationships with hospitals/health systems, payers, state boards, CAQH, and third-party credentialing partners. * Maintain credentialing files and documentation standards (primary source verification, attestations, NPDB queries where applicable, licensure, DEA, malpractice, education, references). * Collaborate with Compliance/Legal to ensure adherence to NCQA/URAC standards where required and internal policies. * Work with Product/Engineering to improve tooling: workflow automation, document collection, status transparency, integrations (CAQH, NPPES, PECOS, etc.), and reporting. * Lead continuous improvement initiatives that reduce cycle time and increase reliability as we scale. What We’re Looking For * 5+ years in provider credentialing and/or provider enrollment operations, including 1–3+ years in a lead/manager capacity. * Deep familiarity with credentialing best practices (primary source verification, file auditing, recredentialing cadence, documentation standards). * Experience working with CAQH and common verification sources (state boards, OIG/SAM exclusions, NPDB where applicable, malpractice carriers, education verification). * Track record building processes in a fast-moving environment (startup, high-growth healthcare org, or building a new function). * Strong operational rigor: you can manage multiple queues, deadlines, and stakeholders without dropping details. * Comfort with ambiguity and ownership—able to diagnose problems, propose fixes, and implement improvements. * Excellent written and verbal communication; able to work cross-functionally and manage escalations calmly. * Proficiency with tools like Google Workspace/Excel; experience with credentialing platforms (e.g., Modio, symplr, VeraSuite, Medallion, or similar) is a plus. Nice to Have * Experience credentialing across multiple specialties and state footprints. * Familiarity with NCQA/URAC standards and audits. * Experience with payer enrollment (commercial, Medicare/Medicaid) or delegated credentialing. * Prior experience managing a CVO relationship and negotiating SLAs. * Product-minded operator who’s helped implement or improve credentialing software/workflows. Why Join * Meaningful mission with direct impact on patient access and provider experience. * Opportunity to build and own a critical function at a high-growth, venture-backed company. * Competitive compensation, equity upside, and benefits. * High-trust environment with autonomy and room to grow.

Job DescriptionDescription: Job Title: Residential Psychiatric Nurse Supervisor: Director of Residential Services Job Status: Non-Exempt/Part Time Job Hours: 15-20 hours, On-site Location: Midtown Manhattan Compensation: $55,000 - $55,640 About Encore: Known widely as Broadways longest running act of loving care, Encore’s mission is to improve the quality of life for older New Yorkers so they are not just surviving, but thriving. Through a robust array of programming, Encore takes a “no wrong door approach” to ensure Seniors are able to age in place comfortably for as long as possible. Encore is recognized as one of the most respected and trusted nonprofit organizations providing services for older New Yorkers in New York’s City. Encore is on the cutting edge in the human service field and is a staunch advocate not only for older New Yorkers, but also for the essential human service employees who serve as the City’s safety net. Do not miss this chance to work for a mission-oriented organization, which centers employees as its number one resource. About Position: The ultimate aim of the Encore 49 Residence is to prevent recidivism of hospitalization and/ or homelessness and improve quality of life for older New Yorkers. The Residential Psych Nurse is responsible for promoting clinical excellence and evidence-based practice. The Residential Psych Nurse supports a healthy work environment in which a team-based, patient centered care can flourish. The Residential Psychiatric Nurse will be a part Encore 49’s residential team providing clinical direction and support. They will report to the Senior Director, while collaborating with the team consisting of the Residential Manager, Residential Coordinator, Case Managers, Psychiatrist, License Social Worker, Visiting Nurses, and Home Health Aides. Benefits: This position is a part-time position with benefits that include flexible paid time off (vacation, sick days and earned floating holidays) and flexible spending account, dependent care and transit benefits. Requirements: Responsibilities: • Conducts medical health assessments, behavioral health pre and post evaluations, care stabilization, and referral services to clients in need of follow up appointments, • Work with the Residential Coordinator to update and maintain medication advocacy; ensuring all medication changes are documented and followed., • Using a client-centered approach to client care, the Psychiatric Nurse Practitioner will ensure that the clients receive an integrated, multidisciplinary assessment and immediate stabilization plan., • Assessments are to include client choice and/or mandated care, harm reduction, trauma-informed care, and psychosocial rehabilitation., • The Residential Psychiatric Nurse will perform with a demonstrated ability and sensitivity providing services to highly vulnerable individuals who have history of homelessness, substance affected, and/or have serious and persistent mental illness., • The Residential Psychiatric Nurse will work with culturally and lifestyle diverse populations., • Refer individuals to immediate/urgent care as well as establish community connections with primary care, mental health services and substance use disorder care., • Provide preliminary health diagnosis, care, and treatment plans to clients., • Provide crisis intervention assistance when needed., • Document each client interaction, health data and notes in the AWARDS system., • Coordinate and follow-up on internal and external doctors’ appointments, hospital and rehabilitation admissions of clients including healthcare assessments as needed, • Collaborate with the Residential Manager, Buildings and IT Manager and other interdisciplinary staff to prioritize placement meetings for Encore 49., • Establish and maintain community health resources with direct linkages to care., • Participate in internal and external health care management meetings with Senior Director, Program Director, Case Managers, and other care coordinators when needed., • Administer medication as prescribed when needed, including but not limited to ointments, injections, ophthalmic, etc., • Manage and report quarterly on any an assessment and treatment outcomes., • Maintain a safe and confidential working environment that meets federal, state, funding source and Encore Community Services requirements., • Actively participate in the weekly Case Review Meeting along with the monthly Psych meetings with the Psychiatrist., • Create, update, and add addendums to current medical Policy and Procedures, ensuring adherence to state, federal, and Encore 49 requirements and regulations., • Clearly and accurately document all incidents and report in a timely manner, • Ensure timely reporting, documentation and record-keeping and hard copy files in accordance as mandated by funding sources or agency administrator, in an orderly and up-to-date manner;, • Actively participate in the interdisciplinary team approach at Encore 49, including communicating with the Senior Director, Residential Manager and Buildings and IT Manager., • Participate in staff meetings and supervisory sessions.? All other duties as assigned by supervisor(s). Required Qualifications: • Sensitivity and empathy for all residents;, • Current Registered Nurse Licensure in NY State, • Psychiatric Mental Health Nurse Certification, • Active Medicare/Medicaid Registration preferred, • Commitment to providing care services for individuals experiencing homelessness, mental health disorders, and/or substance use., • Demonstrated experience working with diverse educational, lifestyle, ethnic and cultural origins, • Excellent interpersonal skills and ability to work as both part of a team and independently, • Strong written and verbal communication skills, • A proactive person-centered approach, • Ability to triage emergencies when needed (can be via telephone, • Flexibility in schedule required, • Commitment to Encore’s mission and to uplifting the voices of people with lived experiences of homelessness and mental health disorders, • Desire to perform the essential functions of this job, • Ability to handle emergency situations Preferred Qualifications: • Proven experience with the seniors who are formerly homeless, and/ or those with mental health diagnoses;, • Expert written, oral, and interpersonal communication skills;, • Experience working both independently and in a team-oriented and collaborative environment;, • Competency in using relevant patient care data base systems preferably AWARDS;, • Excellent organization skills;, • Works well under supervision;, • Works well and takes initiative in a fast paced, high intensity and ever evolving environment;, • Bilingual a plus.

Job DescriptionDescription: Scope of Role & Responsibilities • Maintain communication with the credentialing contacts at facilities and provider sites to coordinate receipt of information required for credentialing, re-credentialing, and update of provider credentialing information • Review provider re-credentialing and credentialing file for completion and presentation to the Credentialing Committee. • Perform primary source verification on required elements and in accordance regulatory guidelines and policies and procedures • Data entry and upkeep of provider information in the credentialing and other pertinent databases, • Verify New York State OPMC, Medicare/Medicaid lists and other pertinent databases for any current sanctions, restrictions on licensure and/or limitations on the scope of practice on all credentialed providers in interim credentialing periods • Verify New York State license registration and DEA registration status for all credentialed providers in the interim credentialing periods • Generate and disseminate monthly provider credentialing updates to appropriate departments and participating facilities and provider groups, • Review and respond to request for credentialing information/copies of credentialing files to appropriate departments • Generate and disseminate provider rosters to delegated facilities, contracted group practices etc., • Perform provider roster reconciliation, • Create, copy, file, and maintain all relevant documentation into provider credentialing folder., • Maintain confidentiality of provider credentials by filing the credentialing folder in respective cabinets in the file rooms. • Perform annual delegated file audits and participate in pre-delegation and delegation site reviews, • Respond to inquiries from other departments relative to a provider’s credentialing status, • Performs other related tasks as directed by the Deputy Chief Operating Officer or her designee, the Credentialing Director or Credentialing Team Lead. Required Education, Training & Professional Experience • High school Degree required; Bachelor’s Degree preferred, • 2 years of previous experience with provider credentialing processes and procedures, • Knowledge of CACTUS or MD-Staff preferred, • Must be able to handle multiple projects simultaneously., • Comprehensive knowledge of managed care with a specific emphasis on physician credentialing., • Ability to meet time-sensitive deadlines and multi-task in a changing healthcare environment., • Understanding of credentialing activities as they relate to initial credentialing, re-credentialing, and credentials modification(s). Requirements:

