• Performing care management within the scope of licensure for members with complex and chronic care needs • assessing, developing, implementing, coordinating, monitoring, and evaluating care plans • Ensures member access to services appropriate to their health needs • Conducts assessments to identify individual needs and a specific care management plan • Implements care plan by facilitating authorizations/referrals as appropriate • Coordinates internal and external resources to meet identified needs • Monitors and evaluates effectiveness of the care management plan • Modifies as necessary • Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans • Negotiates rates of reimbursement, as applicable • Assists in problem solving with providers, claims or service issues

• Operational management: ensure the smooth daily running of the center, supervise schedules and ensure the quality of services. • Business development & marketing: implement initiatives to increase the center’s visibility, grow the client portfolio and achieve revenue targets. • Recruitment and teacher (tutor) coordination: recruit, train and engage a team of teachers, fostering a positive and motivating work environment. • Educational follow-up: ensure family and student satisfaction through regular monitoring and by adapting services to identified needs. • Facilities management: oversee upkeep and maintenance to provide a welcoming and safe environment. • Reporting: analyze performance indicators, produce regular reports and propose areas for improvement.

• Lead a team of Medicaid Provider Data Services Analyst responsible for loading and maintaining Medicaid Provider data within Aetna QNXT. • Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. • Coordinates provider status information with member services and other internal departments. • Monitor Provider Data pends and keep inventory within KPIs and/or Metrics. • Recruits, develops, and motivates staff. • Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions. • Monitors staff performance, including weekly staff metrics.

• Lead, mentor, and develop a high-performing implementation team, fostering a collaborative environment that encourages innovation and continuous improvement • Oversee the execution, and delivery of client implementation projects, utilizing best practices in project management to ensure timelines and quality standards are met • Analyze data to identify trends and areas for improvement, providing actionable insights to both the team and cross-functional onboarding teams • Work closely with cross-functional leaders, including sales, plan teams and support, to ensure alignment on client needs and successful onboarding experience