Comagine Health

• Administering face-to-face assessments and person-centered service planning (in partnership with individuals and their designated agents) • Continuous monitoring of service plans, • Assisting with transitions from and between community and institutional settings.

• Support ESRD operational workflows, CMS forms processing activities, and operational tracking processes • Validate, update, and maintain information within End Stage Renal Disease Quality Reporting System (EQRS) and other internal systems to support data quality and reporting activities • Maintain operational records, documentation, tracking systems, and internal databases • Manage communications and follow-up activities with dialysis facilities, CMS contacts, vendors, help desk teams, and external partners • Monitor and route communications through shared phone, email, and virtual fax systems • Support facility onboarding, closure activities, and related operational processes • Prepare reports, reminders, meeting materials, operational correspondence, and recurring resources • Coordinate scheduling, Outlook invitations, Zoom meetings, shipment tracking, operational mailings, and meeting logistics • Assist with workflow documentation, process standardization, and operational support initiatives • Support department operational priorities, annual meetings, and other team activities as assigned

• Conduct annual in-home assessments across Las Cruces and the Southern New Mexico region with adults receiving services through the New Mexico Mi Via Waiver. • Manage a flexible, primarily field-based schedule—visiting participants’ homes, completing assessments, and using your home office for follow-up, scheduling, and documentation. • Build meaningful rapport with participants and their families or caregivers. • Administer a structured assessment tool using our electronic systems, and gather detailed information about daily living skills, behaviors, and support needs. • Translate observations and findings into accurate, clear documentation to help ensure individuals maintain access to community-based services to support their independence and quality of life. • Be part of a growing, collaborative team of assessors with opportunities to learn, develop, and make a real impact every day.

• Provide day-to-day leadership and management of the Washington CIE program • Ensure adequate staffing, regulatory compliance, and adherence to organizational and client policies • Lead cross-functional teams supporting implementation and operational delivery of the statewide CIE initiative • Drive achievement of key program objectives, including standardization of Health-Related Social Needs (HRSN) service delivery data exchange • Interoperability between state, regional, and local technology systems • Scalability of Community Care Hub efforts across Washington State • Build and maintain strong partnerships with state agencies, providers, community organizations, and stakeholders • Partner with client, VP of Data Solutions, and organizational leaders to develop and manage project budgets • Provide oversight of Washington CIE program financials, including subcontractor budgets and resource allocation • Monitor financial performance and support long-term sustainability planning • Foster collaboration and alignment across service lines and teams supporting the Washington CIE program • Support team development through communication, mentorship, and leadership engagement • Promote organizational values, mission, and culture throughout program operations.

• Define and lead architecture for scalable, secure, and resilient cloud infrastructure across enterprise platforms • Establish and enforce cloud architecture standards and best practices • Establish infrastructure automation standards including Infrastructure-as-Code (IaC), deployment pipelines, and configuration management • Design and implement observability frameworks to support system reliability and proactive monitoring • Lead modernization initiatives including container orchestration, distributed systems, and cloud-native architecture patterns • Collaborate with security teams to ensure infrastructure meets regulatory, compliance, and cloud security standards • Mentor engineers and provide technical leadership across cloud engineering initiatives

• Analyze data from a variety of sources and conduct methodologically sound analyses to generate meaningful insights • Interpret and present data findings to internal and external stakeholders in a clear and actionable way • Collaborate with project teams to ensure analytic deliverables meet business and client needs • Partner with analytics and project teams to ensure data governance and data integrity standards are followed • Support the development of reports, dashboards, and data visualizations to communicate key findings

• Design and lead analytics for quality improvement, research, and care management projects • Develop and maintain dashboards, reports, and ad hoc analyses • Serve as a subject matter expert on healthcare data interpretation and use • Apply advanced statistical methods and programming solutions • Standardize analytic and reporting processes and documentation • Translate complex data into clear insights for leadership and stakeholders • Mentor and provide guidance to less-experienced analysts • Partner with IT and data governance teams to ensure data integrity and compliance

• Conduct prospective, concurrent, and retrospective utilization management reviews • Apply clinical review criteria, organizational policies, guidelines, and screening tools (InterQual) • Consult with physician/practitioner consultants when services do not meet medical necessity criteria • Collaborate with internal teams and refer cases for additional review or escalation as appropriate • Respond to provider, customer, and stakeholder questions regarding determinations and processes

• Lead and mentor a team of clinical reviewers, providing training, performance feedback, and professional development opportunities. • Conduct and oversee detailed clinical reviews of medical records, claims, and related documentation to ensure accuracy and compliance with established guidelines. • Collaborate with healthcare providers, auditors, and internal departments to resolve discrepancies and improve review processes. • Develop, update, and implement clinical review protocols and quality assurance measures to maintain regulatory compliance and enhance review effectiveness. • Analyze clinical data and review outcomes to identify trends, recommend improvements, and support strategic decision-making.

• Assess the medical necessity and quality of healthcare services through prospective, concurrent, and retrospective utilization management reviews • Apply Alabama Medicaid program criteria and guidelines to determine medical necessity • Complete reviews within timelines established by all applicable state and federal requirements • Consult and forward cases for which a medical necessity determination cannot be rendered • Identify customer needs and expectations and respond to them in a timely and effective manner • Attend Medicaid meetings, fair hearings, and legislative committee meetings as required