Village Care

Role Description Join VillageCare as a Full-Time Medicare Risk Adjustment Coding Manager and enjoy the thrill of playing a vital role in healthcare's future while working from the comfort of your home. This position offers unparalleled flexibility, allowing you to balance personal and professional commitments seamlessly. The Risk Adjustment Coding Manager at VillageCare plays a crucial role in enhancing healthcare quality and operational efficiency. This position is responsible for: - Coordinating Risk Adjustment and Quality coding operations. - Emphasizing documentation integrity across both areas. - Overseeing retrospective and prospective chart review programs. - Supervising the Risk Adjustment coding staff. - Managing day-to-day vendor operations. - Acting as the operational bridge between Risk Adjustment and the HEDIS/Quality abstraction team. - Ensuring effective utilization of all medical record interactions for Hierarchical Condition Category (HCC) accuracy and closing quality gaps. This role aims to achieve year-over-year improvements in: - Risk Adjustment accuracy. - Risk Adjustment Factor (RAF) performance. - STARs quality measure outcomes, directly impacting patient care and organizational success. Qualifications - CPC, CPMA, CRC, CCS-P, CCS, RHIA, or RHIT certification. - 5+ years of Medicare Risk Adjustment coding experience, including work on RADV audits. - Experience with HEDIS measure specifications and quality gap closure operations preferred. - Strong knowledge of ICD-10 and CPT codes. - Previous experience using electronic medical record systems. - Excellent communication skills to facilitate collaboration within the department and with cross-functional teams. - Bachelor's degree in Business Administration, Finance, or a relevant field, or equivalent work experience required. Requirements - Robust set of skills and qualifications as outlined in the qualifications section. Benefits - Compensation ranges from $102,549.17 to $115,367.82 annually.

Role Description Join VillageCare as the Manager of Broker Sales Operations and embrace an exciting opportunity to shape the healthcare landscape from the comfort of your home. This pivotal role allows you to leverage your problem-solving skills and customer-centric mindset while engaging with a dynamic team committed to excellence. Experience the thrill of driving sales operations in a flexible, high-performance environment that values integrity and innovation. Your contributions will directly impact our service delivery in New York, NY, and beyond. The Broker Manager - Sales Operations at VillageCare is vital in upholding the operational integrity and efficiency of our broker sales infrastructure. This role encompasses comprehensive responsibilities, including: - Broker onboarding - System configuration - Enrollment tracking - Payment alignment - Overseeing operational platforms with external vendors like Convey and Connecture By effectively identifying and resolving system errors that could affect broker readiness, enrollment processing, and compensation accuracy, this position strengthens operational cohesion. Ultimately, the role ensures that brokers operate efficiently, members gain timely access to benefits, and compensation remains accurate, promoting sustainable growth within our organization. Qualifications - Expertise in operational platforms such as Convey and Salesforce - Deep understanding of broker system setup and readiness-to-sell oversight - Strong analytical and problem-solving abilities - At least five years of experience in broker or sales operations, with a focus on healthcare insurance operations - Knowledge of broker compensation structures - Excellent organizational skills - Familiarity with Medicare Advantage and related healthcare products preferred Requirements - Broker System Setup & Readiness-to-Sell Oversight - Convey Platform Oversight & System Integrity - Enrollment Processing & Connecture Application Oversight - Broker Payment Oversight & Compensation Alignment - Operational Process Management & Accountability - Broker Operational Support & Issue Resolution - Cross-Functional Collaboration - Operational Risk Management & Continuous Improvement Experience - Bachelor's degree preferred (Business Healthcare Administration or related field) - 5+ years of experience in broker operations, sales operations or healthcare insurance operations - Strong experience working with broker operational systems including Convey, Connecture, and Salesforce - Experience supporting broker onboarding readiness-to-sell processes and enrollment operations - Strong understanding of broker compensation structures and payment workflows - Experience identifying and resolving system and operational issues - Knowledge of Medicare Advantage, MAP, MLTC and related healthcare products preferred - Strong organizational, analytical and operational problem-solving skills - Ability to manage multiple systems workflows and operational priorities Join our team today! If you have these qualities and meet the basic job requirements, we'd love to have you on our team. Apply now using our online application!

