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  • Staten Island, NY, USA ● Req #11425
    Monday, November 28, 2022
    JOB SUMMARY:   Responsible for supervision and oversight of the Claims Processing unit of Centers Plan for Healthy Living (CPHL) in accordance with CPHL workflow, policies, state and federal standards.   PRIMARY RESPONSIBILITIES:    Supervises staff to ensure claims are processed accurately, within regulatory timeframes and individual performance goals while adhering to department, industry and productivity standards. Schedules daily work assignments and assists staff in the ... More
  • Staten Island, NY, USA ● Req #11353
    Monday, November 21, 2022
    JOB SUMMARY:   Reports directly to the Assistant Director of Business Development Support, the Internal Support Coordinator will be based in Staten Island office providing updates and working on several reports for our Referral Sources and Account Representatives. This position will communicate directly with Account Representatives and Referral Sources.   PRIMARY RESPONSIBILITIES:              Responsible for bi-monthly Disenrollment Report. To combin ... More
  • Staten Island, NY, USA ● Req #11414
    Monday, November 7, 2022
    Outreach 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 ad ... More
  • Staten Island, NY, USA ● Req #11374
    Monday, November 7, 2022
    Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.   The Director of Staff Development oversees the successful development, implementation and continuous improvement of orientation programs, professional development, evaluations, mandatory educations and trainings of all clinicians hired to ensure safe effe ... More
  • Margate, FL, USA ● Req #11358
    Monday, November 7, 2022
    JOB SUMMARY:   The Enrollment Associate position is responsible for processing referrals/applications in an accurate and timely manner, entering all information into Case Trakker, communicating with appropriate departments as needed, maintaining accurate records, and appropriately escalating any issues that arise. The Enrollment Associate understands and easily communicates the eligibility criteria for the line of business they work under, and utilizes those programs and software n ... More
  • Jamaica, Queens, NY, USA ● Staten Island, NY, USA ● Req #11355
    Monday, November 7, 2022
    JOB SUMMARY:   The Intake CDPAS Coordinator is responsible to review the CDPAS documents obtained by the Field Intake RN and Intake Social Worker team, ensuring quality and accuracy on documentation and compliance with DOH and CPHL policies.   PRIMARY RESPONSIBILITIES: Assist and assign Intake Social Worker in outreach and education process for prospective members that have expressed interest in the CDPAS program. Collaborate with MD offices to ensure DOH-4359 ( ... More
  • Staten Island, NY, USA ● Req #11334
    Monday, November 7, 2022
    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 career advancement, and with opportunities for cross-training and education, CPHL is the place for a fulfilling long-term career.    JOB SUMMARY:    Responsible for the timely and accurate adjudication of all provider disputes (reconsiderations) or claims for Centers Plan for Healthy Living (CPHL) produc ... More
  • Staten Island, NY, USA ● Req #11294
    Monday, November 7, 2022
    JOB SUMMARY:    This position is responsible for collaborating with internal and external customers, analyzing, understanding and translating business needs into business/technical requirements with minimal supervision    PRIMARY RESPONSIBILITIES:    This position is responsible for analyzing, understanding and translating business needs into business/technical requirements with minimal supervision    Actively participate in requirements gathering, ... More
  • Margate, FL, USA ● Req #1217
    Monday, November 7, 2022
    Essential Duties and Responsibilities   Manages communications between clinical staff and referral sources Responds to inquiries from referral sources quickly and efficiently Contributes to the management of the organization’s referrals by ensuring work is handled accurately Makes calls to doctor’s offices, nursing homes, and hospitals on behalf of the intake team to retrieve necessary information for patients Reviews team spreadsheets to ens ... More
  • Brooklyn, NY, USA ● Manhattan, New York, NY, USA ● Queens, NY, USA ● Staten Island, NY, USA ● The Bronx, NY, USA ● Req #1221
    Monday, November 7, 2022
    We are expanding our foot print and seeking compassionate Physical Therapist to provide home-based physical therapy services. Our Therapist contribute to improving mobility and enhancing the quality of life to our members.   Physical Therapist Responsibilities: Travel to and from patients' homes, providing physical therapy as ordered by a physician in accordance with the designated plan of care. Design treatment plans that achieve results through personalized, 1-on-1 individu ... More
  • Brooklyn, NY, USA ● Manhattan, New York, NY, USA ● Queens, NY, USA ● Staten Island, NY, USA ● The Bronx, NY, USA ● Req #1226
    Monday, November 7, 2022
    Occupational Therapy Assistants (OTA) We are expanding and seeking compassionate Occupational Therapy Assistants (OTAs) to provide home-based OTA services. As a participating team member, you will contribute to improving mobility and enhancing the quality of life of our members.   Position Responsibilities: Provide Occupational Therapy treatments to patients according to treatment plans developed by the Occupational Therapist Assists in the evaluation of patien ... More
  • Brooklyn, NY, USA ● Manhattan, New York, NY, USA ● Queens, NY, USA ● Staten Island, NY, USA ● The Bronx, NY, USA ● Req #1227
    Monday, November 7, 2022
    Physical Therapy Assistants (PTA) We are expanding and seeking compassionate Physical Therapy Assistants to provide home-based PTA services. As a participating team member, you will contribute to improving mobility and enhancing the quality of life of our members. Position Responsibilities: Administers: Active and passive manual therapeutic exercises including aerobic capacity conditioning, balance coordination, agility training, body mechanics and postural stabiliza ... More
  • Brooklyn, NY, USA ● Manhattan, New York, NY, USA ● Queens, NY, USA ● Staten Island, NY, USA ● The Bronx, NY, USA ● Req #1228
    Monday, November 7, 2022
