Chief Compliance Officer – Medicare Advantage (Hybrid)

  • Bachelor's (Preferred)
  • US work authorization (Required)
  • Compliance management experience: 5 years (Preferred)
  • Managed Care Health Insurance experience: 3 years (Required)

Medicare Risk Adjustment (MRA) Specialist- Coding

The Medicare Risk Adjustment Specialist (MRA) conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Risk Adjustment Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Care Manager (Clinical)

(Multiple Positions are Available)
  • Clinical Nursing: 2 years (Required)
  • RN License (Required)
  • Work authorization (Required)
  • Case management: 3 years (Preferred)
  • Medicare, D-SNP, and C-SNP: 2 years (Preferred)

Provider Credentialing Specialist

  • Provider Credentialing: 1 year (Required)
  • Customer service: 1 year (Required)
  • Work authorization (Required)
  • High school or equivalent (Preferred)

Provider Engagement Representative

The Provider Engagement Representative Assists in developing and managing the Medicare Advantage physician/provider network for assigned territory. Responsible for relationship management with assigned provider groups and their staff, as well as executing with provider group on initiatives that benefit the customer, provider, and health plan.

Project Manager – Healthcare

  • Provides excellent written and oral skills and have technical skills using Excel and Access data bases.
  • Undergraduate degree
  • Healthcare Experience (Required) Medicare/Medicaid
  • 4 years of project management experience.
  • Proficient in Microsoft Suite, Project applications, Excel and Access.

Licensed Clinical Social Worker

  • Bachelor's (Required)
  • Clinical Social Work: 1 year (Required)
  • Clinical Social Work License (Required)
  • Healthcare: 1 year (Preferred)
  • Day Shift (Preferred)

Utilization Review Nurse (RN) Hybrid

  • Bachelor’s – Preferred
  • Utilization management: 2 years (Required)
  • RN License (Required)
  • Medicare Advantage: 1 year (Preferred)

Member Services Representative (Member/Provider Services)

  • Three-five years minimum Member/Provider service experience in a healthcare environment.
  • Excellent verbal and written communication skills.
  • Excellent organization skills with ability to handle multiple tasks and prioritize work in a fast-paced environment.
  • Three - five-year minimum ACD or comparable multi-line call center experience.
  • Computer literate with high proficiency in Microsoft applications.

Licensed Medicare Sales Representative – Gwinnett County

  • One year minimum sales experience in a healthcare environment, a broker insurance company, Medicare Advantage insurance plans and/or individual sales environment.
  • High School Diploma or equivalent required.
  • Medicare health insurance license in the state of Georgia required.
  • Highly self-motivated and self-disciplined with ability to work effectively in a sales