Role Description Join VillageCare as a Full Time Risk Adjustment Coder and embrace the opportunity to work remotely while making a significant impact in the Health Care sector. This role offers the flexibility of a work-from-home environment, allowing you to balance your professional and personal commitments without the daily commute. You'll be part of a dynamic team that thrives on innovation, problem-solving, and a customer-centric approach, all while contributing to the excellence and integrity that VillageCare stands for. Your responsibilities will include: - Performing critical code abstraction of medical records, ensuring accurate assignment of ICD-9-CM, ICD-10-CM, CPT, and HCPCS codes supported by clinical documentation. - Conducting comprehensive reviews of medical records to validate that documentation meets CMS requirements, including provider signatures and relevant dates. - Identifying improvement opportunities in documentation and coding processes. - Participating in quality initiatives that enhance overall outcomes. - Maintaining current knowledge of coding standards and regulations. - Supporting the Medicare Risk Adjustment team in educating providers on compliance and consistency. - Reporting findings from audits and assisting in analysis. - Maintaining a minimum accuracy of 95% on coding quality audits while meeting productivity requirements. Qualifications - Strong knowledge of clinical terminology, disease processes, anatomy/physiology, and pharmacology. - 5 recent years of HCC/Risk Adjustment and/or inpatient coding experience. - Certified through AAPC or AHIMA (CPC, CRC, RHIT, or RHIA). - Must reside in NY, NJ, or CT. Requirements - Exceptional attention to detail. - Basic computer skills. - Ability to maintain a productive home office environment with high-speed internet. - Strong knowledge of claims processing procedures and systems. - Understanding of state, federal, and Medicare regulations and Coordination of Benefits applications. - Strong problem-solving skills and a commitment to coding excellence. Benefits - PTO package. - 10 Paid Holidays. - Personal and Sick time. - Medical/Dental/Vision. - HRA/FSA. - Education Reimbursement. - Retirement Savings 403(b). - Life and Disability. - Commuter Benefits. - Paid Family Leave. - Additional Employee Discounts. Company Description VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health, and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.

Role Description Join VillageCare as a Full Time UAS RN Reviewer and elevate your nursing career in an innovative, fully remote environment! This role offers the chance to apply your expertise in a customer-focused healthcare setting while being a crucial part of a dynamic, forward-thinking team. With a competitive salary ranging from $87,647.11 to $98,603.00, you'll find the satisfaction of enhancing patient care from the comfort of your own home. Embrace the flexibility of a remote position that fosters high performance and integrity in everything we do. Bring your problem-solving skills and commitment to excellence to a role that truly makes a difference in people's lives. Must reside within the New York Tri-State Area - NY, NJ, or CT. As a new UAS RN Reviewer at VillageCare, your day-to-day responsibilities will include: - Performing Quality Assurance reviews completed by the Nurse Assessors - Reviewing completed UAS-NY for accuracy, completeness and timeliness of finalization - Reviewing all documentation for appropriateness of care and consistency of documentation - Review of all responses and comments in community, functional and mental health assessments for consistency - Utilizing QAS reports to maintain knowledge of current trends related to quality measures and risk score - Reviewing proposed plan of care/ATSP to ensure that it reflects the clinical and psychosocial needs of the member - Communicating with the Nurse Assessor for requested revisions and clarification in order to finalize assessment - Following up to ensure timely completion of assignments and submission of original paperwork to the office - Providing guidance and training to the Nurse Assessors related to accurate completion of the UAS-NY - Monitoring finalization of UAS-NY in order to ensure adherence with State policy - Collaborating with Care Management in order to ensure plan of care is in alignment with the needs of the member Expect to work Monday through Friday from 9 AM to 5 PM, allowing for a structured schedule that promotes a healthy work-life balance. You will collaborate with a high-performing team, participating in regular meetings to discuss cases and share best practices, all within a flexible and professional virtual environment. Qualifications - Strong analytical abilities for performing quality assurance reviews - Attention to detail for reviewing community, functional, and mental health assessments - Proficiency in essential software and tools, including the QCSS Assessment Analyzer - Effective communication skills for collaborating with Nurse Assessors Requirements - Must reside within the New York Tri-State Area - NY, NJ, or CT Benefits - Generous PTO package - 10 Paid Holidays - Personal and Sick time - Medical/Dental/Vision - HRA/FSA - Education Reimbursement - Retirement Savings 403(b) - Life & Disability - Commuter Benefits - Paid Family Leave - Additional Employee Discounts Company Description VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.

