The OT Coordinator oversees and coordinates care for patients treated by Certified Occupational Therapy Assistants (COTAs). Responsibilities include developing patient treatment plans, supervising COTAs, evaluating patient needs, providing therapy, and ensuring compliance with policies. The role also involves documentation of care activities and participation in team meetings.

The Manager of Utilization Management Operations oversees the utilization management team to ensure adherence to service standards, problem resolution, and customer service adherence. Responsibilities include reviewing utilization issues, trend reporting, compliance assurance, and staff management. Additionally, this role involves financial management to meet medical loss ratios and participating in quality assurance initiatives.

The IPS Employment Specialist provides integrated vocational services to clients with mental health disorders, focusing on job readiness and training. Responsibilities include evaluating clients' needs, case management, vocational counseling, job development, and maintaining partnerships with employers. The role involves a significant amount of community outreach and participation in team meetings.

The Community Outreach Representative enhances market awareness for VNS Health Plans through coordinating presentations and community events, establishing relationships with local organizations, and educating the public about their services. They assess program effectiveness and collaborate with community-based organizations to improve visibility and referrals.

The Senior Enrollment Assistant initiates the enrollment process for VNS health plan services, performing outreach to assess eligibility, troubleshooting enrollment inquiries, and collaborating with various departments for timely referrals. The role includes maintaining member records, processing submissions, and preparing reports.

The Director oversees the development and implementation of provider networks for VNS Health, focusing on contracting, network adequacy, and strategic relationship management. Responsibilities include negotiating contracts, managing recruitment strategies, ensuring regulatory compliance, and collaborating with leadership to enhance quality and efficiency in health services.

The Cost Containment Analyst conducts detailed analyses of claims and payment data for health plans to ensure payment integrity and cost containment. They investigate utilization patterns, validate claims, and engage with internal departments to resolve issues and implement corrective actions.

The Financial Analyst at VNS Health provides analytical and accounting support to meet reporting and planning goals. Responsibilities include preparing reconciliation reports, conducting trend and variance analysis, participating in monthly close processes, and ensuring compliance with Medicaid billing regulations, while also acting as a financial liaison to management and overseeing premium billing processes.

The Compliance Specialist provides project management and analytical support for compliance and regulatory affairs entities. They review operational systems, prepare audit reports, assist in investigations, and facilitate external audits. Other duties include tracking policies and implementing monitoring systems, providing training, and ensuring that compliance practices meet regulatory standards.

The COTA provides occupational therapy interventions to patients under the supervision of an OT, monitors patient progress, educates patients and families, modifies treatment as needed, and ensures compliance with established service standards while participating in interdisciplinary team meetings.

The Sales Operations Specialist assesses the eligibility of referrals, processes and enters them into the referral management system, and schedules assessments. They provide education on Medicare plans, handle inquiries, collaborate with departments, and ensure effective referrals and enrollments. They also participate in special projects as needed.

The Risk and Quality Provider Educator educates healthcare providers on clinical documentation and quality measures to improve patient care. This role involves assessing educational needs, developing training programs, conducting training sessions, and collaborating with the Risk and Quality team for ongoing education. The educator will maintain professional communication, ensure regulatory compliance, and evaluate the effectiveness of educational programs.

The Provider Data Coordinator performs various administrative tasks to support the Provider Operations Department, including maintaining provider information, resolving data issues, and assisting with credentialing procedures. Responsibilities include data entry, quality checks, and provider outreach, along with administrative support for the department's functions.

The Director of Sales Operations and Support at VNS Health Plans is responsible for designing and managing sales operations, ensuring compliance with regulations, driving sales growth, and overseeing daily activities of sales support staff. The role includes developing tools for lead management and broker support, maintaining vendor relationships, conducting strategic analyses, and participating in special projects.

The Coding Specialist reviews and audits medical claims for billing and coding compliance, provides training and support to ensure best practices, assigns appropriate codes (ICD-10, HCPCS, CPT), performs medical chart reviews, and engages with medical practitioners and other stakeholders on coding-related matters.

The Specialist in Grievance and Appeals resolves grievances and appeals for VNS Health plans, ensuring regulatory compliance and timely handling of cases. Responsibilities include investigating cases, communicating outcomes, preparing for Fair Hearings, and collaborating with various departments. The role requires maintaining accurate documentation and developing policies for improved operations.

The Wellness Operations & Quality Assurance Coordinator provides business and administrative support to enhance patient care and operational efficiency. Key responsibilities include client communication, assessments, crisis intervention, documentation, and maintaining quality standards while working closely with management and clients to coordinate services.

Develop and deploy machine learning models and workflows on AWS SageMaker, ensuring reliable CI/CD practices and model performance. Collaborate with data scientists to evaluate ML algorithms and build feature extraction pipelines, while maintaining data quality and managing ML lifecycle.

The Senior Enrollment Assistant initiates the referral and enrollment process for VNS health plan services, performing outreach to assess eligibility and troubleshoot enrollment inquiries. Responsibilities include providing education on benefits, confirming eligibility, processing enrollment submissions, and maintaining member records.

As an Authorization Coordinator, you will handle authorization requests efficiently, troubleshoot issues, and collaborate with internal teams to ensure timely delivery of services. Duties include modifying authorizations, communicating with providers and members, and resolving processing discrepancies.