• Provides clinical and administrative leadership to care management team(s) • Responsible for direct daily oversight of both medical and behavioral health clinicians and non-clinical staff in the delivery of care management services • Implements care management programs and ensures program operations and documentation support regulatory standards • Prioritizes daily workflows, assignments, and triage priorities to meet state and Federal regulatory requirements • Monitors performance and productivity of team and team members to ensure guidelines are followed and goals are met • Facilitates collaboration with internal partners for a coordinated approach to care coordination for members • Supports regionalized care team structure to coordinate care across Integrated Managed Care (IMC) regions • Responsible for a strong understanding of health plan benefits • Participates in Care Management Rounds to support a productive and collaborative discussion and provide clinical input

• Analyze high-risk accounts to identify fraudulent merchants • Lead root cause analyses to identify gaps in systems • Drive cross-functional projects aimed at refining operational processes • Investigate, mitigate, and remediate urgent fraud incidents • Communicate regular updates during business reviews • Travel to vendor locations for training sessions

• Manage end-to-end Revenue Cycle Management (RCM) for pediatric dental practices • Handle Accounts Receivable (AR) management and insurance follow-ups • Perform accurate payment posting (ERA/EOB) • Submit, track, and reconcile insurance claims • Investigate denials and process appeals to maximize reimbursements • Verify patient insurance eligibility and dental benefits • Communicate with insurance companies regarding claim resolution and authorization requirements

• Providing skilled pediatric Speech Therapy evaluations and treatment via telehealth • Completing timely documentation from evaluation through discharge • Communicating with families to review progress, support carryover, and establish home practice programs • Maintaining HIPAA compliance and client confidentiality • Collaborating with clinical and administrative leadership as needed