RN - Care Manager *Fully Remote* Must reside within the New York Tri-State Area - NY, NJ, or CT. Join our team at Village Care as a Full Time RN- Care Manager! This exciting position offers the opportunity to work remotely, providing care and support to our members in the greater NYC area. As an integral part of our team, you will have the chance to showcase your nursing expertise while managing the care needs of our diverse patient population. With a competitive salary ranging from $95,000 to $105,000, this role provides a rewarding opportunity to make a real difference in the lives of others. Don't miss out on this chance to be part of a dynamic and customer-centric organization that values excellence and integrity. As a team member you'll be able to enjoy benefits such as a generous PTO package, 10 Paid Holidays, Personal and Sick time, Medical/Dental/Vision, HRA/FSA, Education Reimbursement, Retirement Savings 403(b), Life and Disability, Commuter Benefits, Paid Family Leave, and Additional Employee Discounts. Apply now and take the next step in your nursing career! Must reside within the New York Tri-State Area - NY, NJ, or CT. What does a Care Manager do? As a Care Manager at Village Care, you will play a crucial role in all aspects of care management, including care planning, coordination, and health assessments. Monitoring the quality and effectiveness of services, you will track progress towards individual goals and ensure the highest level of care for our patients. Your responsibilities will also involve overseeing transitions for patients, facilitating smooth discharge planning from hospitals or nursing homes. By identifying health, environmental, and psychosocial risks, you will recommend and implement interventions in collaboration with the Interdisciplinary Care team. This position offers a dynamic opportunity to make a significant impact on the well-being of our diverse patient population while working remotely in a customer-centric environment. What you need to be successful To excel in the role of Care Manager at Village Care, candidates must possess a valid NYS RN License and a minimum of 3 years of relevant experience in Managed Care, Home Care, or Community settings. An Associate's degree or higher is required for this position. Successful applicants will demonstrate a passionate attitude, exceptional communication skills, and strong problem-solving abilities. Bilingual proficiency is essential, with a particular focus on languages such as Korean, Bengali, Cantonese, Mandarin, Spanish, Russian, or Creole. The ability to effectively navigate and utilize various software and tools relevant to care management is a key requirement for this role. If you meet these qualifications and are ready to contribute to a forward-thinking and customer-focused healthcare organization, we encourage you to apply. Your next step If you think this job is a fit for what you are looking for, great! We're excited to meet you! VillageCare is an Equal Opportunity Employer.

Position:Care Coordinator Supervisor Location: Remote (Must reside within the New York Tri-State Area - NY, NJ, or CT) Schedule: Monday - Friday 9am-5pm Compensation: $58,039 - $65,294 Introduction: VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a number of Medicaid and Medicare managed care plans, and through our Assisted Living Program. VillageCare has delivered quality health care and social services to individuals residing within New York City for over 45 years. Our service area now includes all five boroughs of NYC, as well as Westchester, Nassau, and Putnam counties. Job Summary: The Care Coordinator Supervisor is responsible for the day-to-day oversight and supervision of the Care Coordinator team within the Care Management department. This role is accountable for ensuring Care Coordinators deliver exceptional customer service, timely follow-up, and seamless support to Care Managers, members, and providers. The Care Coordinator Supervisor will lead the team in meeting performance goals and promote a culture of service excellence by fostering accountability, engagement, and collaboration, while ensuring compliance with organizational standards and regulatory requirements. Experience: - Minimum of 2 years of supervisory experience in healthcare - Demonstrated proficiency in Windows and Microsoft Office Suite - Experience with care management EMR platforms required - Bilingual is preferred - Education and certification: Associate degree is required; bachelor's degree is preferred Are you ready for an exciting opportunity? So, what do you think? If you can meet these requirements and perform this job as described above, we would be happy to have you as part of our team! VillageCare is an Equal Opportunity Employer.

