
UM/CM Department Coordinator
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.
Clever Care는 우리가 섬기는 지역사회에 속한 회원이 복잡한 의료 서비스 체계를 이해하도록 돕고자 설립되었습니다. 당사는 다문화 맞춤 의료 솔루션을 제공해 드릴 때 회원님께서 이해하실 수 있는 언어로 필요한 서비스에 더 잘 접근하실 수 있도록 최선을 다하고 있습니다. 당사는 동양과 서양 의학의 이점을 결합한 플랜을 제공함으로써 회원님의 건강과 웰빙에 대한 약속을 이행하고 있습니다.
Clever Care offers our associates medical, dental and vision plans, as well as Health Care and Dependent Care reimbursement accounts, life insurance, disability, and accident coverage.
Our competitive 401(k) plan includes a generous company match and vesting schedule.
Full time employees are eligible for paid vacation days and sick leave hours. Clever Care observes ten paid holidays per year.
We are looking for people that are as excited as we are to help build a platform that empowers our members and connects Eastern and Western medicine to provide comprehensive health solutions.
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 Channel Leader is responsible for achieving Clever Care’s established Medicare enrollment objectives in their assigned territory, by working with contracted Agencies and Agents.
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).
Responsible for creating and maintaining eligibility records and addressing any concerns related to member enrollment.
Member Advocates are the main point of contact at Clever Care; interfacing with members, prospective members, providers, brokers, and vendors.
The consultant will educate prospective members on Clever Care products and enroll into product of choice over the phone or other sales enrollment channels.
The Medicare Benefit Consultants (Field Sales) generate Clever Care’s Medicare sales; taking and making telephone calls with prospective members.
This role supports day-to-day network development activities including managing key action items, special project initiatives, and deadlines.
Assist the Sales Operations team with ongoing daily tasks to manage key action items, special project activities/initiatives, and deadlines.
H7607_21_CM0028A_EN_M Accepted 09292020
Clever Care of Golden State는 Medicare 계약을 수반하는 HMO 보험입니다. Clever Care of Golden State 가입은 계약 갱신에 달려 있습니다.
10월 1일~3월 31일:
주 7일, 오전 8시~오후 8시
4월 1일~9월 30일:
월요일~금요일, 오전 8시~오후 8시
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