COPE Health Solutions

The Director, Customer Success and Technical Solutions plays a pivotal role in bridging technical expertise and customer-facing outcomes. This position focuses on empowering the sales team with compelling demonstrations and use case presentations while ensuring newly signed clients achieve their goals during implementation. Collaborating closely with key stakeholders across engineering, product, finance, and clinical leadership, this role ensures the SaaS platform evolves to meet customer needs and supports organizational growth. FLSA Status Exempt Salary Range $172,100 - $218,200 Reports To Vice President, Customer Success and Technical Solutions Direct Reports None Location Los Angeles, or remote with travel Travel Up to 60%, depending on location Work Type Regular Schedule Full Time Key Responsibilities - Support the sales team in preparing and delivering demos, tailoring pitches to showcase platform strengths while demonstrating value through ROI-focused examples - Identify key use case for priority client types that define how our team powered by ARC solves for the use case through workflows, slides, and other content - Support client relationships to ensure adoption, retention, and expansion, including training on platforms and resolving integration challenges. - Lead quarterly client user groups to enhance collaboration between clients to build stronger engagement - Provide hands-on technical guidance, such as designing workflows for data aggregation, analytics tools, and tech capabilities to support clinical and financial goals - Act as a strategic advisor for clients, troubleshooting data integrations and architecting solutions to enhance value-based care outcomes - Monitor industry trends in healthcare tech to ensure success, engineering, product, and sales teams. - Develop and articulate strategic recommendations aligned with client goals related to quality performance, cost management, and financial sustainability. - Partner with analytics, finance, clinical and actuarial resources to assess cost drivers, risk adjustment performance, and quality outcomes. - Build and manage strong executive-level relationships with client leadership, serving as a trusted advisor throughout the engagement lifecycle. - Contribute to thought leadership through development of articles, case studies, sales materials, internal curricula, and client-facing content. - Support the professional development and growth of direct reports and team members in line with the values and culture of the organization; serve as a leader/mentor to generate a vision, establish direction, motivate team members, create an atmosphere of trust Qualifications: - Master’s degree in an applicable field preferred (e.g., MBA, MPH, MHA, MPA) - At least 8 years of health care analytics and/or consulting experience of progressively advanced reports, data management and visualization experience. - Knowledge of technology needs for Health plans, MSSP/ACO REACH, CA RKK and delegated IPAs - Proven experience in SaaS platform engineering, development, or technical leadership, with a strong understanding of software architecture and delivery. - Exceptional communication and presentation skills, with the ability to distill complex technical concepts for non-technical audiences, including sales teams and clients. - Experience collaborating with cross-functional teams, including sales, engineering, product, finance, and clinical stakeholders. - Prior experience in: - Population health management reporting and analytics - Health information technology - Health care policy with experience in CMS, Medicare, and Medicaid contracts - Healthcare claims data and clinical data integration (EMR, HIE, etc.) - Strong project management skills, including organization, prioritization, and problem-solving skills; strong oral, verbal and interpersonal communication skills. Ability to take direction and feedback from both internal and external stakeholders. - Ability to work effectively on multiple projects in a fast-paced environment Benefits: As a firm passionate about health care, we’re deeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities and a paid parental leave program. You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/why-cope-health-solutions/. About COPE Health Solutions COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers, health plans and self-insured employers. For more information, visit CopeHealthSolutions.com. To Apply: To apply for this position or for more information about COPE Health Solutions, visit us at https://copehealthsolutions.com/careers/open-positions/.