Senior Financial Data Analyst - Healthcare Salary: $87,647.11 - $98, 603.00 Must reside in NY, NJ or CT Join VillageCare as a Full-Time Senior Financial Data Analyst in the dynamic healthcare sector and play a pivotal role in shaping the financial strategies that impact our community. This position offers work-from-home flexibility, allowing you to balance your professional responsibilities with your personal life while contributing to meaningful healthcare solutions. Based in New York, NY, you will be part of a dedicated team that values excellence and customer-centricity in its mission to provide outstanding healthcare services. Your analytical expertise will drive decision-making in an energetic and forward-thinking environment. With a competitive salary range of $87,647.11 to $98,603.00, this opportunity not only offers rewarding challenges but also financial recognition for your skills and contributions. Take the chance to apply and further your career in a company that embraces innovation and integrity. VillageCare: Our Story VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years. Make a difference as a Senior Financial Data Analyst - Healthcare As a Senior Financial Data Analyst at VillageCare, you will play a crucial role in developing, documenting, and maintaining reports and analytics that empower leadership with key insights to drive financial success. You will ensure the accuracy and timeliness of routine and ad hoc reports, collaborating closely with both internal and external customers to guarantee successful report roll-ups and high customer satisfaction. Utilizing advanced tools such as SQL, Tableau, and RedShift, you will create customized dashboards for the Finance department, while working with the IT team to automate these reports for efficient metric monitoring. Your responsibilities will also include supporting the monthly close process, conducting claim reserve analysis, and creating member economics reports to aid strategic decision-making. Additionally, you will lead medical claims reinsurance reporting, support the preparation of provider group financial statements, and ensure compliance with regulatory reporting requirements, all while demonstrating VillageCare's commitment to Service Excellence. Does this sound like you? To excel as a Senior Financial Data Analyst at VillageCare, you will need a robust skill set and a solid professional background. A minimum of five years of relevant experience, particularly in an actuarial role focused on claims reserves, claims triangles, and IBNR estimation, is essential. Your ability to conduct complex data analyses and develop insightful reports and dashboards in a healthcare environment will be crucial. Proficiency in technical tools such as MS Excel, SQL, Tableau, Access, and Python is required, enabling you to manipulate and present data effectively. Additionally, the capacity to multi-task while maintaining a high level of attention to detail is vital for success in this role. Strong communication skills, both verbal and written, along with robust presentation capabilities, will enhance collaboration with internal and external stakeholders. A Bachelor's degree in Healthcare, Finance, or a related field is required, or equivalent years of experience, to support your analytical and problem-solving abilities in a fast-paced setting. Knowledge and skills required for the position are: - Minimum 5 years of relevant professional work experience  - Experience working in an actuarial function with a focus on building the claims reserve updating claims triangles and IBNR estimation  - Ability to perform complex data analysis and report/dashboard development in a health care setting   - Excellent technical skills (MS Excel, SQL, Tableau, Access, Python, etc.)  - Capacity to multi-task at high detail-oriented level  - Strong communication skills (verbal, written, presentation, interpersonal)  - Strong analytical and logical skills paired with strong attention to detail  - Bachelor's degree in Healthcare, Finance or relevant field or equivalent years of experience required.  Make your move If you think this role will suit your needs, great! Applying is a piece of cake. Good luck - we're excited to meet you!

Supervisor of Utilization Management - Concurrent Review VillageCareMAX 112 Charles Street, New York, NY 10014 **MUST LIVE IN NJ/NY/CT** VillageCare is looking for a motivated RN for our Supervisor of Utilization Management - Concurrent Review opening. This role is responsible for the oversight of concurrent review and discharge planning process for members with inpatient and skilled nursing facility stays. Training, mentoring, and monitoring work process and output will be essential to this role. Some daily responsibilities will include: - Supervise staff to ensure concurrent and post reviews for inpatient acute care, skilled and long-term care facilities are completed in a timely manner. - Reconcile inpatient and SNF census daily, addressing any discrepancies. - Ensure daily assignments are completed at the close of the day. - Facilitate inpatient and discharge planning rounds on a weekly basis. - Ensure that Interqual Guidelines or other criteria adopted by the VCMAX are appropriately applied to inpatient reviews. - Review complex cases and authorizations of services with Medical Director. - In collaboration with the medical management team develop and implement projects, systems, programs, policies, and procedures. - Assist UM and Care Management Team to prepare for audits and other regulatory activities - Conducts orientation and training related to Concurrent Review Unit functions for all VCMAX staff, including the development and maintenance of training materials, in conjunction with the Training and Development team. We would like to speak to those who have a current and unrestricted New York State RN license. Bachelor's degree in Nursing required, advanced degree preferred. 2 years of utilization review experience at a Managed Care Organization or Health Plan required. Supervisory experience required. Knowledge of Medicaid and/or Medicare regulations along with ability to apply Interqual Care Guidelines will be essential to this role. URAC/CCM certifications preferred. There are many benefits to working for VillageCare. If you are someone who likes being part of a team, enjoys a highly competitive benefits package from world leading carriers and competitive compensation, than we would love to speak with you! - PTO package, 10 Paid Holidays, Personal and Sick time, Medical/Dental/Vision, HRA/FSA, Education Reimbursement, Retirement Savings 403(b), Life & Disability, Commuter Benefits, Paid Family Leave, Additional Employee Discounts VillageCare offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual's needs to help them attain and maintain the greatest level of independent living possible. We are committed to superior outcomes in quality health care.

