• Responsible for maintaining and improving existing provider relationships through communication, support, analysis, problem solving, and education • Works directly with providers to ensure they are educated on all policies and procedures in a professional manner • Collaborates with stakeholders to meet existing and newly identified needs • Maintains a comprehensive provider contact database • Builds relationships with Clinical Centers of Excellence for support • Assists with incoming inquiries and addresses provider grievances • Supports the secure exchange and management of provider enrollment documentation • Assists with ensuring providers are compliant with program requirements • Provides education and guidance to providers on required metrics and programs • Takes ownership of provider’s recruitment, enrollment, and participation experience • Ensures provider records are updated timely and accurately

• Provides active care management, assessing service needs, developing and coordinating action plans in cooperation with members, monitoring services and implementing plans, including member goals • Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions • Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits • Provides telephonic support for members with chronic conditions, high-risk pregnancy, or other at-risk conditions, including intensive assessment/evaluation • Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans • Ensures coverage for appropriate services within benefit and medical necessity guidelines • Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, etc.) • Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies

• Become your own boss in an expanding market • Work full-time or part-time • No cold calling, only contact qualified buyers • Offer living benefit life insurance for mortgage protection

• This is a sales position with an incredible commission structure. • You will become your own boss in this expanding market and can work FULL TIME OR PART TIME. • This career is for you if you just need a few extra dollars for debt reduction or if you would like to build a secure income within your first year.