This role focuses on educating members about care gaps, assisting with appointment scheduling, supporting medical record retrieval, and providing operational support to the HEDIS Lead and Quality Improvement Manager. The Coordinator plays a key role in improving clinical outcomes, documentation completeness, and member engagement for the Medicare Advantage population. FLSA Status Non-Exempt Salary Range $17.75 Reports To Medical Director of Medical Management Direct Reports No Location Remote Travel None Work Type Regular Schedule Full Time Key Responsibilities Member Outreach & Care‑Gap Education - Conduct outbound calls to members to educate them on open care gaps (e.g., screenings, chronic condition monitoring, immunizations). - Assist members with scheduling preventive and follow‑up appointments with their primary care provider or specialist. - Provide reminders, instructions, and follow‑up support to ensure members complete recommended services. - Document all outreach attempts, outcomes, and barriers in the appropriate systems. Provider Outreach & Chart Retrieval Support - Contact provider offices to request medical records needed for HEDIS hybrid measures. - Coordinate chart retrieval logistics, including fax requests, EMR access, secure email, and vendor retrieval scheduling. - Track provider responses, escalate non‑responsive offices, and ensure timely completion of retrieval tasks. - Maintain organized logs of outreach attempts, record status, and documentation received. HEDIS Season Operations - Support the HEDIS Lead with chase list management, outreach prioritization, and data entry. - Assist with basic chart review tasks such as confirming documentation presence, verifying dates of service, or flagging incomplete records (non‑clinical abstraction). - Monitor daily progress toward retrieval and outreach targets and report barriers or delays. Member Experience & Engagement - Provide clear, empathetic communication to members regarding preventive care, chronic condition management, and the importance of screenings. - Identify and document member‑reported barriers to care (transportation, access issues, appointment availability) and escalate as appropriate. - Support CAHPS‑related initiatives through member education and service navigation. Operational Support - Maintain accurate, audit‑ready documentation of all outreach activities, provider interactions, and record retrieval efforts. - Assist with preparing materials for Stars workgroups, HEDIS meetings, and quality committees. - Support the development of outreach scripts, workflows, and process improvements. Cross‑Functional Collaboration - Work closely with the HEDIS Lead, Quality Improvement Specialist, Care Management, Provider Relations, and vendor partners. - Communicate provider issues, member barriers, and operational challenges to the HEDIS Lead for resolution. - Participate in training sessions, huddles, and performance review meetings during HEDIS season. Qualifications Required - High school diploma or equivalent; associate degree preferred. - 1–2 years of experience in healthcare, customer service, call center operations, or medical office support. - Strong communication skills and comfort speaking with members and provider staff. - Basic understanding of preventive care, chronic conditions, and healthcare terminology. - Proficiency with Microsoft Excel and ability to learn new systems quickly. - Strong organizational skills and attention to detail. Preferred - Experience in managed care, Medicare Advantage, or HEDIS operations. - Prior experience with member outreach, appointment scheduling, or medical record retrieval. - Familiarity with EMRs, chart retrieval platforms, or care‑gap reporting tools. - Bilingual skills (Spanish, Mandarin, etc.) helpful but not required. Competencies - Clear and empathetic communication - Persistence and follow‑through - Strong documentation discipline - Ability to manage high‑volume outreach - Comfort navigating provider offices and workflows - Team‑oriented and adaptable - Detail‑focused and process‑driven Benefits: As a firm passionate about health care, we’re deeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities and a paid parental leave program. You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/why-cope-health-solutions/. About COPE Health Solutions COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers, health plans and self-insured employers. For more information, visit CopeHealthSolutions.com. To Apply: To apply for this position or for more information about COPE Health Solutions, visit us at https://copehealthsolutions.com/careers/open-positions/.

The Care Manager (CM) RN will lead a multidisciplinary healthcare team in a primary care / telephonic setting, focusing on coaching and coordination of care for patients needing navigation, addressing nursing care needs and follow up after clinical events. The CM RN will identify the needs of patients at risk and assist the providers to develop processes for managing the patient’s preventative care, transitions of care, and or chronic disease management using defined protocols as well as their own sound clinical judgement. This person will promote patient-centered care, working with primary care providers and medical home team members. The CM RN is a key role in the care coordination of patients attributed to value based contracts. FLSA Status Exempt Salary Range $80,000-110,000 Reports To Medical Management Director Direct Reports Yes Location Remote Travel Up to 10% Work Type Regular Schedule Full Time Position Description: The Care Manager (CM) RN will lead a multidisciplinary healthcare team in a primary care / telephonic setting, focusing on coaching and coordination of care for patients needing navigation, addressing nursing care needs and follow up after clinical events. The CM RN will identify the needs of patients at risk and assist the providers to