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  • Suffolk County, NY, USA
    Req #436
    Tuesday, November 24, 2020
    FIELD NURSE RN (NEW GRAD & EXPERIENCED) – SUFFOLK COUNTY Come join our team of dedicated professionals. Take your career in a new direction. We are currently accepting applications for compassionate, motivated Full Time, and Fee for Service, EXPERIENCED & NEW GRADUATE REGISTERED NURSES for our CHAA division. We strive to provide QUALITY services to our patients. Reporting to the Coordinator Of Care (COC), the Field RN assesses, plans and coordinates home care services for assig ... More
  • Nassau County, NY, USA
    Req #435
    Tuesday, November 24, 2020
    FIELD NURSE RN (NEW GRAD & EXPERIENCED) – NASSAU COUNTY Come join our team of dedicated professionals. Take your career in a new direction. We are currently accepting applications for compassionate, motivated Full Time, and Fee for Service, EXPERIENCED & NEW GRADUATE REGISTERED NURSES for our CHAA division. We strive to provide QUALITY services to our patients. Reporting to the Coordinator Of Care (COC), the Field RN assesses, plans and coordinates home care services for assign ... More
  • Staten Island, NY, USA
    Req #394
    Monday, November 23, 2020
    JOB SUMMARY:The role of the Senior Data and Interface Analyst is to ensure the integrity and accuracy of Centers Plan for Healthy Livings data and reporting across all systems.PRIMARY RESPONSIBILITIES:·Develop integrations between both internal and external systems.·Database modeling and design of Enterprise Data Warehouse to allow for ease of reporting.·Utilize advanced querying techniques with Data Marts and Cubes.·Support encounter reporting to both New York State and CMS.·Work with users to ... More
  • Brooklyn, NY, USA
    Req #422
    Monday, November 23, 2020
    JOB SUMMARY:   The Intake Field Coordinator is responsible for obtaining any outstanding documents needed by the Intake department, ensuring productivity, quality and compliance with all CPHL policies. The position entails reaching out to CPHL Managed Long Term Care Plan (MLTCP) referrals by phone as well as conducting home visits as needed; carefully explaining plan benefits and enrollment procedures; determining patient’s current services and understanding what they are looking ... More
  • Staten Island, NY, USA
    Req #430
    Monday, November 23, 2020
    JOB SUMMARY:   Centers Plan for Healthy Living is seeking a Reporting and Business Intelligence Analyst. The person in this role will act as a liaison to other departments within the organization to discuss and solve for reporting needs.   PRIMARY RESPONSIBILITIES:    Meet with end user and work through presented requirements in the preparation of the report. Determine most effective and user-friendly method for report delivery. Crea ... More
  • Staten Island, NY, USA
    Req #341
    Monday, November 23, 2020
    JOB SUMMARY:   At CENTERS PLAN FOR HEALTHY LIVING (CPHL), our market-leading Medicare Advantage benefits and aggressive marketing has seniors calling in daily to become members. Are you the right person to sign them up?   As a Phone Benefits Advisor, you have two important jobs to do: the first part of your job is to actively sell the Medicare product directly over the phone for CPHL. Can’t make the sale? CPHL has a strong team of Field Marketing Representatives who w ... More
  • Staten Island, NY, USA
    Req #424
    Monday, November 23, 2020
    JOB SUMMARY:   The objective is to ensure ongoing compliance, provide support and training by monitoring the field staff on a monthly basis.  The Trainer/Auditor will provide oversight of the field staff. He/she will bring back observations and recommendations for the Training & Development department to utilize in developing strategy and plans that ensure compliance and can also be used to keep class trainings relevant and up to date. The Trainer is responsible for conducting new ... More
  • Rockland County, NY, USA
    Req #384
    Friday, November 20, 2020
    FIELD NURSE RN (NEW GRAD & EXPERIENCED) – ROCKLAND COUNTY Come join our team of dedicated professionals. Take your career in a new direction. We are currently accepting applications for compassionate, motivated Full Time, and Fee for Service, EXPERIENCED & NEW GRADUATE REGISTERED NURSES for our CHAA division. We strive to provide QUALITY services to our patients. Reporting to the Coordinator Of Care (COC), the Field RN assesses, plans and coordinates home care services for assigned ... More
  • Westchester County, NY, USA
    Req #385
    Friday, November 20, 2020