Job DescriptionAbout Baba Baba is rebuilding healthcare for older adults. Navigating healthcare can be overwhelming. By 2030, over 65 million older adults will make up nearly a quarter of the U.S. population, creating one of the largest and most urgent challenges in healthcare. Baba makes it easier by pairing older adults with an expert advocate (usually a nurse or social worker) who coordinates their care. Baba's insurance-covered advocates have supported thousands of families by writing insurance appeals, researching specialists, getting medical equipment and cheaper medications, and scheduling appointments. Baba's investors include General Catalyst, Genius Ventures, Soma Capital, and Ground Up Ventures, along with angel investors who were founders or executives of leading companies. More than 50% of the Baba team are former founders, with backgrounds from MIT, Carnegie Mellon, Stripe, Palantir, and Liquid AI. The Role We're looking for a Clinical Operations leader to build and run the engine that powers Baba's care delivery, the people, processes, and systems that turn a patient into consistent, high-quality advocacy, and follow through on the KPIs for positive, high NPS outcomes. Today, Baba's advocate team is growing fast. We need someone who has actually built and managed a clinical workforce at scale, hiring, training, supervising, and holding accountable a distributed team of community health workers, social workers, nurses, and care coordinators. Someone who understands what it takes to deliver measurable outcomes for complex elderly patients. This is not a "strategy and decks" role. You'll be in the weeds, building scheduling and assignment systems, designing QA processes for clinical documentation, establishing supervision structures between advocates and physicians, and creating the operational playbook that lets us 10x the team without quality falling apart. You’ll also be instrumental in new product and service offerings to create a scalable platform. You'll work closely with our product, engineering, and growth teams to shape how Baba scales. What You'll Do * Build the clinical workforce machine. Own recruiting pipelines, onboarding, training curricula, and competency assessments for healthcare advocates. Design tiered staffing models (CHWs, social workers, RNs) matched to patient acuity and service requirements. * Create systems for quality and compliance. Build audit-ready QA processes, chart reviews, peer supervision, and corrective action workflows. * Design and manage the advocate-physician supervision model. Define escalation pathways, clinical oversight cadence, and co-signature workflows that satisfy Medicare requirements without creating physician bottlenecks. * Operationalize patient panels and caseload management. Build assignment logic, capacity planning, and workload balancing across a distributed remote team. Define what "right-sized" caseloads look like for different advocate tiers and patient complexity levels. * Own clinical outcomes and operational KPIs. Track and improve engagement rates, documentation completion, billing capture rates, patient satisfaction, and downstream outcomes (readmission reduction, care plan adherence). Build dashboards and reporting cadences that surface problems before they compound. * Partner with product and engineering. Shape EHR workflows, AI tools, and care coordination features based on frontline clinical reality. Translate operational pain points into product requirements. Pressure-test new features with the team before rollout. * Expand clinical programs. Support the launch of adjacent services. Define clinical protocols, staffing models, and supervision structures for each new line. What You Bring * 7+ years in clinical operations, care management, or social work leadership within a health system, managed care organization, or post-acute provider. You've personally built and managed a team of 20+ clinical staff (social workers, care managers, CHWs, nurses). * Experience with care transitions and post-acute populations. You've worked at the intersection of hospitals, SNFs, home health, and community-based services. You know the discharge planning ecosystem and its failure modes intimately. * Operational builder, not just operator. You've created clinical programs, training curricula, QA systems, or workforce models from scratch, not just managed inherited ones. You're comfortable with ambiguity and can design v1 systems that work today while scaling tomorrow. * Comfort with technology and data. You work fluently with EHRs and care management platforms. You can define metrics, read dashboards, and use data to drive decisions. You don't need to code, but you need to think in systems. * Clinical licensure or credential (LCSW, RN, LMSW, or equivalent) preferred. What matters more is that you can credibly lead, train, and evaluate clinicians. Nice to Have * Experience at a healthcare startup or high-growth environment where you built clinical operations from early stage. * Background in social work leadership within a large health system (managing social work and case management departments across multiple sites). * Exposure to value-based care contracts and outcomes-based reporting. * MSW, MPH, MBA, or equivalent advanced degree. Compensation & Benefits * Competitive base salary + equity * Health, dental, and vision insurance * Unlimited PTO * Work in our beautiful SoHo, NYC office * The opportunity to define how consumer healthcare works for millions of families

Job Description Position Title Wellness Coordinator About West Side Federation for Senior and Supportive Housing (WSFSSH) The West Side Federation for Senior and Supportive Housing, Inc. (WSFSSH) is a community‐based organization whose mission is to provide safe, affordable housing with supportive services within a residential setting which enhances the independence and dignity of each person. WSFSSH develops and manages housing and provides social services for low‐income older persons, many of whom live with mental illness and/or have experienced homelessness. Our 440 staff members serve more than 2600 residents in 30 buildings located throughout Manhattan and the Bronx. About WSFSSH’s Wellness Initiative WSFSSH’s Wellness Initiative seeks to create a culture of wellness within our residential developments for older adults to facilitate the adoption of healthy habits that will improve their overall physical, emotional, and mental well-being. We aim to identify, develop and implement best practices to improve health outcomes for older adults, including and particularly for those with histories of homelessness, mental illness and/or substance abuse. An overarching goal of the initiative is to increase our resident connections to high quality primary and preventive health care so as to encourage better resident health management and quality of life through reduced emergency room visits and hospitalizations. The initiative will focus on utilizing appropriate primary and preventive medical care, managing chronic conditions (including medication management), and expanding resident knowledge of healthy habits such as increasing physical activity and consuming more nutritional food. Position Overview The Wellness Coordinator report to the Director of Clinical and Social Services and is responsible for the overall coordination of residents’ health-related services at the site level. The Coordinator must be capable of comprehending complex public health issues and have the ability to develop programs and strategies to engage residents in taking a more proactive approach to their health. The Coordinator builds relationships with the residents and their care team (physicians, nurses, social workers, etc.) to coordinate and ensure the provision of health-related services. The Coordinator assists the residents and their social workers with navigating health-related systems, access issues, and service coordination. The Coordinator acts as a liaison to external health agencies and serves as a conduit for the transmission of health information between WSFSSH’s social work team and the health care providers. Note: This position is funded by a 2- year grant. Continued employment in this role may be contingent upon receipt of additional grant funding. Candidates with appropriate credentials may have the opportunity to transfer to other roles within WSFSSH upon conclusion of the grant term. Essential Duties and Responsibilities Program Design • Build collaborative partnerships with third party health and wellness providers, including but not limited to the on-site Federally Qualified Health Center (FQHC), area hospitals, physicians and medical practices, pharmacies, and PACE providers to focus on coordination of care, sharing of care information, and co-creation of programs focused on the health and wellness of residents, • Work with the residents and residents’ social workers to complete initial and ongoing health screens and surveys aimed at identifying the residents’ physical, emotional, and mental health needs and to develop plans of care that are comprehensive in meeting those needs., • Coordinate all documentation and data entry associated with the wellness initiative, • Track resident enrollment with Medicaid Managed Long Term Care Organizations (MCOs), • Obtain resident consents to share health related data, • Verify that resident Electronic Medical Records are updated after each health care visit and share updated health dashboards with residents’ social workers, • Collaborate with staff within WSFSSH’s data department to regularly monitor and analyze resident health-related data and to assess program performance at both an aggregate and individualized level – with the goal of continuously identifying barriers to quality care to refine best practices, • Initiate and maintain relationships with the resident/resident’s social worker and the third parties providing health-related services to the resident (e.g. physicians, hospitals, health clinics, limited licensed home care agencies, PACE providers, etc.), • Specifically build a strong relationship with the on-site (FQHC) to actively refer residents for primary (and specialty) care, • Schedule resident medical appointments and assist residents in attending their appointments, including facilitating transport, • Provide post-appointment coordination as appropriate (e.g. obtaining prescriptions, scheduling follow-ups), • Participate in regular team meetings with WSFSSH on-site wellness staff (nurse, social workers and medication management staff) to review resident care plans, • Plan, lead and implement health-related group activities and events for residents, including and in particular activities sponsored by the on-site FQHC, • Plan and conduct resident outreach to encourage participation in wellness activities, • Familiar with health issues and concerns prevalent in underserved communities of color, • Masters degree, or experiential equivalent, in Human Services, Public Health, Social Work, or a related area, • Proven knowledge of health-related community resources, including a clear understanding of health-related benefits and entitlements, as demonstrated by a minimum of 2 years of job-related experience, • Prior experience providing case management &/or medical focused care coordination services to individuals with chronic medical conditions is strongly preferred, • Bilingual Spanish speaking preferred, • Prior experience working with older adults preferred Equal Opportunity Employer WSFSSH is committed to principles of Diversity, Inclusion & Equity. Individuals with life experiences as a person of color; being LGBTQIA+; having a disability; &/or having a family background which can contribute different views to the workplace – such as experiences of poverty or housing insecurity — are strongly encouraged to apply. WSFSSH is an Equal Employment Opportunity Employer (EEO); employment is based upon employees’ qualifications without discrimination on the basis of race, creed, color, national origin, religion, sex, age, disability, marital status, sexual orientation, military status, citizenship status, genetic predisposition or carrier status, or any other protected characteristic as established by law. Powered by JazzHR HojIfJPj2F

Job Description The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. Reporting to the Supervisor of Care Management this position will provide case management to our members including medical, social, psychological, physical, and spiritual needs by developing, implementing, and monitoring the care plan in conjunction with the PCP, caregivers, and other team members to help meet the member's needs. • Associate’s Degree in Nursing for experienced candidates, • BSN for new graduates, • NYS RN license required, • CCM preferred, • 1 year of RN experience in managed care, home care, acute care or nursing home preferred

Job Description The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. Even in a non-clinical role, employees have an opportunity to make a positive impact on the quality of our health plan members' lives. Processes all requests for services in accordance with Medicare and NYS Medicaid Guidelines as well as departmental criteria and guidelines. Works collaboratively with other disciplines including Care Manager, Assessment Nurse and Primary Care Physician or other Specialists as necessary to ensure timely provision of services. Coordinates timely completion of UAS NY assessment that accurately reflects current condition of the member. Ensures that the member’s Individualized Person-Centered Care Plan has been updated and accurately reflects present status of the member. • Graduate of an accredited nursing program, Bachelor’s preferred, • Knowledge with Utilization management processes preferred, • Current NY RN license and registration required, • CCM preferred, • Minimum three to five years nursing experience in long term care, managed care, home care, geriatrics or hospice, • Prior experience in an interdisciplinary service delivery environment preferred, • Working knowledge of Medicare and Medicaid regulations, • Prior experience in an interdisciplinary service delivery environment preferred, • Working knowledge of Windows, Word and Excel, • Knowledge of current standards of medical practice and healthcare delivery systems, • Strong assessment skills, • Knowledge of Interqual preferred