develop processes for managing the patient’s preventative care, transitions of care, and or chronic disease management using defined protocols as well as their own sound clinical judgement. This person will promote patient-centered care, working with primary care providers and medical home team members. The CM RN is a key role in the care coordination of patients attributed to value based contracts. Duties and Responsibilities (including but not limited to) - Evaluates patients for care management services, determines appropriate level of care coordination management for the patient - Complete a comprehensive assessment to identify patient risk and develop a care plan utilizing clinical expertise and judgement to evaluate needs for alternative services as needed - Work collaboratively with physicians and in-house resources including pharmacists, registered dieticians, social workers and other disciplines to create a person-centered care plan with measurable SMART goals - Monitor and update care plan to include progress towards achieving established goals and self-management activities - Interact with patient, family and providers and multidisciplinary care team to assess the options of care including use of benefits ad community resources to update care plan. Utilize developed systems, processes, and initiatives to engage patients in relevant case management activities necessary to promote wellness and care at the right place and time. - Work collaboratively with physicians and in-house resources including pharmacists, registered dieticians, social workers and other disciplines to support patient adherence to medical plan of care. - Supervise and act as a resource for non-clinical staff [i.e. care coordinators, social workers]. - Verify that appropriate home care, hospice care, and other ancillary services (DME, infusion services etc.) are in place and are being delivered as directed by the care team - Coordinate necessary referrals and authorizations within care management areas - Facilitate the information flow between hospital, long-term care, specialists and home health representatives and the care team - Use available data and work with physician and office staff to help identify high risk, high need, and potentially high-cost patients - Coordinate care and communicate with multiple providers, internal and external to the practice. - Identify and utilize cultural and community resources and align with the patient’s cultural preferences as much as possible - Verify that members are screened for behavioral health concerns (depression / substance abuse) and are receiving appropriate screening and behavioral health interventions. - Facilitate any necessary follow-up behavioral health needs with local behavioral health providers. - Attend required training and collaboration sessions [i.e., learning sessions, care management meetings, and practice team meetings] as scheduled. - Provide and facilitate open communication, regarding patient status, with physicians and office staff. - Obtain records from other physicians/labs/diagnostic centers as requested by the physicians and as needed for care coordination efforts. - Develop constructive relationships with internal population health team members, participating providers, and community resources. - Other job-related duties as assigned Qualifications or Education, Training and Experience - Compact RN License – California and NY Licensure preferred in addition - Bachelor’s degree in nursing preferred; Associate degree in nursing is minimum requirement. - 1-2 years’ experience in acute inpatient, rehabilitation, sub-acute, skilled facility, home care, ambulatory care management, or managed health plan. - Preferred: Certified Case Management (CCM) certification - Preferred: Care/Case Management experience Working knowledge of the following required: - Principles of utilization management; care management principles; basic knowledge of health plan contracts and benefit eligibility requirements; Hospital structures, Managed Care and payment systems - Timely and accurate documentation of day-to-day activities in designated technology platform - Adaptable to new technologies and software - Proficiency in EMR system(s), Outlook and data entry experience preferred - Basic PC skills (MS Word/Outlook/PPT/Excel) Examples of Competencies: - Ability to use independent judgment and to manage and impart confidential information. - Ability to analyze and solve problems; requires details, data and facts that must be analyzed and challenged prior to making decisions. - Strong communication and interpersonal skills. - Ability to clearly communicate medical information to professional practitioners and/or the public. - Excellent organization, prioritization, follow up, analytical and time management skills with ability to handle multiple priorities and deadlines. - Good interpersonal skills, sense of urgency, being proactive and ownership for one’s work. - Dependable, with strong work ethic and extremely high degree personal integrity. - Ability to deal with multiple interruptions on a continual basis that must be met with a friendly exchange with others. - Ability to develop and implement new approaches to improve processes, procedures, or the general work environment. - Ability to review critical issues, effectively solve problems and create action plans. Benefits: As a firm passionate about health care, we’re deeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities and a paid parental leave program. You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/why-cope-health-solutions/. About COPE Health Solutions COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers, health plans and self-insured employers. For more information, visit CopeHealthSolutions.com. To Apply: To apply for this position or for more information about COPE Health Solutions, visit us at

