Clever Care Health Plan Careers

The UM/CM Department Coordinator provides support to the utilization and case review process. The coordinator works collaboratively with all team members of Utilization and Case Management department.

The HEDIS Outreach Educator under the guidance of the Director of Quality and Star Programs oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs

The ideal candidate is a proven team player, leader, and individual contributor who is able to engage relevant parties cross‐functionally, drive decision making, and as applicable, facilitate operational change.

Clever care is seeking HCC Coding Quality Auditor/Educator for our Risk Adjustment (RA) team who will facilitate the development and maintenance of HCC coding and audit programs.

This position ensures regulatory compliance in the processing of all inbound claims that are within the Centers for Medicare & Medicaid Services (CMS) regulations as well as Clever Care Health Plan policies and procedures as they apply to claims processing and payment.

Claims Payment and Recovery Auditor is responsible for analyzing payments, review detailed paid claims reports, eligibility reports, etc to ensure claims are adjudicated in a consistent and accurate manner.

The Claims Auditor conducts routine oversight, monitoring and auditing of all internal business functions within Clever Care, as well as externally delegated functions and contracted first tier entities to ensure compliance with state, federal, and accreditation standards.

The Agency Account Executive is responsible for helping the regional teams to achieve Clever Care’s established Medicare enrollment objectives in their assigned language segments, by working with the Regional Managers and Field Agency Leaders to drive enrollments through contracted Agencies and Agents.

Key team member who is participant in all FP&A activities, including budgeting and forecasting, variance reporting, and decision support. Maintain budgets and forecast toolsets, produce variance analyses, support FP&A monthly closing activities, and create analytical support for key corporate initiatives such as evaluating growth opportunities and annual bid processes. Assist in the production of iterative Board of Directors financial reporting. Produce ad‐hoc analyses as necessary. Position will report to the Senior Director of FP&A.

The Medicare Enrollment Supervisor serves as a proxy for the Manager of Enrollment and Reconciliation, overseeing the activities and personnel of the Enrollment department while ensuring its processes operate smoothly. The Enrollment Supervisor also works with customers, vendors, and with federal and State agencies to resolve eligibility issues in order for the plan to continue receiving payment for medical services provided.

The Product Implementation Manager position is responsible for multiple Medicare operational process and functions, including bid submission and implementation of products to downstream systems and vendors with a focus on quality assurance, ensuring end-to-end that what we implement is consistent with our product filings. This function will support both existing and new markets.

Clever Care is looking for a Registered Nurse Case Manager to coordinate medical services and ensure that our members receive the care they need.

The ideal candidate will be motivated by Clever Care’s mission to deliver culturally‐sensitive health care solutions to seniors in our community and connect our offerings with community groups with similar
missions.

The Translation and Communication Specialist is responsible for using their knowledge of two or more languages and cultural awareness to translate text from English to another language (Mandarin, Korean, Vietnamese, and/or Khmer).