Job Description Your Next CFO opportunity - working with people who care! Are you ready to lead with purpose and innovate with heart? Join a top healthcare company partnered with us as their Chief Financial Officer (CFO) and play a pivotal role in transforming end-of-life care through smart, future-focused, mission-driven financial leadership. Your expertise will help redefine hospice and palliative care, ensuring that every financial decision supports deeply personalized and compassionate care. Key Responsibilities: • Lead all financial operations, including budgeting, forecasting, and financial reporting to ensure fiscal health and transparency., • Translate complex financial data into actionable insights that inform strategic decisions., • Collaborate with clinical and operational teams to ensure financial strategies align with patient care goals, fostering sustainable growth., • Oversee revenue cycle management, including billing, reimbursement, and collections, with a strong emphasis on Medicare and Medicaid processes., • Ensure compliance with hospice regulations and maintain adherence to financial standards., • Identify and implement opportunities for growth, efficiency, and innovation in financial processes and strategies., • Manage audits, tax filings, and mitigate financial risks to safeguard the organization's financial integrity., • Build and mentor a high-performing finance team capable of driving the company's mission forward., • Evaluate the financial implications of new service lines, partnerships, and expansion opportunities., • Encourage and implement fresh ideas and innovations, such as automation and tech adoption, within the financial systems. Requirements: • Bachelor’s degree in Finance, Accounting, or a related field; MBA or CPA strongly preferred., • Minimum of 7 years of progressive financial leadership experience, with a background in hospice, healthcare, or regulated industries., • Strong knowledge of Medicare hospice reimbursement and compliance is essential., • Proven track record in financial strategy, growth planning, and operational improvement., • Demonstrated ability to lead teams and build robust financial infrastructure., • Experience in a startup or high-growth healthcare environment is advantageous., • Proficiency with financial technology, dashboards, and automation tools., • Exceptional communication skills, particularly in explaining financial concepts to non-financial stakeholders. Benefits: • Engage in mission-driven work that deeply impacts lives., • Experience a leadership team that values creativity, innovation, and new ideas., • Enjoy flexibility and autonomy, allowing for a significant impact in your role., • Competitive compensation package with a comprehensive benefits plan., • Join a culture that balances professionalism with personality, where your contributions are recognized and valued. Take the lead in reshaping hospice care with strategic financial insights and innovative thinking. If you’re ready to make a meaningful difference where compassion meets innovation, we’d love to meet you.

Job DescriptionBenefits: • Company parties, • Competitive salary, • Employee discounts, • Competitive Compensation, • Great Work Environment Responsibilities • Assist processing insurance claims through both private insurance and Medicaid/Medicare, • Note and process all necessary forms from the insurance, • Assist patients in navigating the billing and insurance landscape, including collecting all necessary forms and signatures, • Work with doctors obtain charge information and billing details, • Enter all billing and payment information into the system properly and without errors, • Maintains the highest level of confidentialityQualifications, • Previous experience with medical coding and billing portals such as Versant, Eyemed, Trizetto, Availity, Eyesynergy and others, • Strong organization skills, • Excellent attention to detail

Job Description Silver Lake Hospital of Newark, NJ is seeking to hire a full-time Social Worker to provide comprehensive assessments for new patients and assists the patients and their families with discharge planning. ABOUT SILVER LAKE HOSPITAL Silver Lake Hospital is a long-term acute care hospital with a reputation of providing patients with a place to heal before heading home. A long-term acute care hospital (LTACH) is an acute care specialty hospital that provides highly advanced and focused care for higher acuity patients who have not responded to short-term treatment in traditional general hospitals. The average length of stay in an LTACH is 25 days as compared to a 3-5 day average stay in a general hospital. Our safe and state of the art hospital is designed to admit and care for the most critically ill patients. POSITION SUMMARY The Social Worker completes comprehensive assessments for new patients, including mental and psychosocial. Responsible for patient charting using EMR System. Identifies and creates care plans to meet individual patient levels of need to establish a safe discharge. Participates in discharge planning; development and implementation of discharge plans and patient assessments. Provide information to patient and/or family on Medicare/Medicaid and other financial assistance programs. Assist in obtaining resources from community, social, health and welfare agencies to meet the needs of the patient. Assist in providing solutions for social and practical environmental problems including seeking financial assistance, discharge planning (including collaboration with community agencies), and referrals to other community agencies when specialized assistance is required. QUALIFICATIONS • Master degree in Social Work (MSW) required., • Valid New Jersey State license in Social work (LSW) required., • EARC Screener certification required., • Minimum of 1 year of work experience in a hospital or sub-acute care setting is preferred., • Proficient in Microsoft Office and EMR Systems. Full time employees are offered generous benefits including medical, dental, vision, a 401(k) plan, supplemental insurance, free life-long term disability insurance. Additional benefits include free parking in a safe and secure garage, paid time off (PTO), and a comprehensive wellness program. ARE YOU READY TO JOIN OUR TEAM? If you feel that you would be right for this position complete our initial 3-minute, mobile-friendly application. After this step, you will receive an invite to complete your full application. Thank you. Job Posted by ApplicantPro

Job DescriptionEmpower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. Position Overview: The Behavioral Health Utilization Management (BH UM) Clinician is responsible for conducting utilization and quality management activities in accordance with New York State and MetroPlusHealth Utilization Management policies and procedures. The position responsibilities include the management of medical costs through timely prospective, concurrent, and retrospective review activities. Work Shifts 9:00 AM-5:00 PM Duties & Responsibilities * Performs telephonic review for inpatient and outpatient services using InterQual with Secondary Dimensions & LOCADTR and OMH Criteria Sets * Contributes to UM program goals and objectives in containing health care costs and maintains a high-quality medical delivery system through departmental UM procedures * Collects all pertinent clinical information and documents within CareConnect * Promotes alternative care programs and research available options including costs and appropriateness of patient placement in collaboration with health plan members * Communicates directly with Physician providers/designees when appropriate to gather all clinical information to determine the medical necessity of requested healthcare services * Communicates with Medical Director regarding all inpatient cases and outpatient/ambulatory requests for health care services that do not meet medical necessity or appropriate level of care and out of network transfer issues * Recommends, coordinates, and educates providers regarding alternative care options * Educate providers on medication and treatment compliance while also promoting the use of Long Acting Injectables * Enlist existing provider network in promoting first episode psychosis treatment. * Educate providers to alternate treatment services being promoted by Health + Hospitals in lieu of Inpatient Detox * Attends and prepares for bi-Weekly Interdisciplinary Care Team (ICT) meetings which will feature newly enrolled, frequently admitted, high utilizing at risk CORE and HARP members * Evaluate housing needs-Collaborating timely with MetroPlusHealth internal housing team for supportive assistance * Maintains an active role in assuring the continuity of care for all inpatients through early discharge planning and working with hospital discharge planning staff * Identifies potentially catastrophic and high-risk cases for case management referral * Identifies and communicates all potential quality of care concerns to the BH UM Clinician Team Lead in a timely manner * Contributes to MetroPlusHealth corporate goals through ongoing active team participation, offering input and assistance with development and delivery of education and trainings. * Performs other appropriate UM Behavioral Health duties and participates in other special projects as assigned, including, but not limited to, monthly audit review and preparation, quality improvement, community health education, facility/provider relations and marketing activities. * Support Coverage for Retrospective Reviews and BH UM Appeals as needed Minimum Qualifications * Master’s Degree required * Minimum 3 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience in managed care utilization review, quality assurance, discharge planning. (Experience working in a Psychiatric Hospital Inpatient and/or Outpatient setting preferred) * Previous Experience within the Integrated Collaborative Care Model Approach * Experience with chronic condition management, particularly Diabetes, HIV, Heart Disease * Pharmacy, Psyckes, E-Paces, LOCADTR, InterQual, Guiding Principles, HCS (UAS) MAPP, * Medical Background & Bilingual preferred * Previous Quality Management liaison experience with hospitals and other large volume providers to address cost. as well as HEDIS/QARR quality performance, preferred. Licensure and/or Certification Required: * LCSW, LMSW, or LMHC. Current valid unrestricted NY State License. Professional Competencies: * Integrity and Trust * Teamwork and Problem-Solving Attitude * Customer Service * Superior Technical Computer skills (Microsoft Office, Care Connect, Teams Video Application) * Exceptional Organizational and Communication Skills. * Strong interpersonal and assessment skills, the ability to remain calm and poised with challenging providers #LI-Remote #MPH50

Job Description Position: Manager of Business Analysts Location: Hybrid (Must Reside in NY/NJ/CT) Compensation:$135,292.44 - $152,204.00 Join VillageCare as a Manager of Business Analysts and take the lead in transforming healthcare insights into actionable solutions. Located in the heart of New York, NY, this position offers an opportunity to shape strategies that impact patient care and operational excellence. With a competitive salary range of $135,292.44 - $152,204.00, you will not only be rewarded for your expertise but also for your innovative contributions to our customer-centric mission. Collaborate with a dynamic team of problem-solvers and forward-thinkers, driving excellence in a high-performance environment. Your leadership will inspire a culture of integrity, ensuring that our services remain top-notch. Embrace the chance to elevate your career while making a meaningful difference in healthcare delivery at VillageCare. A little about us VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years. What would you do as a Manager of Business Analysts The Manager of Business Analysts at VillageCare will play a pivotal role in shaping the Strategy & Analytics team by establishing a robust framework for analytics and reporting across the organization. This innovative position goes beyond simple requirement gathering; it demands a thought leader who collaborates strategically with the technical team to develop integrated analytics solutions. As this is a new role, you will have the unique opportunity to build and lead a team of Business Analysts, effectively bridging business needs with technical solutions. Responsibilities include improving business analysis processes, assessing the analytics landscape, defining key performance indicators, and designing reports that enhance operational efficiency. Additionally, you will facilitate collaboration with business partners to ensure requirements are clearly articulated and documented, while establishing deadlines for the requirement gathering process. Your leadership will be key in nurturing a high-performing, collaborative team dedicated to achieving VillageCareMax's strategic goals. Are you a good fit for this Manager of Business Analysts job? To thrive as the Manager of Business Analysts at VillageCare, candidates must possess a robust background in healthcare analytics and team management. A minimum of 7 years of Business Analyst experience, preferably within a healthcare setting on the payor side, is essential. Experience with healthcare consulting firms is advantageous, alongside at least 2 years in a leadership role. Candidates should hold certifications such as Certified Business Analysis Professional (CBAP) or Project Management Professional (PMP), which are highly desired. Proficiency in writing simple SQL statements for data review is necessary, as is familiarity with visualization software like Tableau. Additionally, effective facilitation of meetings and collaborative sessions with diverse stakeholders is critical for gathering requirements and driving solutions. A solid understanding of Medicare operations, compliance, and the factors influencing health plan success will further enhance your ability to lead and implement innovative analytics strategies. A bachelor's degree is required for this position. Knowledge and skills required for the position are: • 7+ years in Business Analyst experience in health care setting, • ideally on the payor side; In addition, • experience working with healthcare consulting firms is a plus · 2+ years of managing a team in similar role., • · Certified Business Analysis Professional (CBAP), • PMP certification or other applicable certifications are highly desired · Familiarity and ability to write simple SQL statements to review data. · Experience with Tableau or other visualization software as an end user · Experience running effective meetings and working sessions with various stakeholders. · Must have an understanding of Medicare operations, • compliance Job Posted by ApplicantPro