This role focuses on educating members about care gaps, assisting with appointment scheduling, supporting medical record retrieval, and providing operational support to the HEDIS Lead and Quality Improvement Manager. The Coordinator plays a key role in improving clinical outcomes, documentation completeness, and member engagement for the Medicare Advantage population. FLSA Status Non-Exempt Salary Range $25.00 Reports To Medical Director of Medical Management Direct Reports No Location Remote Travel None Work Type Regular Schedule Full Time Key Responsibilities Member Outreach & Care‑Gap Education - Conduct outbound calls to members to educate them on open care gaps (e.g., screenings, chronic condition monitoring, immunizations). - Assist members with scheduling preventive and follow‑up appointments with their primary care provider or specialist. - Provide reminders, instructions, and follow‑up support to ensure members complete recommended services. - Document all outreach attempts, outcomes, and barriers in the appropriate systems. Provider Outreach & Chart Retrieval Support - Contact provider offices to request medical records needed for HEDIS hybrid measures. - Coordinate chart retrieval logistics, including fax requests, EMR access, secure email, and vendor retrieval scheduling. - Track provider responses, escalate non‑responsive offices, and ensure timely completion of retrieval tasks. - Maintain organized logs of outreach attempts, record status, and documentation received. HEDIS Season Operations - Support the HEDIS Lead with chase list management, outreach prioritization, and data entry. - Assist with basic chart review tasks such as confirming documentation presence, verifying dates of service, or flagging incomplete records (non‑clinical abstraction). - Monitor daily progress toward retrieval and outreach targets and report barriers or delays. Member Experience & Engagement - Provide clear, empathetic communication to members regarding preventive care, chronic condition management, and the importance of screenings. - Identify and document member‑reported barriers to care (transportation, access issues, appointment availability) and escalate as appropriate. - Support CAHPS‑related initiatives through member education and service navigation. Operational Support - Maintain accurate, audit‑ready documentation of all outreach activities, provider interactions, and record retrieval efforts. - Assist with preparing materials for Stars workgroups, HEDIS meetings, and quality committees. - Support the development of outreach scripts, workflows, and process improvements. Cross‑Functional Collaboration - Work closely with the HEDIS Lead, Quality Improvement Specialist, Care Management, Provider Relations, and vendor partners. - Communicate provider issues, member barriers, and operational challenges to the HEDIS Lead for resolution. - Participate in training sessions, huddles, and performance review meetings during HEDIS season. Qualifications Required - High school diploma or equivalent; associate degree preferred. - 1–2 years of experience in healthcare, customer service, call center operations, or medical office support. - Strong communication skills and comfort speaking with members and provider staff. - Basic understanding of preventive care, chronic conditions, and healthcare terminology. - Proficiency with Microsoft Excel and ability to learn new systems quickly. - Strong organizational skills and attention to detail. Preferred - Experience in managed care, Medicare Advantage, or HEDIS operations. - Prior experience with member outreach, appointment scheduling, or medical record retrieval. - Familiarity with EMRs, chart retrieval platforms, or care‑gap reporting tools. - Bilingual skills (Spanish, Mandarin, etc.) helpful but not required. Competencies - Clear and empathetic communication - Persistence and follow‑through - Strong documentation discipline - Ability to manage high‑volume outreach - Comfort navigating provider offices and workflows - Team‑oriented and adaptable - Detail‑focused and process‑driven Benefits: As a firm passionate about health care, we’re deeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities and a paid parental leave program. You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/why-cope-health-solutions/. About COPE Health Solutions COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers, health plans and self-insured employers. For more information, visit CopeHealthSolutions.com. To Apply: To apply for this position or for more information about COPE Health Solutions, visit us at https://copehealthsolutions.com/careers/open-positions/.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This role will be working with a cross-functional team in a centralized firm role, supporting multiple accounts, and is responsible for working closely across firm and client leadership to meet the finance, analytics, and population health needs of our clients. - Generate quantitative analyses and financial models using available data and industry knowledge-based assumptions to provide forecasts of future Medical Loss Ratio, Out-of-Network utilization, RAF scores, premium revenue, membership growth, etc. - Subject matter expert on MSSP and ACO Lead to support financial modeling and strategic decisions for ACO clients. - Build or configure financial models, financial statements, budgets, and analytical reports based on client and team specifications. - Support analytics and finance functions for CHS IPA/RKK and ACO such as required financial filings with California DMHC and CMS. - Collaborate with and help develop a team of consultants to execute client engagements related to healthcare finance and ensure that deliverables are prioritized appropriately, complete, and accurate. - Deliver effective decision-making support by analyzing complex financial information, forecasting business trends, industry and economic conditions, and presenting implications and