Alignment Health

• Provides in-market, specialized member support • Conducts in-market member engagement • Ensures members have access to PCP and specialists • Educates members on gaps in care

• Review and render Part D coverage determination and appeal requests. • Conduct comprehensive medication reviews via telephone for members enrolled in the MTM program. • Participate in pharmacy quality improvement projects aligned with Medicare Star Ratings. • Maintain appropriate records of all clinical reviews, coverage determinations, and consultations in accordance with CMS timelines.

• Coordinates care by serving as a resource for the member, their family, and their physician. • Ensures access to appropriate care for members with urgent or immediate needs. • Completes comprehensive assessments within their scope of practice. • Collaborates with the member, the PCP, and other members of the care team to implement a plan of care. • Provides education and self-management support based on the member’s unique learning style.

• Provides outreach and support to ensure all eligible members have access to care • Conducts member outreach phone calls and/or receiving inbound phone calls • Collaborates with partners to facilitate the member experience • Identifies members for care gaps and connect to appropriate provider or vendor • Responsible for real-time documentation and timely wrap-up for outcomes reporting • Excels in customer service to ensure high member satisfaction

Role Description The Remote Regional Concierge Navigator provides outreach and support to all our members, ensuring they have access to the care they deserve. Supports our members to navigate through their health care and benefits. Connects the dots between our provider network, health plan operations, and supplemental vendors. Maintains a high knowledge of the member needs of their respective market and assists our members every step of the way to ensure they are never alone in their healthcare journey and have the highest level of coordinated care. Lays the groundwork for future and ongoing member support. Has familiarity with assigned markets and understands the meaningful contributions to members’ healthcare outcomes. - Provides in-market, specialized member support in respective market or region. - Conducts in-market member engagement including: - Welcome Calls - New Member Onboarding - JSA Scheduling - High Quality PCP and Provider Terms - Product/Vendor Changes - CAHPS Proxy - Disenrollment Quality Assurance - Proactive Service Recovery - Conducts case follow-ups and quality member issue resolution for all cases assigned. - Ensures members have access to PCP and specialists to coordinate care. - Educates members on gaps in care and assists with scheduling provider appointments. - Serves as the patient's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures. - Makes appropriate and timely patient appointments, reminders, and confirmations and mails letters and correspondence as needed. - Places regular/consistent outreaches to the patient. - Communicates with PCP with any member updates and requests. - Assists with obtaining medical records from any healthcare providers involved in care or hospitals. - Helps members with any authorizations and referrals involved in their care plan. - Resolves incoming calls concerning members’ eligibility, benefits, provider information, clinical, and pharmacy needs; coordinates membership changes such as member’s primary care physician and proactively engages member with their wellness plan options. - Participates in on-site member engagement activities as needed, such as in-person member meetings, handling lobby calls at a retail or care center location, etc. (subject to change). - Other duties as assigned. Qualifications - Required: Minimum 1 year of customer service experience. - Preferred: High-volume inbound customer service experience, particularly for health plan or Medicare “Member Services” roles in health plan and supplemental benefits preferred. - Preferred: Telemarketing and/or member outreach experience preferred. - Preferred: Specialized experience in escalation or resolution units preferred. - Required: High School Diploma or GED. Requirements - Knowledge of ICD-10 and CPT codes. - Keyboard typing 40+ words per minute. - Ability to help members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations. - Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. - Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors. - Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization. - Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations. - Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly. - Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. - Preferred: Bilingual English/Spanish or English/Vietnamese or English/Mandarin. Fluency in written and verbal Spanish, Korean, or Vietnamese, a plus. Benefits - Pay Range: $44,790.00 - $67,185.00 - Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

• Serve as the primary technical resource for the Corporate Accounting team during Monthly, Quarterly, and Year-End close cycles • Troubleshoot complex journal entry issues and resolve root causes • Own and maintain all GL system configurations • Identify and implement automation opportunities within the Oracle Close Monitor • Monitor and troubleshoot inbound interfaces from Oracle sub-ledgers and external systems • Build, maintain, and optimize complex financial reports using Oracle Financial Reporting Studio • Maintain Segregation of Duties (SoD) controls within the GL module • Act as the final technical escalation point for complex incidents

• Architect and Maintain Financial Data Pipelines • Engineer and Support Application Integrations • Ensure Financial Data Compliance and Security • Build and Sustain Reporting Infrastructure • Serve as Tier 3/4 Escalation Expert for Integration Incidents • Support Implementation and Continuous Improvement

• Administer and Optimize the Oracle EPM Planning Environment • Maintain Data Integrity Between ERP and EPM Systems • Deliver Advanced Analytics and Executive Reporting • Enable Strategic Scenario Modeling and Forecasting • Ensure Security, Governance, and SOX Compliance • Provide Tier 3/4 Escalation Support and System Reliability

• Lead Enterprise ERP Implementation and Transformation • Direct the end-to-end implementation of Oracle Cloud Financials • Govern Platform Operations and Continuous Improvement • Drive Financial Systems Data Strategy and Integration • Ensure Regulatory Compliance and Financial Controls • Manage Vendor and Systems Integrator Relationships • Align Technology Strategy with Finance Business Objectives • Build, Lead, and Develop a High-Performing Team

• Lead, mentor, and develop a team of RN Case Managers, ensuring alignment with organizational policies and regulatory standards • Oversee daily outpatient case management operations, including referrals, transitions of care, and care coordination • Maintain audit readiness by coordinating chart reviews and monitoring case management processes • Train and onboard new staff while providing ongoing coaching and performance feedback • Assign and prioritize team workload to ensure efficiency and quality outcomes • Collaborate cross-functionally with Medical Directors, Quality, and Compliance leadership • Manage escalated cases and step in to perform case management duties as needed • Ensure accurate and compliant documentation across all team activities • Analyze and report clinical and program data to leadership to support continuous improvement • Support the development and implementation of protocols, workflows, and best practices • Supervise a team of RN Case Managers and coordinators • Lead hiring, onboarding, and training efforts • Provide performance management, coaching, and development