Job DescriptionBenefits: • 401(k) matching, • Bonus based on performance, • Competitive salary, • Employee discounts, • Opportunity for advancement, • Paid time off, • Profit sharing, • Signing bonus, • Training & development Lens Lab has been serving New York for over forty years and has a deep history of promoting from within which is exactly what we plan on doing for this role. Responsibilities • Assist processing insurance claims through both private insurance and Medicaid/Medicare, • Note and process all necessary forms from the insurance, • Assist patients in navigating the billing and insurance landscape, including collecting all necessary forms and signatures, • Work with doctors obtain charge information and billing details, • Enter all billing and payment information into the system properly and without errors, • Maintains the highest level of confidentialityDesired Qualifications, • Previous experience with medical coding and billing portals such as Versant, Eyemed, Trizetto, Availity, Eyesynergy and others, • Strong organization skills, • Excellent attention to detail

Job Description Hi, we're Oscar. We're hiring a Quality Improvement Associate to join our Accreditation team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: You will manage the day-to-day operations of a portfolio of projects, and providing support for ongoing projects within Oscar's Quality Improvement Department. You will ensure program activities are completed in a high quality and timely manner, and you will ensure compliance with all regulatory guidelines such as Medicaid (Medi-Cal), Medicare, CMS, and National Committee for Quality Assurance (NCQA) Accreditation. You will report to the Quality Improvement Operations Manager. Work Location: This position is based in our NYC office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid Pay Transparency: The base pay for this role is: $96,876 - $127,149 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses. Responsibilities: • Key focus areas: NCQA Accreditation, Quality Improvement Program, Population Health Program, • Organize and support daily activities based on the goals of the program, • Identify optimization opportunities and lead process improvement initiatives that align with regulatory expectations and operational goals, • Lead specific components of the program, including timelines, documentation, committee operations, and internal project governance, • Support end-to-end implementations, including stakeholder coordination, progress tracking, risk management, and milestone reporting, • Serve as a liaison between stakeholders and internal teams to promote execution and regulatory alignment, • Assist in the development of meeting content such as agendas, presentations, policy updates, and program documentation to support internal governance, • Support quarterly program and compliance reporting, including data synthesis and presentation for executive and regulatory audiences, • Partner with other departments and stakeholders to ensure operational excellence, including compliance with NCQA, CMS, and other state/federal regulations, • Develop tools, standards, and meeting structures to support team performance and audit readiness, • Track and monitor project controls, risks, and key performance indicators to support compliance and efficiency, • Facilitate project retrospectives to assess operational strengths and gaps, and apply insights to future implementations, • Act as a key contributor in maintaining accreditation and quality improvement documentation standards, • Support training and documentation related to internal policies and regulatory expectations, • Compliance with all applicable laws and regulations, • Knowledge of NCQA Accreditation standards & guidelines, • 3+ years of strong project management or operational experience in the health insurance space, • 3+ years experience in change management and process improvement, • 3+ years stakeholder management experience At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Job Description Join a Company That Puts People First! Licensed Practical / Vocational Nurse – LPN/LVN We are one of the largest private duty nursing companies in the nation and growing! At Aveanna, we’re proud to foster a workplace culture that celebrates diversity, encourages connection, and supports our team members every step of the way. Here’s what sets us apart: Award-Winning Culture • Indeed’s Work Wellbeing Top 100 Company in 2024, • Paid Time Off Available, • Flexible scheduling- full-time, part-time, or PRN. Days, nights, and weekend shifts— we will work with your availability!, • 24/7 Local support from operators and clinicians, • Aveanna has a tablet in each patient’s home allowing for electronic documentation, • Career Pathing with opportunities for skill advancement, • Weekly and/or Daily Pay, • Employee Stock Purchase Plan with 15% discount, • Employee Relief Fund We consider it both a privilege and an honor when we welcome a new patient into our Aveanna family. Our homecare is always delivered from a place of heartfelt compassion and empathy, and every one of our Licensed Practical / Vocational Nurses (LPN/LVN)s works together to make sure we achieve outstanding clinical outcomes. Aveanna isn’t just a provider of compassionate homecare to children and adults. We are a national leader. Qualifications • Must have and maintain an active, unencumbered license (LPN/LVN) in the state in which the clinician will practice, • Compact licenses must be transferred to your state of residence within 90 days, • Current CPR certification (with hands-on component)- Aveanna can assist in obtaining this requirement after hire, if necessary., • TB skin test (current within last 12 months), • Six months prior hands-on nursing experience preferred but not required As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate. Notice for Job Applicants Residing in California Notice for Job Applicants Residing in Florida

Job Description JOB SUMMARY Social Workers establish and maintain a therapeutic relationship with individuals and their families by effectively utilizing professional social work skills. They may review the individual s psychiatric, medical and other case records and discuss issues with families and other members of the treatment team; complete admission screening; conduct psychosocial assessments; make treatment recommendations; participate in treatment planning; provide social casework services; provide individual, group, and family therapy; assess availability of services; serve as consumer advocate; develop and implement discharge plans; and coordinate services with community providers. Incumbents advocate to ensure individuals receive appropriate treatment/services, that their legal and human rights are protected, and promote effective and consistent utilization of services and resources. ESSENTIAL JOB FUNCTIONS: List all essential job duties. (To perform this job successfully, an individual must be able to perform each essential duty listed satisfactorily with or without a reasonable accommodation. Reasonable accommodations may be made to enable qualified individuals with a disability to perform the essential duties unless this causes undue hardship to the agency.) • Interviews individual after a thorough review of the record to construct the psychosocial assessment., • Obtains psychosocial history by interviewing the individual, the family, significant others, and former service providers to formulate clinical recommendations for therapeutic interventions., • Assesses individual s treatment needs., • Prioritizes the individual s treatment needs; assesses impact of treatment on the individual and the family; assesses ability of significant others to assist in the treatment planning process; and involves the individual and significant others in a comprehensive treatment plan; and in some settings, determines which individuals are appropriate for other levels of care., • Participates in the development of a written comprehensive individualized treatment plan that is based on the assessment of the individual s clinical needs; determines need for services and ensures that referrals for ancillary, support and consultative services are noted and made; reviews and updates individual treatment plan according to all applicable guidelines and in response to clinical change; and ensures that arrangements are made and documented for continuation of care well in advance of individual s planned departure., • Provides individual therapy to enhance social, emotional, and behavioral functioning., • Advises the individual and family about the nature of the illness, needed and available services and how to access them., • May identify, coordinate and plan for the individuals’ financial needs., • May identify and provide intervention to individuals in crisis in a range of settings; or provide consultation to others to enable them to appropriately intervene., • Assesses the individual’ s readiness for discharge; identifies needed resources; works with consumers/patients, families and providers to link him/her with appropriate resources; may conduct follow-up visits., • Prepares required progress notes, treatment team recommendations, written and verbal reports, discharge plans and other documents within required timeframes., • As an integral member of the treatment team, ensures that all relevant clinicians are kept informed of the individual’s clinical needs, family social adjustment, services needed and their availability through clear documentation of the record., • Conducts group life-skills training, treatment, or group counseling sessions., • Prepares an outline of objectives and conducts sessions according to treatment program schedule., • Meets with assigned group according to treatment schedule., • Conducts specialized groups to meet the needs of target populations and maintains topic-focused discussion; provides opportunities for participation., • Ensures that individual attendance and participation in sessions is documented., • Documents, within required timeframes, the content and results of group counseling or therapy., • Provides treatment to family or significant others or advocates for such services:, • Reviews and evaluates the involvement of family/significant others in treatment and carries out corrective action as appropriate and/or makes recommendations and/or referrals for needed services such as mental health issues, safe homes for domestic violence, parenting skills, and how to apply for financial assistance., • Prepares an outline of family program sessions and objectives., • Facilitates family education session according to treatment plan., • May supervise social work students., • Meets with staff on caseload and identified issues., • Committed to the active promotion of ICL values and goals., • Ability to work with clients, families, and staff in a caring and respectful manner, and with due understanding of and consideration for cultural differences., • Ability to develop, evaluate, implement and modify a treatment plan, meeting all deadlines and productivity standards., • Ability to communicate effectively with staff, clients, families, and the public., • Ability to prepare accurate and timely documentation, reports and other written material as assigned using computers and computer software assigned (e.g., Word, EHR, etc.), • Ability to understand and adhere to internal and external laws, rules, and policies., • Ability to secure the cooperation of and work effectively with others. Licensed by New York State as a Master Licensed Social Worker or as a Licensed Clinical Social Worker; current, valid registration certificate. Experience with the type of clientele served by the particular clinic very helpful. Must be eligible for full and unconditional participation in the Medicaid and Medicare programs May be required to possess a valid NYS driving license and a clear driving record. FOR ALL POSITIONS: Continued employment is based on the ability to maintain professional licensure, current registration and participation in the Medicaid and Medicare programs.

