Career Opportunities

JOB SUMMARY The Appeals and Grievance Analyst performs research, investigation and analysis of appeals, grievances, and other types of complaints filed by members and customers to administer timely resolution within state and federal guidelines, benefit plan guidelines, and company policies and procedures. The analyst is expected to maintain the confidentiality of all sensitive documents…

JOB SUMMARY Under the direction of the Director of Quality, the Stars Project Manager is responsible for providing project management for the Medicare Advantage Stars program at HealthTeam Advantage. ESSENTIAL DUTIES AND RESPONSIBILITIES This position must be able to: Project manage multiple cross-functional department strategies as they are related to the HealthTeam Advantage Stars…

JOB SUMMARY Under the direction of the Director of Quality, the Quality Manager is responsible for helping to develop, administer, and manage the CMS Medicare Stars/Quality programs at HealthTeam Advantage. Will collaborate with the Director of Quality and other internal and external teams to coordinate activities related to HEDIS, CAHPS, and HOS and ensure programs provide high-quality care…

JOB SUMMARY Responsible for reviewing prior authorization requests for medical services including elective admissions (Post-Acute and Acute), inpatient surgeries, outpatient surgeries, home health, and durable medical equipment. RN will prioritize expedited requests for medical necessity and efficiency in accordance with health plan coverage guidelines and CMS coverage determinations…