Job Search
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75 Vanderbilt Ave, Staten Island, NY 10304, USA ● Req #266Monday, December 2, 2024JOB SUMMARY: The Medicare MAP Advisor- Will promote and sale MAP and Medicare Line of Business, maintains relationships, services our existing customers and secures new customers by consultative selling/marketing and performing all required tasks assigned by the Sales Field 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 poli ...Read more about Medicare MAP AdvisorMore
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Bronx, NY, USA ● Brooklyn, NY, USA ● Manhattan, New York, NY, USA ● Queens, NY, USA ● Staten Island, NY, USA ● Req #333Monday, December 2, 2024JOB 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 Licensed Benefits ...Read more about Licensed Benefits Advisor (Field Based)More
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JOB SUMMARY: The Care Coordinator works within a multidisciplinary care team to help assist with the care of members enrolled in CPHL Managed Long Term Care program and other LOBs to facilitate, schedule and arrange a variety of treatments and healthcare related activities. REPORTING RELATIONSHIPS: Reports to Care Coordination Manager and shares a collaborative relationship with the Care Management Team and other departments involved in member’s care. PRIMARY RESPONSIBILITIES: ...Read more about UAS CoordinatorMore
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One of the fastest growing Managed Long-Term Care company in New York, Centers Plan For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer 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. Utilization Management Clinical Reviewer will assess and process all authorization requests to ...Read more about UM Clinical ReviewerMore
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75 Vanderbilt Ave, Staten Island, NY 10304, USA ● Req #811Monday, December 2, 2024Individualized professional and personal growth is a primary focus at CPHL. With various teams to match the unique strengths of each individual, tiered roles to support the advancement, and with opportunities for cross-training and education, CPHL is the place for a fulfilling long-term career. 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 ...Read more about Claims Service RepresentativeMore
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Individualized professional and personal growth is a primary focus at CPHL. With various teams to match the unique strengths of each individual, tiered roles to support the advancement, and with opportunities for cross-training and education, CPHL is the place for a fulfilling long-term career.JOB SUMMARY: Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims. Collaborates with other Health plan departments and Management to ensure claims are processed in ac ...Read more about Claims AuditorMore
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JOB SUMMARY: The Intake RN is responsible for conducting UAS-NY assessments, determining when individuals are appropriate for membership and developing plans of cares for prospective CPHL members. Intake RNs must complete full productivity and submit all paperwork in a timely fashion. This position is also responsible for explaining managed long term care benefits and services to prospects. The Intake RN will be in constant communication with their Intake RN Supervisor as well as Intake UAS re ...Read more about Intake RNMore
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Bronx, NY, USA ● Brooklyn, NY, USA ● Manhattan, New York, NY, USA ● Queens, NY, USA ● Staten Island, NY, USA ● Req #1237Monday, December 2, 2024JOB 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 Licensed Benefits ...Read more about Licensed Benefits Advisor (Bilingual Preferred - Field Based)More
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75 Vanderbilt Ave, Staten Island, NY 10304, USA ● Req #11379Monday, December 2, 2024JOB SUMMARY: The Training Coordinator works directly with Trainer/Auditors and reports to the Director of Training and Development. The primary objective is to provide overall support to the Training & Development team, handle office duties and optimize office operations. The Training Coordinator will provide oversight of the Tele-sales staff and ensure ongoing compliance, by conducting call monitoring. He/she will provide topic suggestions based on the findings for trainers/Auditors to utiliz ...Read more about Training CoordinatorMore
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75 Vanderbilt Ave, Staten Island, NY 10304, USA ● Req #11414Monday, December 2, 2024Outreach and Retention Associate (ORA)–Medicare Advantage CPHL is a Medicare Advantage Prescription Drug plan serving Medicare eligible beneficiaries living in the 5 boroughs of New York City, Erie and Nassau County. If you are a professional, self-motivating, NYS DFS licensed producer*, CPHL has an excellent opportunity for you to advance your career. Overview: This position is responsible to provide a concierge experience to our members by providing new members additional educati ...Read more about Outreach and Retention AssociateMore
