• Comunicar regularmente con los clientes para proporcionar actualizaciones del caso y responder preguntas • Coordinar con los abogados para asegurar que los clientes reciban la atención médica adecuada • Abrir y gestionar reclamos ante compañías de seguros; responder a consultas y solicitudes • Solicitar, organizar y dar seguimiento a registros médicos y facturas junto con el equipo administrativo • Mantener expedientes de casos actualizados y precisos utilizando software de gestión de casos • Colaborar estrechamente con los equipos internos para asegurar el progreso eficiente de cada caso

• Resolve member complaints and escalated issues, ensuring a satisfactory outcome. • Document and track escalated issues, maintaining clear and comprehensive records from initiation to resolution. • Manage casework queues in Customer Relationship Management tool (Microsoft Dynamics). • Research account history, notes, treatment plans and settlement documents to identify escalation root cause and devise positive outcomes. • Consult with various departments including Claims, Rx and Sales to gather information and coordinate efforts in devising effective solutions. • Manage inbound call volume. • Outreach to providers, pharmacies, and members to obtain additional information as needed. • Develop and implement strategies to reduce the volume of escalated issues by identifying drivers, patterns, and trends. • Demonstrate proficiency in problem-solving and thinking critically when it comes to resolving member complaints. • Communicate effectively with members, internal teams, and management. • Ability to explain coverage determinations. • Identify and recommend ways in which our Member Care team can further build connections through empowerment and ownership. • Ensure familiarity with the most up-to-date policies and procedures and recognize potential additions or modifications as needed. • Share opportunities for learning and development on member issues and potential improvements based on trend analysis with management and other team members.

• Provide telephonic case management to medically complex and chronically ill members • Conduct comprehensive health assessments and create individualized care plans • Coordinate care with internal and external partners, including physicians and specialists • Educate members and caregivers on disease management and preventive care • Monitor member progress and advocate for timely, appropriate interventions • Identify and help resolve service or access issues impacting care quality

Hybrid Virtual Model | Innovative Patient-Centered Care At Rezilient Health, we’re reimagining what primary care can be. We’re not telehealth, and we’re not a traditional doctor’s office — we’re the best of both worlds. Our mission is simple: make access to primary care seamless, timely, and truly patient-centered. As a Physician with Rezilient, you’ll be at the center of our hybrid care model. You'll deliver care virtually while partnering closely with our on-site paramedics, who support the physical exam using live-streaming connected devices that offer real-time assessments (ENT, dermatology, cardio-respiratory, and more). This model enables you to provide hands-on-quality care remotely while ensuring patients are active participants in their health journey. You’ll also work closely with our Specialty Program teams, collaborating with experts in various fields designed to deliver in-house speciality care. This integrated approach allows you to co-manage patients, ensure continuity of care, and provide comprehensive support across a wide range of health needs. If you're looking for a clinically meaningful role where technology amplifies your impact, and where collaboration is the norm, not the exception, Rezilient offers the future-facing platform modern providers deserve. Key Responsibilities: - Provide virtual primary and acute care for our diverse patient population. - Conduct thorough patient assessments using virtual tools, clinical judgment, and support from our on-site paramedics.  - Diagnose and treat common and chronic conditions and manage follow-ups. - Address urgent concerns and triage appropriately for higher-level care when needed. - Collaborate with internal specialty program teams for integrated, coordinated treatment plans. - Order and review labs, imaging, and diagnostics; prescribe medications; and manage referrals as appropriate. - Maintain accurate, timely documentation in our EMR system. - Participate in peer collaboration, clinical meetings, and continuous improvement efforts.