    Occupational Therapist We are expanding and seeking compassionate Occupational Therapist to provide home-based OT services. As a participating team member, you will provide therapy services to patients needing to develop, recover and maintain occupational skills. Our Occupational therapists help patients of all ages who have limited abilities establish, develop and/or maintain the ability to complete daily functions and tasks. Through regular therapy sessions, occupational therapists wor ... More
  • Jamaica, Queens, NY, USA ● Req #1183
    Monday, November 7, 2022
    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 Coordina ... More
  • Rockland County, NY, USA ● Req #1277
    Monday, November 7, 2022
    Licensed Practical Nurse (LPN) Certified Home Health Agency   Perform under the direction of a Registered Nurse in following the Plan of Care for individual clients.  Competent in assessing client physical and psychosocial status changes and reporting findings to the Registered Nurse. JOB DUTIES/KNOWLEDGE Provides skilled nursing to clients including, but not limited to treatment, medication administration, and treatment as directed by Registered Nurse and the Physician’s ... More
  • Staten Island, NY, USA ● Req #850
    Monday, November 7, 2022
    JOB SUMMARY: The Talent Acquisition Coordinator (TAC) supports internal and external recruiting processes while partnering with recruiters and hiring managers to ensure a smooth transition from candidate to new hire on-boarding. TACs are responsible for scheduling and coordinating interviews across multiple functional disciplines/locations, coordinating pre-employment paperwork, providing administrative logistical support, assisting with events, as well as ad hoc projects.    ... More
  • San Juan, Puerto Rico ● Req #1081
    Monday, November 7, 2022
    We're expanding our footprint and seeking Full Time LPN’s to join our San Juan, Puerto Rico team. ESSENTIAL DUTIES AND RESPONSIBILITIES Implements plan of care initiated by the registered nurse. Provides accurate and timely documentation consistent with the plan of care. Assesses and provides patient and family/caregiver education and information pertinent to diagnosis and plan of care. Informs Team Lead of issues pertinent to the care plan process and any known or ... More
  • Staten Island, NY, USA ● Req #1020
    Monday, November 7, 2022
    Summary The Care Transition Specialist is a core member of the CPHL Interdisciplinary Care Team (ICT)  and works collaboratively with the I-SNP nurse practitioners to ensure the coordination and continuity of care as members move between different settings and levels of care to improve quality of care and reduce unnecessary hospitalization.  Essential Functions Develop and facilitate collaborative partnerships with all members of the ICTParticipate in case discussion conferenc ... More
  • Staten Island, NY, USA ● Req #907
    Monday, November 7, 2022
    JOB SUMMARY:   Centers Plan for Healthy Living is seeking a Reporting and Business Intelligence Lead. The person in this role will oversee the reporting department. This includes but is not limited to ensuring all submitted report requests are being worked, reports being shared are accurate and will act as a SME for all reporting needs.  PRIMARY RESPONSIBILITIES:    Meet with team members to ensure that report requests from other departments are understood and assist/ offer s ... More
  • Staten Island, NY, USA ● Req #1035
    Monday, November 7, 2022
    JOB SUMMARY:   The Encounter Data Analyst oversees and monitors the encounter generation and submission processes to ensure the complete, timely and accurate encounter reporting to Federal and State agencies.   PRIMARY RESPONSIBILITIES:    As subject matter expert for all Federal and State encounter reporting requirements, shares requirements with third party software vendors and internal Information Systems staff to ensure the complete encounter reporting process ... More
  • Staten Island, NY, USA ● Req #996
    Monday, November 7, 2022
    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   The Claims Service Quality Specialist (CSQS) is responsible for monitoring and assessing the quality of the performance of our Claims Reconsideration Representatives. The CSQS will ... More
  • Staten Island, NY, USA ● Req #1057
    Monday, November 7, 2022
    JOB SUMMARY:   The Information Systems Team is looking for an enthusiastic SQL/Data Warehouse Developer who will be responsible for ensuring our data is in synch between system, data is always up-to-date, performance of databases, overall data management and analysis of the data across a variety of internal systems.   PRIMARY RESPONSIBILITIES:  Work independently and lead data projects Development of high-quality Database Solutions Develop, implement and optimize ... More
  • Brooklyn, NY, USA ● Farmingdale, NY 11735, USA ● Flushing, Queens, NY, USA ● Garden City, NY, USA ● Jamaica, Queens, NY, USA ● Long Island, New York, USA ● Manhattan, New York, NY, USA ● New York, NY, USA ● Queens, NY, USA ● Staten Island, NY, USA ● The Bronx, NY, USA ● Req #856
    Monday, November 7, 2022
    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). ... More
  • Garden City, NY, USA ● Req #879
    Monday, November 7, 2022
    JOB SUMMARY:   The HEDIS Reviewer is responsible for supporting the overall direction, coordination and implementation of the HEDIS Medical Record Review process for Centers Plan for Healthy Living (CPHL) under the direction of the Director of Quality Management. Responsibilities include, but are not limited to coordination of outreach efforts to secure clinical documentation from Providers, reviewing and abstracting data from electronic and/or paper medical records for the annual HEDIS ... More
  • Farmingdale, NY 11735, USA ● Garden City, NY, USA ● Req #790
    Monday, November 7, 2022
    JOB SUMMARY:   The Field Intake Nurse is responsible for assessing a member’s eligibility for the Managed Long Term Care program. The Intake Nurse will conduct a face-to-face comprehensive assessment utilizing NYSDOH approved assessment tool (UASNY) with a potential member in his/her place of residence. The Intake RN also utilizes CPHL’s database of record, completing all necessary documentation to meet CPHL standards. This position requires thorough knowledge of CPHL’s program and servi ... More