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JOB SUMMARY: The Care Coordinator works within a multidisciplinary care team to help assist with the care of members enrolled in CPHL Managed Long Term Care program and other LOBs to facilitate, schedule and arrange a variety of treatments and healthcare related activities. REPORTING RELATIONSHIPS: Reports to Care Coordination Manager and shares a collaborative relationship with the Care Management Team and other departments involved in member’s care. PRIMARY RESPONSIBILITIES: ...Read more about UAS CoordinatorMore
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75 Vanderbilt Ave, Staten Island, NY 10304, USA ● Req #11905Monday, December 2, 2024JOB 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 hire in cla ...Read more about Trainer/AuditorMore
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Brooklyn, NY, USA ● Manhattan, New York, NY, USA ● Queens, NY, USA ● Staten Island, NY, USA ● Req #11993Monday, December 2, 2024JOB SUMMARY: The Field Coordinator is an essential team member of Centers Plan for Healthy Living’s Care Management department and assists with the care of all members enrolled in CPHL’s managed care plans. The Field Coordinator schedules and completes in-person visits as part of routine follow-up and collaborates with Care Management to ensure the member’s care needs are met. PRIMARY RESPONSIBILITIES: Schedule in-person visit appointments Perform routine in-person visits at th ...Read more about Field CoordinatorMore
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75 Vanderbilt Ave, Staten Island, NY 10304, USA ● Req #12102Monday, December 2, 2024JOB 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 member Coordinates with providers regarding authorization acti ...Read more about UM Care CoordinatorMore
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75 Vanderbilt Ave, Staten Island, NY 10304, USA ● Req #12109Monday, December 2, 2024JOB SUMMARY: The Home Care Relations Liaison position is responsible for working with internal departments and external providers regarding existing members request for provider change. This position will assist with CDPAS documentation and authorizations. PRIMARY RESPONSIBILITIES: Point person for Utilization Management, Case Management and G&A regarding resolution to members request for a change in provider Communicate with current provider regarding stabilizing services ...Read more about Home Care Relations LiaisonMore
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JOB SUMMARY: The Assessment Nurse, works in collaboration with the Care Management team and is responsible for assessing a member’s eligibility for the Centers Plan for Health Living’s (CPHL all LOB programs. The Assessment Nurse will conduct a face-to-face comprehensive assessment utilizing NYSDOH approved assessment tool (UASNY) and risk acuity visits with a member in his/her place of residence. The Assessment Nurse is a member of the interdisciplinary care team (IDT). The members inte ...Read more about Assessment RNMore
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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: Authorization of medically necessary servi ...Read more about UM RNMore
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75 Vanderbilt Ave, Staten Island, NY 10304, USA ● Req #12139Monday, December 2, 2024JOB SUMMARY The Claims Trainer is responsible for planning, developing and delivering training programs that meet specific needs for the Claims Department. The trainer will collaborate with the claims management team to identify and analyze learning gaps and opportunities to facilitate staff development and promote continued high performance. PRIMARY RESPONSIBILITIES Designs, develops, and implements training programs, material and curriculum that identify learning and educational needs of ...Read more about Claims TrainerMore
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75 Vanderbilt Ave, Staten Island, NY 10304, USA ● Req #12146Monday, December 2, 2024JOB SUMMARY: The Project Manager is responsible for leading and overseeing projects that align with organizational goals. This includes ensuring compliance with regulatory requirements and improving efficiency of departmental processes. This role involves managing cross-functional teams, meeting deadlines, and delivering solutions that enhance business outcomes. PRIMARY RESPONSIBILITIES: Access and monitor Enrollment and Intake data, stream lining processes and checking for ...Read more about Project ManagerMore
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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 member Coordinates with providers regarding authorizati ...Read more about UM CoordinatorMore