Job Description Director of Clinical Documentation and Reimbursement Compensation: $150K per year Job Type: Full-Time, Monday–Friday, On-Site Our client, is seeking an experienced and compassionate Director of Clinical Documentation and Reimbursement to oversee clinical operations across multiple residential care settings. This senior leadership role is pivotal in ensuring high-quality, resident-centered care while maintaining full compliance with regulatory requirements. The Director of Clinical Documentation and Reimbursement is responsible for the overall operational and strategic planning of the Clinical Documentation and Reimbursement (MDS) Department and Health Information Management (HIM) Department. This position will ensure that all operational and regulatory requirements are maintained related to the MDS and Resident Assessment Instrument (RAI) process. Key Responsibilities • Collaborates with other department heads to utilize objective information from the clinical documentation to drive the highest quality of care., • Leads the strategic planning development related to Medicare/ Medicaid reimbursement and Managed Care Case Management., • Monitors and incorporates facility wide education plans related to MDS updates, payment reforms and changes to quality measures., • Analyzes and tracks data related to MDS item sets to support organizational quality assurance/ performance improvement plan., • Audits and tracks all aspects of the RAI process to ensure performance is reflective of NYS DOH regulatory statues and standards., • Bachelor’s Degree in Nursing required, Master’s Degree preferred., • NYS RN license required with required following experience a plus, • Minimum 3 years of RAI process and SNF reimbursement experience., • Completion of New York State approved PRI assessor program preferred, RAC-CT preferred., • Knowledge of Federal and State regulations and NYS nursing standards required. Familiarity with Medicaid and Medicare regulations required., • Required Experience with data extraction and manipulation required., • Proven expertise in managing SNF-based quality metrics, including Quality Measures (QM), Quality Reporting Programs (QRP), and Value-Based Purchasing (VBP) models to drive facility-wide performance and 5-star rating improvements., • Demonstrated strong analytical, project management Skills, • Effective oral and written communication and interpersonal skills required. Must be able to communicate with clients and employees of all backgrounds and educational levels., • Ability to understand industry specific content and requirements required, • Demonstrated ability to lead both small and large teams effectively and be comfortable presenting and communicating to people across the organizational structure and beyond. Benefits • Health insurance, • Retirement plans, • Paid time off, • Professional development opportunities. Disclaimer This job description is not intended to be an exhaustive list of duties, responsibilities, or qualifications. Management reserves the right to modify or assign other duties as necessary. If you're excited about the potential of this role, we’d love to hear from you!

Job Description Position: Risk Adjustment Coder Location: Remote (Must reside in NY/NJ/CT) Schedule: Monday - Friday 9am-5pm Compensation: $77,506.87 - 87,195.23 annual salary CPC, CCS, RHIT or RHIA and CRC are required Join VillageCare as a Full Time Risk Adjustment Coder and embrace the opportunity to work remotely while making a significant impact in the Health Care sector. This role offers the flexibility of a work-from-home environment, allowing you to balance your professional and personal commitments without the daily commute. You'll be part of a dynamic team that thrives on innovation, problem-solving, and a customer-centric approach, all while contributing to the excellence and integrity that VillageCare stands for. With a competitive salary up to $77,506.87 - $87,195.23, this is not just a job but a chance to build your career in a forward-thinking organization dedicated to healthcare improvement. As a team member you'll be able to enjoy benefits such as PTO package, 10 Paid Holidays, Personal and Sick time, Medical/Dental/Vision, HRA/FSA, Education Reimbursement, Retirement Savings 403(b), Life and Disability, Commuter Benefits, Paid Family Leave, and Additional Employee Discounts. Seize the opportunity to grow in a high-performance culture that values your contributions. Apply today and help shape a healthier future! A little about us VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years. What's your day like? As a Full Time Risk Adjustment Coder at VillageCare in New York, NY, you will perform critical code abstraction of medical records, ensuring accurate assignment of ICD-9-CM, ICD-10-CM, CPT, and HCPCS codes supported by clinical documentation. Your role involves a comprehensive review of medical records, validating that documentation meets CMS requirements, including provider signatures and relevant dates. You will identify improvement opportunities in documentation and coding processes and participate in quality initiatives that enhance overall outcomes. By maintaining current knowledge of coding standards and regulations, you will support the Medicare Risk Adjustment team in educating providers on compliance and consistency. Your contributions will include reporting findings from audits, assisting in analysis, and maintaining a minimum accuracy of 95% on coding quality audits while meeting productivity requirements. This is an exciting opportunity to make a meaningful impact in healthcare while advancing your coding expertise. Requirements for this Risk Adjustment Coder job To thrive as a Full Time Risk Adjustment Coder at VillageCare, candidates must possess a robust understanding of clinical terminology, disease processes, anatomy and physiology, as well as pharmacology. A strong foundation in claims processing procedures, state and federal regulations, and Medicare Coordination of Benefits applications is essential. Ideal candidates will have at least three recent years of experience in HCC/Risk Adjustment and/or inpatient coding, complemented by relevant certifications such as CPC, CRC, RHIT, or RHIA from AAPC or AHIMA. Additionally, successful candidates will exhibit exceptional attention to detail, basic computer skills, and the ability to maintain a productive home office environment with high-speed internet. Residing in New York, New Jersey, or Connecticut is also a prerequisite to ensure alignment with local regulations and standards. Strong problem-solving skills and a commitment to coding excellence are crucial for contributing to the organization's mission in improving healthcare quality. Knowledge and skills required for the position are: • Strong knowledge of clinical terminology, disease processes, anatomy/physiology and pharmacology, • Have high speed internet at their house and a distraction free home office, • Must be detail oriented and have basic computer skills, • Strong knowledge of claims processing procedures and systems, • State, Federal and Medicare Regulations and Coordination of Benefits applications required, • Must reside in NY, NJ or CT, • 5 recent years of HCC / Risk Adjustment and/or inpatient coding are required, • Certified through AAPC or AHIMA(CPC, CRC, RHIT or RHIA), • CPC, CCS, RHIT or RHIA and CRC are requiredConnect with our team today! VillageCare is an Equal Opportunity Employer. Job Posted by ApplicantPro

Job DescriptionDescription: About Us Union County Orthopaedic Group, a division of OrthoNJ, LLC, is a fast-paced, patient-centered medical practice specializing in orthopaedics, pain management, and podiatry across three convenient New Jersey locations. We are seeking an experienced Billing Supervisor to lead our billing team, drive revenue cycle performance, and ensure the accuracy and efficiency of our billing operations. Position Overview The Billing Supervisor is responsible for overseeing the day-to-day workflow of the billing department, including follow-up on rejected claims and overdue balances, payor relationship management, and patient accounts receivable. This role is both a hands-on operational position and a people leadership role — requiring someone who can coach and develop staff while also rolling up their sleeves to keep the revenue cycle running smoothly. Requirements: What You'll Do Leadership & Supervision • Assist with recruitment, discipline, and termination of Reimbursement and Patient Collections staff, • Train, develop, and oversee the performance of billing team members; conduct regular one-on-ones to address key issues, A/R performance, and growth opportunities, • Monitor overall department workload and distribute work accordingly; ensure coverage during vacations and absences, • Maintain working knowledge of all key billing functions including claims processing, payment posting, insurance follow-up, and patient collections, • Analyze aged A/R reports, days in receivable, and collection statistics by payor; present findings to physicians as needed, • Perform quarterly billing audits to ensure timely and accurate charge and payment posting, • Conduct quarterly reviews of EOB forms from commercial and managed care payors, • Meet with physicians to discuss complex or difficult claims, • Monitor patient payment plan adherence and intervene as needed, • Maintain and update the practice fee schedule, CPT, ICD-10-CM, adjustment, and payment codes, • Maintain and distribute contracted payment schedules from carriers; input/update into the practice management system, • Request updated payment schedules from contracted carriers annually and prepare quarterly fee/payment comparative reports, • Maintain carrier contracts and assist with credentialing applications and reapplications as requested, • Uphold HIPAA compliance standards; report identified or suspected violations to the Privacy Officer, • Maintain coding compliance standards; actively participate on or support the Compliance Team, • Maintain detailed knowledge of practice management systems and EMR as it relates to job functions, • Minimum 2 years of medical office management experience, preferably in a physician group practice — required, • Revenue cycle experience in a physician group practice setting — required, • Orthopaedic billing experience — required, • Commercial insurance billing experience (e.g., BCBS, Aetna, Cigna, UHC) — required, • Proven knowledge of CPT and ICD-10-CM coding for orthopaedic, podiatry, and pain management procedures, • Strong understanding of managed care contractual arrangements and accounts receivable processes, • Working knowledge of practice management systems and electronic medical records (ModMed/EMA experience a plus), • Strong analytical skills with the ability to interpret and present A/R data, • Excellent verbal, written, and interpersonal communication skills, • Bilingual (English/Spanish) a plus — our patient population includes Spanish-speaking patients and the ability to communicate in both languages is highly valued, • Knowledge of HIPAA and OSHA guidelines We offer a collaborative, supportive environment where strong performers are recognized and leadership is valued. If you're an experienced billing professional ready to take ownership of a department and make a meaningful impact, we'd love to hear from you. Union County Orthopaedic Group is an equal opportunity employer. OrthoNJ, LLC is required by New Jersey law to include the salary range for this role. The hiring range for this role is $62k-$80k annually. The range for this role is typically determined by several factors, including the geography in which the selected candidate will be working, and alignment with qualifications and experience. Certain roles may also be eligible for additional compensation (bonus, etc.) and/or benefits. In addition, full-time employees are eligible for standard benefits package including paid time off, medical, dental, vison and retirement plan.

Job Description 'I just love working there and that's a good place to work' 'It feels good every day to know that what you do at your job, will help and make a differece in somebody’s life. Especially elderly people that feel lonely, sick and abandoned by friends and family. We are there for them. I love to work at Lutheran and I love my Participants. Because of the pandemic we can’t see each other everyday-but I call them; and I can feel their happiness when they hear my voice. They know I care.We all do at Lutheran Senior Life At Jersey City.' Those are real statements from real employees at Lutheran Senior LIFE. We hope you feel the same way once you experience what it is like to work here..... This is how our team members describe the culture at Lutheran Senior LIFE! Apply today to find out more! We have a new opportunity for a full-time Enrollment Specialist! This position offers a salary of $65-$70k annually with a full complement of benefits and paid time off! Position Summary: Under the supervision of the Marketing Director, obtains initial information relating to admissions, coordinates intake process, and provides information and referrals to community agencies as appropriate. Promotes the Lutheran Senior Healthcare Program to potential participants and community agencies. Basic Qualifications: Education/Training/Certifications: Current driver’s license and proof of auto insurance Skill(s): • Ability to effectively present PACE philosophy and model to the community and to prospective participants, • Working knowledge of physical, psychosocial, behavioral and family needs of the elderly, • Working knowledge of HudsonCounty community health and social service delivery systems and aging network., • Effective written and verbal communication skills, • Working knowledge of Medicaid system, • Able to assess potential participant’s financial status, • General knowledge of financing mechanisms such as Medicaid, Medicare, Prospective Payment Systems, and HMO Managed Care providing risk-based capitated systems., • Good working knowledge of PACE philosophy and eligibility/denial criteria, • Computer proficiency in word processing and spreadsheet applications Experience: • A Bachelor's Degree in business, or a health or human services field, sales experience or a high school diploma and office assistant training (preferably health care specific)., • Minimum of 1 year working with the frail or elderly Medical Clearance: Employees must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact. LSMNJ is an Equal Opportunity Employer. We have awesome benefits! You will be eligible to participate in most of the following as of your 1st day of employment! Offering flexible pay - accessing your pay anytime! Medical Insurance Dental Insurance Vision Insurance Wellness Program Life Insurance Long-Term Disability Short-Term Disability Critical Care & Accident Coverage NJM Auto and Home Insurance Pet Insurance Identify Theft Protection 403(b) Retirement Savings offering an 8% company paid match! Sick Pay (after 4 months of employment) Paid Time Off (after completion of introductory period) Holiday Pay And much more…..