Position: Medical Director of Utilization Management Location: Remote (Must Reside in NY/NJ/CT) Work Schedule: PER DIEM (5-6 hours/week) Per Diem, hourly physician advisor consultant. Should have flexible schedule to allow coverage for full-time and part-time physicians. Compensation: (Non-exempt) $120 - $125 A little about us VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years Job Summary: The Medical Director for VillageCareMAX is a physician who serves as clinical lead for the Utilization Management Department and medical quality and cost effectiveness activities. The Medical Director assists the VP of Medical Management to direct and coordinate medical management and quality improvement activities for the Health Plan. Essential Job Functions: - Responsible for providing oversight to the delivery of utilization management (UM) services and resources, consisting of case reviews for organizational determinations, peer to peer reviews and appeals - Utilizes the care management system to document all case reviews - Participates in case rounds/ICT meetings in the development of UM/CM plans for individual members to ensure appropriate continuity of care - Analyzes utilization patterns, trends, and implements strategies to bring utilization patterns in line with expected benchmarks - Responsible for successful compliance with regulatory and contractual requirements for Medical Management functions - Participates in State and Federal Regulatory audits, investigations, surveys, and other reviews by the UM Department - Maintains current knowledge of Federal and State regulatory requirements - Develops and proposes annual goals and provides regular reports on progress toward accomplishing those goals Experience: - This position requires 3-5 years of health plan experience in medical management with Medicare and Medicaid Programs (specifically MLTC, MAP, DSNP and MAPD) - Experience with both inpatient and outpatient utilization management (medical, pharmacy) - Experience with appeal reviews - NY Market Experience - No New York Group or Hospital Affiliations Education and certification: - Medical Doctorate is required for this position. Master's - Degree in public health is also preferred - Certification: Required: Current and unrestricted Physician license to practice in NY - Preferred: Board Certified, preferably internal medicine, geriatrics, emergency Medicine, Family Medicine

RN - Care Manager *Fully Remote* Must reside within the New York Tri-State Area - NY, NJ, or CT. Join our team at Village Care as a Full Time RN- Care Manager! This exciting position offers the opportunity to work remotely, providing care and support to our members in the greater NYC area. As an integral part of our team, you will have the chance to showcase your nursing expertise while managing the care needs of our diverse patient population. With a competitive salary ranging from $95,000 to $105,000, this role provides a rewarding opportunity to make a real difference in the lives of others. Don't miss out on this chance to be part of a dynamic and customer-centric organization that values excellence and integrity. As a team member you'll be able to enjoy benefits such as a generous PTO package, 10 Paid Holidays, Personal and Sick time, Medical/Dental/Vision, HRA/FSA, Education Reimbursement, Retirement Savings 403(b), Life and Disability, Commuter Benefits, Paid Family Leave, and Additional Employee Discounts. Apply now and take the next step in your nursing career! Must reside within the New York Tri-State Area - NY, NJ, or CT. What does a Care Manager do? As a Care Manager at Village Care, you will play a crucial role in all aspects of care management, including care planning, coordination, and health assessments. Monitoring the quality and effectiveness of services, you will track progress towards individual goals and ensure the highest level of care for our patients. Your responsibilities will also involve overseeing transitions for patients, facilitating smooth discharge planning from hospitals or nursing homes. By identifying health, environmental, and psychosocial risks, you will recommend and implement interventions in collaboration with the Interdisciplinary Care team. This position offers a dynamic opportunity to make a significant impact on the well-being of our diverse patient population while working remotely in a customer-centric environment. What you need to be successful To excel in the role of Care Manager at Village Care, candidates must possess a valid NYS RN License and a minimum of 3 years of relevant experience in Managed Care, Home Care, or Community settings. An Associate's degree or higher is required for this position. Successful applicants will demonstrate a passionate attitude, exceptional communication skills, and strong problem-solving abilities. Bilingual proficiency is essential, with a particular focus on languages such as Korean, Bengali, Cantonese, Mandarin, Spanish, Russian, or Creole. The ability to effectively navigate and utilize various software and tools relevant to care management is a key requirement for this role. If you meet these qualifications and are ready to contribute to a forward-thinking and customer-focused healthcare organization, we encourage you to apply. Your next step If you think this job is a fit for what you are looking for, great! We're excited to meet you! VillageCare is an Equal Opportunity Employer.