proposed solutions to clients and company leadership. - Provide support to client’s payer and provider contracting strategies and support in contract negotiations. - Manage validation and documentation processes for team’s work outputs to ensure reliability of models, replicable results, and efficiency of the production process. - Lead the implementation of use cases and models to project and test key client needs with respect to population health and financial modeling. - Collaborate with in-house analytics and financial modeling teams to inform further development of existing product tools and/or offerings. - Manage client deliverable from scope development to output generation, with responsibility of informing the firm’s leadership of issues affecting timeline and outputs. Qualifications - Bachelor’s degree with a quantitative, business finance or technical focus required, Master of Business Administration preferred. - Minimum 10 years of professional experience performing financial planning, analytics, and modeling at a health plan, health system/provider group in a client services capacity. - Experience with CA risk models and the CA risk environment. - Minimum 5 years of health plan finance, FP&A, or analytics experience. - Actuarial experience a plus. - Experience with medical and pharmaceutical claims, member eligibility and other payor reporting items. - Awareness of population health analytics and health care data (e.g., CPT/HCPS, ICD9/ICD10, revenue codes, DRGs, risk scores), Medicare and Medicaid value-based care arrangements and dual-risk and capitation models preferred. - Proficiency in SQL, analytical tools, and data visualization and business intelligence platforms (e.g., Tableau, PowerBI). - Ability to create advanced analytical models and visualizations. - Familiarity with SAS/STAT software is a plus. - Knowledge of predictive modeling and ability to communicate its complexity to end users/clients. - Understanding of Medicare, Medicaid and/or Commercial health plan and payment methodologies (e.g., APC, RVU, PPS). - Experience with Medicare Advantage Bid Development preferred. - An ability to effectively manage and communicate with technical contributors and business colleagues to translate business requirements to technical specifications. - Ability to facilitate strategic discussions and presentations around areas of expertise with diverse stakeholders (executives, physicians, and analysts) regarding data management, population health analytics and infrastructure. - Flexibility to work evenings and weekends as needed. - An ability to travel up to 25% at times consistent with firm policies and client preferences. Benefits - Comprehensive, affordable insurance plans for team members and their families. - Yearly stipend for wellness-related activities. - Paid parental leave program. Company Description COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers, health plans and self-insured employers. To Apply To apply for this position or for more information about COPE Health Solutions, visit us at COPE Health Solutions Careers .

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Authorization Coordinator works under general supervision and plays a key role in maintaining efficient UM operations, ensuring regulatory compliance, and supporting high-quality member service. Key Responsibilities - Creates and modifies authorizations and/or orders for new and existing Members in an accurate and timely manner. - Researches, troubleshoots, resolves authorization and/or order processing issues and discrepancies. - Completes activities, including but not limited to, inbound/outbound calls, as assigned, faxes, and emails. - Obtains information from internal and external sources. Processes or triages the request via our medical management information system or external sources. - Coordinates with Providers and Members regarding authorization requests and/or activities. - Communicates with Care Management, Member Services, Membership and Eligibility, and other internal departments regarding Member services, authorization requests, and issues. - Reviews all authorization requests for accuracy and prioritizes based on urgency. - Documents communication, actions taken, and barriers in the Medical Management System as it pertains to the Members Care or request for services. - Utilizes internal and external systems to verify eligibility and Provider Information such as name, address, fax number, NPI, and TAX ID. - Conducts follow-up, as necessary, to ensure member satisfaction and successful delivery of service. - Protects the confidentiality of member information and adheres to company policies regarding confidentiality. - Participates in special projects and performs other duties as required. Core Competencies - Attention to detail and accuracy. - Customer and provider service orientation. - Ability to work in a fast-paced, high-volume environment. - Critical thinking and problem-solving skills. - Collaboration and cross-functional teamwork. - Time management and prioritization. - Adaptability and continuous improvement mindset. Qualifications - 2–3 years of experience in healthcare customer service, authorization processing, or utilization management. - Experience working in a Managed Care or Health Plan environment. - Familiarity with prior authorization workflows. - Strong written and verbal communication skills. - Prior experience in Utilization Management intake or prior authorization within a health plan. Benefits - Comprehensive, affordable insurance plans for team members and their families. - Yearly stipend for wellness-related activities. - Paid parental leave program. Company Description COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. For more information, visit COPE Health Solutions . To Apply To apply for this position or for more information about COPE Health Solutions, visit us at COPE Health Solutions Careers .