Job Description At WelbeHealth, we serve our communities’ most vulnerable seniors through shared intention, pioneering spirit, and the courage to love. These core values and our participant-focus lead the way no matter what. The Medical Director leads and oversees all medical care provided to WelbeHealth participants. This role is also accountable for the development, maintenance, and oversight of the WelbeHealth Quality Improvement (QI) program, and all medical policies, procedures, standards, and protocols. The Medical Director oversees the contracted specialty network of services and provides leadership among staff, colleagues, and providers in the community. As necessary, the Medical Director also provides direct care as a PACE Physician. This role is different because the Medical Director at WelbeHealth: • Plays a key role in launching WelbeHealth’s first center in New Jersey, • Medical insurance coverage (Medical, Dental, Vision), • Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days, • 401K savings + match, • Comprehensive compensation package including base pay and bonus, • Develop and maintain written objectives, policies, procedure manuals, organizational plans, and quality assurance programs for the medical service, reviewing all medical policies and procedures at least annually, as well as develop medical staff bylaws, in cooperation with the medical staff, • Participate in planning and budgeting for the medical service, • Coordinate and integrate the medical service with other participant care services to provide a continuum of care, • Ensure medical staffing patterns are implemented, • Assist in developing and maintaining written job descriptions for the medical staff, participating in the review of credentials and delineation of privileges of medical staff, and assigning duties based upon education, training, competencies, and job descriptions, • Recruit, train, and supervise (including PACE orientation and competency testing) PACE Physicians, Nurse Practitioners, community-based PACE Physicians and other contracted medical staff, and participate in staff orientation and education activities, • Successful completion of a residency program accredited by the Accreditation Council for Graduate Medical Education or approved by the American Osteopathic Association in a medical specialty related to services provided by the facility, or a diplomate of one (1) of the certifying boards approved by the American Board of Medical Specialties or of the American Osteopathic Association in a medical specialty related to services provided by the facility, • Board certification in internal medicine, family practice, emergency medicine, or geriatrics preferred, • Active state physician license without restrictions, • State CDS certification and active DEA registration, • Must be currently enrolled or eligible for enrollment to provide services to Medicare participants, • Minimum of two (2) years of supervisory experience with demonstrated ability to mentor and develop team members, • Current knowledge of chronic care, geriatric issues, and best practices; working knowledge of PACE regulations preferred Salary/Wage base range for this role is $300,000 - $363,000 / year + Bonus. WelbeHealth offers competitive total rewards package that includes, 401k match, healthcare coverage and a broad range of other benefits. Actual pay will be adjusted based on experience and other qualifications. Compensation$300,000—$363,000 USD COVID-19 Vaccination Policy At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations. Our Commitment to Diversity, Equity and Inclusion At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law. Beware of Scams Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to

Job DescriptionSOMOS Innovation, LLC is the organization that has been built to deliver on a simple promise – to provide the administrative infrastructure to enable our physicians to deliver high-quality community healthcare to our vulnerable Medicaid and Medicare patients in a culturally appropriate manner. The physician leaders of Corinthian Medical, Excelsior Medical, Balance Medical, SOMOS Your Health, SOMOS, and Eastern Chinese IPA have seen that to succeed in a VBP world the IPAs and physicians must be supported by an integrated management services organization. The MSO must deliver a portfolio of managed care contracts and the infrastructure to manage the financial risk attached to those contracts. The MSO must deliver administrative simplification for the PCPs and IPAs that generates more patient time and enables the PCPs to deliver the right care, at the right time in the right setting. The MSO must deliver clinical innovation that moves “population health” from theory to practice. The following grid highlights the functionality delivered to each of the IPAs. Patient Assessment and Coordination • Conduct initial and follow-up assessments focused on patients’ medical, psychological, and social support needs under the direction of the RN Care Manager., • Assist in developing and implementing individualized care plans in collaboration with the RN Care Manager and interdisciplinary team., • Monitor patient status through telephonic and in-person outreach to ensure continuity of care., • Support Care Management face-to-face assessments in the home, community, or clinical setting as directed by the care team.Patient and Family Education, • Provide patient-centered education on care plans, medications, chronic disease management, and preventive health practices., • Support families in understanding available health plan resources and empower them to make informed decisions about care., • Reinforce patient self-management goals identified by the care team.Care Transition Management, • Assist in care transition activities by coordinating follow-up appointments, medication reconciliation support, and patient/family education after discharge., • Communicate patient status and needs effectively to providers, RN Care Managers, and other team members to support safe transitions between settings (e.g., hospital, rehab, home).Resource Coordination, • Identify patients in need of social services or community-based resources and route referrals to the appropriate non-clinical coordinators or social workers., • Act as a liaison between patients, caregivers, and the healthcare team to promote access to needed medical and social supports., • Provide ongoing support to clinical staff by tracking progress toward care plan goals and reporting barriers or successes.Documentation and Reporting, • Maintain timely, accurate, and comprehensive documentation in the electronic health record (EHR) in accordance with organizational standards and regulatory requirements., • Prepare and maintain tracking logs for outreach, education, and follow-up activities., • Contribute to reporting on patient progress, barriers to care, and program outcomes.Clinical Risk Escalation, • Identify potential clinical concerns, deterioration in condition, or risk issues during patient outreach., • Promptly escalate concerns to the RN Care Manager or Supervisor for higher-level intervention., • Collaborate with the interdisciplinary team to address clinical issues and prevent avoidable adverse outcomes.Other Responsibilities, • Participate in mandatory in-person team/company meetings, ongoing training, and case reviews., • Provide updates on assigned patients at interdisciplinary team meetings., • Perform other duties as assigned in support of patient care and program objectives.Qualifications, • Current and valid LPN license in the state of practice., • Strong clinical knowledge of chronic disease management, preventive care, and medication adherence., • Prior experience in care management, managed care, community health, or ambulatory care preferred., • Excellent communication, interpersonal, and organizational skills., • Compassionate, patient-centered approach with the ability to build trusting relationships., • Proficiency in EHR systems and intermediate computer skills (Excel, Outlook, Teams, Word, etc.)., • Ability to manage multiple priorities, meet deadlines, and work both independently and as part of a multidisciplinary team., • Skilled in motivational interviewing and patient engagement strategies., • Demonstrated time management and critical thinking skills.Job Type: Full-time Pay: From $75,000.00 per year Benefits: • 401(k), • Health insurance, • Life insurance, • Paid time off, • Vision insuranceLanguage:, • Spanish (Required)License/Certification:, • LPN (Required)Work Location: Hybrid remote in Bronx, NY 10463

Job Description Hi, we're Oscar. We're hiring an Associate, Delegate Oversight to join our Delegation Oversight team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: The Associate, Delegate Oversight supports the enterprise's compliance program and activities. You will assist in the development of all compliance program activities to ensure understanding of healthcare regulatory requirements. You will assess business unit compliance to laws, regulations, standards, and their procedures by conducting audit and monitoring activities. You will report into the Sr. Manager, Compliance Audit and Monitoring. Work Location: This position is based in our New York City office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid Pay Transparency: The base pay for this role is: $96,876 - $127,149 per year. You are also eligible for employee benefits, monthly vacation accrual at a rate of 15 days per year and annual performance bonuses. Responsibilities: • Help create a risk-based audit and monitoring plan for the healthcare organization., • Review healthcare regulations, including HIPAA, Medicare, Medicaid and NCQA regulations to ensure compliance., • Conduct assigned audits based on departmental audit plans., • Partner with teams to understand their business operations and test their compliance with regulations., • Evaluate compliance effectiveness and identify areas for improvement., • Draft and complete accurate audit reports, ensuring that the audit findings and conclusions are communicated to the business unit., • Help identify compliance gaps and risks, and contribute to the development of proactive strategies to address them., • Help maintain compliance policies, procedures, and controls with regulatory requirements., • Provide regular updates to leadership on compliance audit and monitoring activities and recommendations., • Compliance with all applicable laws and regulations, • Bachelor's Degree or equivalent work experience, • 3+ years experience working in health care or related field, • 3+ years experience in health plan compliance, • 3+ years driving compliance with regulatory and accreditation audit/policy requirements, • 3+ years experience working with regulation and translating into operational procedures, • Certification in Healthcare Compliance (CHC), Certified Compliance and Ethics Professional CCEP, or similar, • Fluency with State DOI audit and/or reporting obligations, • State DOI audit management experience, • Experience in a start-up and/or health tech environment At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Job Description Managers for a Managed Care Plan servicing New York. The RN Care Manager position works as a Hybrid - Remote Case Manager, working primarily from home, with 1 day of Field Case Management visits per week, in designated areas. Bilingual Spanish, Chinese and Bengali needed for Manhattan, Bronx or Brooklyn visits. Qualified candidates will be able to work from their home and will make Field visits 1 day per week in field. Qualified candidates will have prior RN Case Management experience within Managed Care, CHHA Home Care or Hospital Case Management, bilingual language ability a plus. Qualified candidates will have a NYS RN License or NYS NP, and prior RN Case Management, Coordination of Care experience within a multi-disciplinary team. Patient visit areas available are: Bilingual Spanish in Manhattan or Bronx visits, Bilingual Chinese in Brooklyn or Upper Manhattan and Bilingual Bengali in the Bronx. Remote / Hybrid - RN Care Manager - Bilingual - Responsibilities: Reporting to the Supervisor of Care Management, this position will provide telephonic and in-person case management to our members including medical, social, psychological, physical and spiritual needs by developing, implementing and monitoring the member's care plan in conjunction with the PCP, caregivers and other team members in order to help meet the member's needs. managed care nurse, managed care rn, nursing, rn, nurse, care management Qualifications: * NYS RN license required * CCM preferred * At least 2+ years of RN Case Management experience in managed care, home care, acute care, hospital or nursing home preferred * Ability to make patient visits 1 day per week, ability to work remote from home the remaining days (In Office during Probation period, remote work begins after Probation period) * Reliable transportation * Covid19-Vaccination * Bilingual Spanish, Bilingual Chinese (Cantonese/Mandarin) & Bilingual Bengali & English in demand! * Prior experience in an interdisciplinary service delivery environment, required. * Working knowledge of Medicare and Medicaid regulations Excellent Salary $105,000 - 115,000 based on relative experience and great Benefits! Medical/Dental/Vision, Matching 401k, PTO & More! Qualified Candidates Please Apply Now for Immediate Consideration! Company DescriptionPermanent Placement Recruitment Services for New York Health Care companies!Permanent Placement Recruitment Services for New York Health Care companies!

