elite care services

Regular Exempt **GENERAL DESCRIPTION:** Manages and ensures the effective execution of the Care Management Program work plan for the Company's lines of business. Ensures that the appropriate resources are in place to ensure compliance with the appropriate care management of the participating members of the program(s). Participates in designing,...

Regular Exempt **GENERAL DESCRIPTION:** Carries out nursing functions in performing care management process, organizational determinations, and transitional care, including, but not limited to, health assessments, biopsychosocial needs assessment, and barriers for policyholders with medical conditions to develop a comprehensive and customized...

Regular Exempt **GENERAL DESCRIPTION:** Serves as a liaison between the company and extended care home administration to coordinate, refer, and manage documents and/or services related to the company’s Home Health Program. Responsible for handling, channeling, and resolving service situations related to complaints, claims, and operational...

**Company Mission** Duo Health is a new type of medical group designed around the needs of patients living with chronic kidney disease. Our proprietary Health Mobilization™ platform partners multidisciplinary care teams with community nephrologists and activates the clinicians, facilities, and community organizations needed to care for the whole patient. ...

**(Región - Sur)** Regular Non-Exempt **GENERAL DESCRIPTION:** The Community Outreach Technician provides administrative support within the case management process for addressing the non-clinical needs of policyholders referred to the unit’s program. This role involves assisting in the development of individualized care plans based on...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for the ongoing monitoring of all elements of the Special Needs Plan Care Coordination (SNP-CC) as needed to comply with regulatory requirements and quality indicators. Evaluates care coordination frameworks, identifies risks and improvement opportunities, supports audit readiness, and works...

Regular Exempt **GENERAL DESCRIPTION:** Conducts prospective reviews (preauthorization’s) of items or services provided to beneficiaries using the Clinical Guidelines criteria for assessing medical necessity. Determines the appropriate level of care according to the severity of the subscriber’s condition. Ensures the appropriate use of...

**Job Summary** Strategic and operational leader responsible for designing, implementing, and optimizing the clinical excellence shared services unit within Clinical Operations. This role ensures that cross-functional clinical and administrative processes are agile, scalable, data-driven, and aligned with the highest quality standards. The Director will lead...

Regular Exempt **GENERAL DESCRIPTION:** Evaluates utilization in clinical records and hospital facilities concurrently and retrospectively. Identifies and refers to other clinical departments (Case management, condition management, among others) cases for the management of treatment alternatives. Makes efforts to receive advice in difficult...

Regular Exempt **GENERAL DESCRIPTION:** Leads orientations and presentations to sell and/or renew MCS Advantage’s line of business products to potential clients or beneficiaries (as applicable) that are eligible for the Medicare Program, according to the regulations established by CMS (Center for Medicare and Medicaid Services), and the...

Regular Exempt **Regions of Arecibo, Manati, Mayaguez, Aguadilla, Ponce, Bayamon, Caguas and Carolina.** **General Description** Leads orientations and presentations to sell and/or renew MCS Advantage’s line of business products to potential clients or beneficiaries (as applicable) that are eligible for the Medicare Program, according to the...

Temporary - AEP Non-Exempt **GENERAL DESCRIPTION:** The Customer Service Representative I – SC is responsible for assisting customers and prospects with information about the company's products and services. They address and clarify any questions from beneficiaries who have concerns. Resolves service needs by following established operational...

Temporary - AEP Non-Exempt **GENERAL DESCRIPTION:** The Customer Service Representative I – SC is responsible for assisting customers and prospects with information about the company's products and services. They address and clarify any questions from beneficiaries who have concerns. Resolves service needs by following established operational...

Temporary - AEP Non-Exempt **GENERAL DESCRIPTION:** The Customer Service Representative I – SC is responsible for assisting customers and prospects with information about the company's products and services. They address and clarify any questions from beneficiaries who have concerns. Resolves service needs by following established...

**Location:** **This position is based in Puerto Rico only.** This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on...

**PURPOSE AND SCOPE:** Under supervision is responsible for the operational condition, maintenance, and repair of all water systems, medical equipment, and mechanical/electrical systems so as to ensure safety of the patients as well as the staff operating the equipment. Responsible for inventory and housekeeping as required. Assists in cost containment in...

At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers. When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our...

At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers. When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our...

Regular Exempt **GENERAL DESCRIPTION:** Provides education to internal and external clients on operational topics that promote efficiency in the process executed by our providers and business partners, such as the Risk Adjustment payment model “CMS-HCC”, ensuring best practices in coding standards and clinical documentation within the medical...

## Overview PURPOSE STATEMENT: Manage the client's/patient's/resident’s cases with a solid background of clinical knowledge and expertise and may be responsible for providing some therapeutic services to clients/patients/residents. ## Responsibilities ESSENTIAL FUNCTIONS: · Provide case management and care coordination services for...