    FIELD NURSE RN (NEW GRAD & EXPERIENCED) – WESTCHESTER COUNTY Come join our team of dedicated professionals. Take your career in a new direction. We are currently accepting applications for compassionate, motivated Full Time, and Fee for Service, EXPERIENCED & NEW GRADUATE REGISTERED NURSES for our CHAA division. We strive to provide QUALITY services to our patients. Reporting to the Coordinator Of Care (COC), the Field RN assesses, plans and coordinates home care services for assig ... More
  • Brooklyn, NY, USA ● Long Island, New York, USA ● Manhattan, New York, NY, USA ● Queens, NY, USA ● The Bronx, NY, USA
    Req #386
    Friday, November 20, 2020
    FIELD NURSE RN (NEW GRAD & EXPERIENCED)  Come join our team of dedicated professionals. Take your career in a new direction. We are currently accepting applications for compassionate, motivated Full Time, and Fee for Service, EXPERIENED & NEW GRADUATE REGISTERED NURSES for our CHAA division. We strive to provide QUALITY services to our patients. Reporting to the Coordinator Of Care (COC), the Field RN assesses, plans and coordinates home care services for assigned patient caseloa ... More
  • Putnam County, NY, USA
    Req #427
    Friday, November 20, 2020
    FIELD NURSE RN (NEW GRAD & EXPERIENCED) – PUTNAM COUNTY Come join our team of dedicated professionals. Take your career in a new direction. We are currently accepting applications for compassionate, motivated Full Time, and Fee for Service, EXPERIENED & NEW GRADUATE REGISTERED NURSES for our CHAA division. We strive to provide QUALITY services to our patients. Reporting to the Coordinator Of Care (COC), the Field RN assesses, plans and coordinates home care services for assigned ... More
  • Staten Island, NY, USA
    Req #431
    Friday, November 20, 2020
    JOB SUMMARY:    Entry/Junior level position to provide system support to Member Services, including obtaining and tracking all system login credentials (both new and termination), locate and pull telephonic records, track and report system responsiveness/downtime.     PRIMARY RESPONSIBILITIES:    Obtain, track all System login credentials for Member Services Research and pull telephonic records from phone platform and storage Maintai ... More
  • Margate, FL, USA
    Req #252
    Thursday, November 19, 2020
    We are seeking Full Time Call Center Representatives for our recently opened office in Florida. This role provides an opportunity for someone who thrives in a logistics environment with a solid customer centric approach. Responsibilities Respond to inquiries and requests via telephone and email in a timely fashion Document inquiries, requests, resolutions, and follow-up tasks Escalate inquires and requests to appropriate channels where applicable ... More
  • Staten Island, NY, USA
    Req #423
    Tuesday, November 17, 2020
    JOB SUMMARY: The Provider Account Management Representative is responsible for the recruitment, contract submission, and maintenance of CPHL Medicare Network providers.   PRIMARY RESPONSIBILITIES: Recruit, negotiate, and initiate contracting of potential Medicare Network Providers Maintain detailed, accurate records Establish and maintain strong, positive relationships with providersAct as a liaison between providers, CPHL, and leadershipAssure tha ... More
  • Staten Island, NY, USA
    Req #414
    Friday, November 13, 2020
    Summary This position supports the I-SNP NP through a collaborative process for options and services to meet a member’s health needs.   Allows for appropriate allocation of member benefits and resources through a collaborative partnership with participating nursing facilities and providers. Liaison for discharge planning activities by insuring documented plan for each acute discharge and coordination and facilitation of non-emergent services and routine care planning and implementati ... More
  • Staten Island, NY, USA
    Req #420
    Wednesday, November 11, 2020
    JOB SUMMARY:   Support strategic planning exercises for all products to determine future growth opportunities; includes researching and data gathering from internal and external data sources and assisting with membership forecasting. Assist with Sales Operations and Business Development projects as needed, including sales lead forecasting and campaign reporting, sales performance tracking, commission processing. For all areas, provide input about data tracking and reporting ... More
  • Staten Island, NY, USA
    Req #408
    Monday, November 9, 2020