Job DescriptionSalary: $32.97- $35.71 per hour Make a difference in the lives of New York City's residents and communities. For over 60 years PSS has performed vital and important work -- through its ten centers and affiliated programs. The agency touches the lives of over 2,000 people each day. As the Community Social Worker, you will be responsible for coordinating supportive services for older adults in one of the many communities that PSS serves. The Social Workers role is vital in ensuring effective supportive services are put in place that allows the residents to remain independent, active and to thrive in their home and community. PROGRAM SUMMARY: The NY Connects program provides telephonic support to older adults and individuals with disabilities across the lifespan (from childhood to adulthood) serving as a connection for community members to access long-term services and support. The goal of the program is to ensure community members are able to obtain the information necessary to make informed decisions on their care or the care of a friend, neighbor, client, or loved one. Utilizing a strengths-based approach and respecting the self-determination of the community member, program staff support the community member in achieving their goals in a culturally competent manner. NY Connects is part of the no wrong door system across the state, focused on supporting community members regardless of ability to pay and level of need. RESPONSIBILITIES: • Provide objective and unbiased information and assistance on long-term care options, services, and supports to community members, professionals, friends, neighbors, and caregivers., • Conduct screenings and assessments to determine programmatic and financial eligibility for various programs, both over the phone and in-person., • Assist with application and enrollment for both publicly funded programs (e.g. Medicaid, SNAP, and HEAP) and privately funded programs., • Conduct home visits to homebound community members, aiding with applying for benefits and entitlements as deemed appropriate and necessary., • Utilize a strength-based, person-centered approach to support aging in place, individual independence, and self-determination., • Respond to individuals in a professional, non-judgmental, and culturally appropriate manner., • Educate community members on benefits and entitlements to aid and support the decision-making process as they explore resources and service options., • Advocate for community members experiencing difficulty navigating governmental and/or community-based organizations., • Support clients with care coordination through various life stages and circumstances (e.g. return home from a long-term care facility such as, hospital, nursing home, or assisted living facility), • Adhere to all NYC Aging Program Standards, maintaining accurate and comprehensive case records on NYC Aging community member database., • Participate in mandated New York State Office for the Aging/Department for the Aging funded trainings and PSS trainings as assigned., • Collaborate with the Program Director in conducting outreach and developing meaningful relationships with community-based organizations across Brooklyn., • Support PSS mission by striving for excellence, with a focus on developing positive interpersonal relationships., • Attend all supervision meetings, team meetings, and educational sessions with a willingness to advance professional skills., • Perform other duties as needed or requested. QUALIFICATIONS AND EXPERIENCE: • Bachelor's Degree (BSW, BS, BA) level education is required. Master's degree in social work is preferred., • Language proficiency: English (Required); Candidates fluent in Spanish, Russian, Mandarin/ Cantonese, or Haitian Creole are encouraged to apply!, • Expected Hours: Full-Time from 9am-5pm; Flexibility on occasional evenings and weekends is preferred., • Experience in health/human/social services, particularly with older adults and individuals with disabilities., • Familiarity with Medicare, Social Security, and Human Resources Administration NYC is preferred., • Proficiency in Microsoft Word, Excel, and Outlook is required., • Excellent written and verbal communication skills with attention to detail., • Ability to manage time effectively, prioritize tasks, and work under pressure to meet strict deadlines., • Respect for diversity and cultural differences, with the ability to work collaboratively., • Creative problem-solving skills, especially in crisis situations., • Strong organizational skills and knowledge of community resources., • Ability to travel independently around Brooklyn using public transportation is required., • Empower clients to make informed decisions about their care., • Implement PSS and NYC Aging procedures and guidelines effectively., • Have the opportunity for remote work 2-3 times per week., • Join a dynamic team with a positive work environment focused on professional development and growth. At PSS we are committed to providing equal employment opportunities to all employees and applicants for employment regardless of race, color, religion, sex, national origin, age, disability, or any other legally protected status. We value diversity and strive to create an inclusive and respectful workplace where all individuals are welcomed, supported, and given the opportunity to thrive. EOE M/F/D/V

Job Description Position overview: The Coding Specialist I is responsible for independently reviewing, analyzing, and resolving all assigned front-end claims to ensure accurate and timely claim submission. This position focuses on identifying and correcting coding-related issues prior to claim transmission, applying established coding guidelines, payer requirements, and organizational policies. The Coding Specialist I works closely with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement processes. This role requires strong attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment. Essential Functions: • Averages 10 front-end holds per hour, • Maintains a minimum of 90% coding accuracy., • Assigns ICD-10-CM and CPT codes with appropriate modifiers for services provided in the professional fee environment., • Reviews medical records and all applicable documentation to determine appropriate codes for documented services and diagnoses., • Ensures all diagnosis codes meet local and national medical necessity guidelines., • Utilizes internal coding resources, payer guidelines, and other reference materials to ensure accurate and compliant coding for all assigned services., • Follows all HIPAA regulations and upholds the highest standards of privacy and confidentiality., • Maintains current knowledge of laws, regulations, payer policies, and industry guidance impacting compliant coding practices., • Independently reviews and resolves all assigned front-end claim holds., • Actively participates in department meetings, one-on-one meetings, and mentorship meetings with the assigned Coding Team Lead., • Escalates identified client trends to the assigned Coding Team Lead., • Escalates all coding-related questions to the assigned Coding Team Lead for guidance and clarification., • Maintains and completes all CEU requirements., • Must hold a current AAPC or AHIMA Certification for a minimum of 3 years., • Strong working knowledge of CPT, ICD-10-CM, medical terminology, anatomy and physiology, and state and federal Medicare reimbursement guidelines., • Familiarity with proper English grammar, usage, and professional documentation standards., • Ability to research and analyze data, draw logical conclusions, and resolve coding or documentation issues., • Ability to read, interpret, and apply policies, procedures, laws, and regulations., • Ability to accurately read and interpret medical documentation, clinical terminology, and documented procedures., • Demonstrated ability to exercise independent judgment in coding and claim resolution., • Excellent written and verbal communication skills, including the ability to prepare reports, clarify documentation needs, and maintain collaborative working relationships with physicians and staff., • Strong commitment to maintaining confidentiality and safeguarding protected health information., • Prior experience working in a medical billing environment with strict adherence to HIPAA compliance requirements., • Demonstrated proficiency in Microsoft Office Suite (Word, Excel, Outlook, Teams)., • Standard business office environment with moderate noise levels., • Requires extended periods of computer and monitor use., • Ability to lift and move up to 30 pounds on a non-routine basis., • Ability to sit for extended periods while performing coding and claim review tasks., • Frequent handling, including seizing, holding, grasping, and fingering objects, tools, and controls., • Close vision required to read medical documentation, electronic health records, and coding resources., • Hearing ability sufficient to receive and interpret detailed information through oral and telephonic communication.

Job DescriptionDescription: The Manager of Licensing Services is responsible for completing licensing, medicare, medicaid registrations with accurate quick turnaround times on application submissions and approvals. This role requires consistent follow-up, strong problem-solving skills, and the ability to escalate issues when necessary to ensure registration processes are completed smoothly and efficiently. The Manager of Licensing Services oversees the Licensing Specialist and reports to the Director of Licensing. Key Results Area • Puts forth best efforts to learn and understand the full training provided upon onboarding., • Maintain a full understanding of Guided Care software for licensing workflow., • Follow processes set forth by senior leadership to successfully submit applications for clients., • Responds to client emails by EOD., • Prepare and send licensing and registration client updates to each client according to the cadence established by senior leadership., • Ensure the accurate and timely submission of Medicaid provider registrations in full compliance with state Medicaid guidelines and requirements., • Complete Medicare 855 applications with a high level of accuracy, ensuring all forms are filled out correctly the first time., • Submit forms, applications, and other requests as necessary to complete client requests including but not limited to, revalidations, NPI registration, Entity application., • Coordinate with internal teams and providers to obtain any missing or clarifying information required for the application process., • Maintain a comprehensive and up-to-date record of all missing information, ensuring clarity and accessibility for follow-up., • Set up and schedule phone meetings with providers to discuss missing or incomplete information after two follow-up attempts via email or other communication methods., • Escalate concerns related to licensing obstacles to Director within 48 hours., • Assist in documentation and refinement of SOPs, • Hold monthly 1:1 meetings with all direct reports., • Evaluate and assess personal performance on a routine basis., • Maintains Excellent attendance., • Maintains time clock, requests, and takes PTO according to HR policies., • Performs other related duties to benefit the mission of the company., • High School Diploma or GED, • Independent and self-motivated., • Innovative and detail-oriented professional with strong research and organizational skills., • Thrives in a fast-paced, high-pressure environment., • Strong time management with a proven ability to meet deadlines.