    JOB SUMMARY:   Ensure compliance with federal and state legal and regulatory requirements relative to Medicare and Medicaid Managed Care. PRIMARY RESPONSIBILITIES:   Auditing and monitoring processes in accordance with all applicable federal and state laws and regulatory requirements, including CMS guidelines governing the administration and marketing of Medicare Advantage. Represent senior management at various committees, meetings, and seminars Communicate with CMS ensure timely completi ... More
  • Staten Island, NY, USA
    Req #415
    Monday, November 9, 2020
    JOB SUMMARY:   The Utilization Management Care Coordinator works within a multidisciplinary care team to assist with the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members.     PRIMARY RESPONSIBILITIES:              Assists in the prior authorization of services and ongoing authorization requests Assists in completing authorization updates as needed based on the care plan of the m ... More
  • Staten Island, NY, USA
    Req #333
    Tuesday, November 3, 2020
    JOB SUMMARY:   The Licensed Benefits Advisor- Medicare Sales, maintains relationships, services our existing customers and secures new customers by consultative selling/marketing and performing all required tasks assigned by the Sales Manager. Incumbent will be responsible for educating and enrolling potential beneficiaries by explaining program benefits in a manner that is compliant with Center for Medicare and Medicaid Services (CMS) and company policies and regulations. The ... More
  • Staten Island, NY, USA
    Req #410
    Tuesday, November 3, 2020
    Provider Data Maintenance Operator Summary:  The Provider Data Maintenance Operator assists the Provider Data Maintenance Supervisor with any of the following: provider demographic updates, contract updates, fee schedule updates, auditing, running reports, etc. The Operator will typically be assigned as a lead on any special projects that may arise. Primary Responsibilities: The Provider Data Maintenance Operator is responsible for, but not limited to: Cre ... More
  • Staten Island, NY, USA
    Req #407
    Friday, October 30, 2020
    JOB SUMMARY:   Responsible for ensuring operational effectiveness through critical analysis and reconciliation of data gathered from multiple sources and creating timely reports in all aspects of the Network/Provider Operations Departments.  This position requires someone with strong analytic skills, ability to gather business requirements, craft data into usable reports, track and trend issues, and provide feedback on solutions.     PRIMARY RESPONSIBILITIES:    Analyze i ... More
  • Staten Island, NY, USA
    Req #405
    Monday, October 26, 2020
    JOB SUMMARY:                        This Claims Business Analyst works collaboratively with the Director of Claims in supporting the department to deliver timely and accurate payment of claims and first call resolution. This role will also provide analysis related to the identification of improved claim system configuration and call flows that would positively impact quality performance, reduce claim inventory and improve the customer experience.     PRIMARY RESPONSIB ... More
  • Jamaica, Queens, NY, USA
    Req #404
    Monday, October 26, 2020
    JOB SUMMARY:   The Utilization Management nurse works within a multidisciplinary team to help identify and manage members who are in need of additional care or support in their home to improve their quality of life. The Utilization Management nurse will assess and process all authorization requests to determine medical necessity to ensure all care services, member education, and preventative interventions are maintained.     PRIMARY RESPONSIBILITIES:              Authoriza ... More
  • Staten Island, NY, USA
    Req #361
    Thursday, October 22, 2020
    Centers Plan for Healthy Living is seeking Claims Reconsideration Representative!  Position Details: Professionally handle incoming inquiries via telephone, email or fax from providers (i.e. physician offices, clinics, social day cares, home care agencies, DME suppliers) regarding claim decision and payments across all Centers Plan for Healthy Living (CPHL) product offerings. Thoroughly and efficiently gather claim information, assess and fulfill the caller’s needs and ... More
  • Margate, FL, USA
    Req #15
    Tuesday, October 20, 2020
    JOB SUMMARY:   As an integral part of the Grievance and Appeals (G&A) Department, the G&A Coordinator lends their support in processing member-related grievances and appeals across CPHL’s various lines of business. Process includes gathering, documenting, tracking, and pursuing resolution of complaints in accordance with regulatory and organizational guidelines to the member’s satisfaction.     PRIMARY RESPONSIBILITIES:    Logs and tracks verbal or written member grievan ... More