Job Description About Fay At Fay, our mission is to make nutrition a foundational pillar of preventative care, improving outcomes, accessibility, and affordability at scale. We're building AI-powered infrastructure to transform preventative healthcare. Think that's bold? We're just getting started. Today, Fay is a three-sided marketplace connecting providers, patients, and payers to revolutionize preventative care delivery. Our b2b2c business-in-a-box solution empowers dietitians to deliver high-quality, affordable nutrition care, helps patients take control of their health, and enables payers to build healthier member populations. Nutrition is our starting point, not the finish line. The platform we're building will expand into new areas of preventative health and wellness as we grow. We're proud to be one of the fastest-growing companies in healthtech, backed by category-defining investors like General Catalyst, Forerunner, 1984, and Goldman Sachs. Ready to leverage AI-driven technology to transform preventative care and make a real-world impact on health? Let's talk. About This Role As Credentialing Manager, you'll own provider enrollment and credentialing operations at Fay — building the systems, processes, and team structures that allow our dietitian network to scale without friction. The compensation range for this role is $80,0000-$120,000. You'll serve as the in-house expert across a dedicated set of payers and act as the critical bridge between Credentialing and Revenue Cycle Management. This is a player-coach role: you'll set strategy, author SOPs, and own SLAs — while also rolling up your sleeves on escalations and complex payer relationships. You'll report directly to the Head of Credentialing. If you want to build a credentialing function from the ground up at one of the fastest-growing healthtech companies in the country, this role is for you. What You'll Be Doing • Own a dedicated portfolio of 10–15 payers end-to-end. Be the internal subject matter expert on each payer's portal workflows, submission requirements, processing quirks, SLA windows, and escalation contacts. When something breaks, you're the one who knows why and how to fix it., • Manage a team of Provider Enrollment Specialists responsible for application execution. You'll assign and prioritize work, review submissions before they reach payers, and hold the team accountable to quality and throughput standards., • Audit existing credentialing workflows and implement scalable improvements — including technology enablement, process redesign, and smarter resource allocation. You'll drive toward a credentialing operation that can grow without growing headcount proportionally., • Define and own SLAs across the credentialing lifecycle. Track and report on key metrics — turnaround time, application accuracy, denial rates, and resubmission timelines — and proactively surface and resolve bottlenecks before they impact provider go-live dates or revenue., • 3+ years of hands-on provider credentialing and enrollment experience, with at least 2 years in a lead or management capacity — ideally at a health plan, MSO, delegated credentialing entity, or high-growth digital health company, • Deep working knowledge of CAQH ProView, NPDB queries, state licensing and scope-of-practice databases, and the enrollment portals of major commercial and government payers (e.g., Aetna, BCBS, Cigna, UHC, Humana, Medicare/Medicaid), • Demonstrated experience redesigning credentialing workflows — not just executing them — across a high volume of providers and multiple national payers simultaneously, • Experience owning credentialing KPIs and building payer health dashboards with SLA tracking and escalation management, • Strong understanding of the downstream impact of credentialing on claims, billing, and revenue cycle — and how to coordinate across those functions, • Experience credentialing allied health or telehealth providers — particularly dietitians, therapists, or other non-physician specialties, • Familiarity with delegated credentialing agreements and the operational implications of delegated vs. non-delegated payer relationships, • Background at a high-growth startup or digital health company, • Tech-savvy with a strong appetite for automation and systems that enhance speed, accuracy, and scalability Compensation Range$80,000—$120,000 USD Fay is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Job DescriptionHealthPlus Staffing is assisting a well established organization with their search for a Ophthalmologist to join their team in Queens, NY. With over 35 clinics and over half a million patients across the 5 boroughs and Long Island, the growth potential is exponential. Job Description: • Location: Queens, NY (Elmhurst), • Position: Ophthalmologist, • Structure: Outpatient, • Credentialing: 60 days Days, • Schedule: Full-Time, • EMR: Epic, • Support: Full Office Staff and APP, • Duties:, • Perform office-based procedures, • Compensation: 350K - 450K, • Benefits: Full Package Qualifications:, • Unrestricted NY license, • BE/BC in Ophthalmology, • Active DEA registration, • Must possess active Medicare/Medicaid Enrollment or be eligible to enroll, • Seeking both experienced – 2 years or above, and newly trained retina fellowsIf interested in this position please apply immediately and someone will be in contact within 24 hours of submission.

Job DescriptionHealthcare Fraud Investigator Employment Type: Full-Time, Mid-Level Department: Litigation Support CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client. 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. Responsibilities will Include:- Review, sort, and analyze data using computer software programs such as Microsoft Excel.- Review financial records, complex legal and regulatory documents and summarize contents, and conduct research as needed. Preparing spreadsheets of financial transactions (e.g., check spreads, etc.).- Develop HCF case referrals including, but not limited to:- Ensure that HCF referrals meet agency and USAO standards for litigation.- Analyze data for evidence of fraud, waste and abuse.- Review and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidence.- Advise the HCF attorney(s) regarding the merits and weaknesses of HCF referrals based upon applicable law, evidence of liability and damages, and potential defenses, and recommend for or against commencement of judicial proceedings.- Assist the USAO develop new referrals by ensuring a good working relationship with client agencies and the public, and by assisting in HCF training for federal, state and local agencies, preparing informational literature, etc. - Assist conducting witness interviews and preparing written summaries. Qualifications:- Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related field.- Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work.- Proficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etc.- Proficiency in analyzing data that would assist in providing specific case support to the Government in civil HCF matters (E.g., Medicare data, Medicaid data, outlier data).- Communication skills: Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. Communication requires tact and diplomacy.- U.S. Citizenship and ability to obtain adjudication for the requisite background investigation.- Experience and expertise in performing the requisite services in Section 3.- Must be a US Citizen.- Must be able to obtain a favorably adjudicated Public Trust Clearance.Preferred qualifications:- Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3.- Relevant experience working with a federal or state legal or law enforcement entity. #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 Description About Shields Advanced Therapies Shields Advanced Therapies partners with health systems to accelerate advanced therapy access and operations, ensuring lifechanging breakthroughs reach more patients. Our management services and technology solutions serve as a horizontal support hub to empower health system-led, world-class advanced therapy care across 50+ disease states. Launched in September 2024, Shields Advanced Therapies is anchored by partnerships with five of the Top 20 Academic Medical Centers in the United States. Additionally, Shields' track record partnering with over 1,000 hospitals across 43 states in prior ventures provides a national channel for expansion. Role Overview The Cell & Gene Therapy Benefits Specialist will play a crucial role in managing and coordinating patient financial services, ensuring that patients understand and can access available financial resources from payers, manufacturers, and foundations. The role will report to the Director, Clinical Operations. This is a full-time, hybrid role based in New York City (4 days/week in office). Core Responsibilities • Benefits Investigation & Verification: Work with all payers (Government, Commercial, and otherwise, including out-of-state Medicaid agencies), pharmacy benefit managers (PBMs) and third-party administrators (TPAs) to identify, investigate and verify patient insurance coverage and benefits as early as possible within the care journey to ensure timely access to care, accurate billing, and minimal claim denials. This involves confirming eligibility and understanding the specifics of various insurance plans, including site-of-care considerations., • Prior Authorization Facilitation: Work with patient, Cell & Gene Therapy Clinical Coordinators, clinical staff, payer, and others to secure prior authorizations for each component of the treatment plan as applicable/required., • Benefit Enrollment Assistance (if applicable): Guide patients through the process of enrolling in appropriate benefit programs, such as Medicaid, Medicare, or other financial assistance options. This may involve helping patients complete necessary applications and providing information on program requirements., • Patient Financial Counseling: Assist patients in understanding their insurance benefits, out-of-pocket costs, and available financial assistance programs. This includes explaining coverage details and guiding patients through the complexities of healthcare billing, including site-of-care considerations., • Collaboration with Departments: Work closely with clinical staff, patient accounting, billing & collections, and other hospital departments (e.g., research) to communicate benefits considerations and serve as point of contact during financial clearance process, ensure accuracy, and enhance patient satisfaction. This collaboration ensures that financial considerations are integrated into patient care planning., • Collaboration with Manufacturers: In partnership with the Cell & Gene Therapy Clinical Coordinators, work with manufacturers to attempt securing additional financial assistance as applicable/appropriate., • Compliance and Documentation: Maintain accurate records of patient interactions, financial agreements, and assistance provided, ensuring compliance with healthcare regulations and privacy laws. This includes documenting all financial counseling sessions and maintaining confidentiality of patient information., • Development and Execution of Financial Pathways: Codify and execute benefits investigation and prior authorization pathways tailored to each product covered by advanced therapy programs across Health System Partner's service lines and therapeutic programs., • Programmatic Expansion: Contribute to development of centralized Benefits Specialist function that will augment dedicated teams at our Health System Partners and other future partners. Experience The ideal candidate will have 5+ years of experience in healthcare billing, insurance coordination, or patient financial counselling, and familiarity with healthcare financial systems and the insurance verification process. Strong communication and interpersonal skills are crucial for effectively assisting patients, and attention to detail, organizational abilities, and proficiency with healthcare information systems are also important. Prior experience/familiarity with payer navigation specifically related to cellular therapy (CAR T, TIL, etc.), gene therapy, and/or bone marrow transplant patient journeys and applicable prior authorizations required to enable is preferred. Prior exposure with both inpatient & outpatient site-of-care also preferred but not required. Compensation The base salary for this role is expected to be between $65,000 and $80,000. Bonus opportunity tied to quality metrics/outcomes and comprehensive benefits coverage also offered. Job Posted by ApplicantPro

Job Description If you are a current YAI employee, please click this link to apply through your Workday account. The Endocrinologist will be responsible for diagnosing and treating conditions related to hormones and other problems relating to the endocrine system. They will work in an outpatient practice and test, diagnose, and treat patients with endocrine disorders such as diabetes, thyroid diseases, obesity, osteoporosis etc. The Endocrinologist will assist our members in dealing with the physical limitations due to diseases stemming from problems with the endocrine system. Key/Essential Functions & Responsibilities: • Analyzing, examining, and investigating patients for signs and history of hormonal imbalances, • Advising, ordering, and performing tests, • Discussing diagnoses with patients, explaining treatment options, and giving advice on medications, lifestyle and dietary changes, and other preventative measures, • Carrying out follow-up appointments, monitoring patient progress, adjusting treatment plans and medications, and updating patient records, • A medical degree (or Masters in Nurse Partitioning) in endocrinology and the successful completion of a residency and fellowship, or;, • Master’s degree in endocrinology with a nurse practitioner specialization, or;, • A medical license and certification to practice endocrinology, • A thorough understanding of the endocrine system and its diseases, disorders, and conditions, • Board certified or board eligible in Endocrinology, • Valid DEA registration and New York medical license, • 2+ years of post-residency clinical experience, • Active Medicare and NYS Medicaid registration, • Familiarity with the NextGen EHR All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or status as a Vietnam or disabled veteran. YAI is an Equal Opportunity Employer.