CareCentrix

Medical Director

• Provides clinical oversight and utilization management for Home Health, Durable Medical Equipment (DME), Home Infusion Therapy, Sleep Medicine, and related services.
• Conducts medical necessity reviews using industry-standard clinical criteria and evidence-based guidelines to support coverage determinations and quality care outcomes.
• Conducts efficient medical necessity reviews and peer to peer consultations in adherence with regulatory and compliance turnaround times on cases that may not meet clinical criteria.
• Issues adverse determinations as needed.
• Provides guidance to licensed and non-licensed associates on clinical issues and case reviews related to authorization requests and clinical guidelines criteria.
• Completes peer to peer discussions when medical necessity criteria are not met.
• Participates in CareCentrix Care Coordination, Utilization Management, Quality Improvement and clinical education activities, as requested.
• Utilizes clinical integrity in all determinations and interactions with internal and external partners.
• Collaborates with Health Plan clinical leadership as requested.
• Achieves Service Level Agreement (SLA) metrics and performance guarantees as required by health plan clients.
• Participates and supports different committees and clinical rounds as necessary or assigned.

Accounts Payable

• Reviews and codes invoices, expense reports, petty cash reimbursements, and check requests.
• Ensures appropriate forms are submitted before processing.
• Monitors that correct approval signatures are used on all invoices per the company’s Delegation of Authority Guidelines.
• Assigns correct vendor numbers and appropriate general ledger codes to all invoices.
• Checks past due balances and ensures non-duplication of payments.
• Ensures vendor information (i.e. changes in address, etc.) is accurate and current in the Accounts Payable address book.
• Enters invoice amounts daily into the Accounts Payable system.
• Assigns batch numbers and edits batches to ensure proper cost center allocation.
• Reviews batch balances for accuracy before posting to the general ledger.
• Reviews all expense reports for accuracy, proper receipts, and appropriate approval signatures.
• Enforces corporate compliant policies and procedures before reimbursing associate related expenses.
• Contacts associates to obtain information needed to complete expense reports for reimbursement.
• Resolves all payment-related issues with expense reports.
• Responds to phone calls, researches vendor inquiries, answers questions regarding pay status and general ledger coding of invoices and processes stop payments.
• Participates in implementing / maintaining operational processes to ensure compliance to Company policies, legal requirements and regulatory mandates.
• Reviews and adheres to all Company policies and procedures and the Associate Handbook.
• Participates in special projects and performs other duties as assigned.

Accounts Payable Representative

Account Manager

• Develop trusted partnerships with internal and external stakeholders
• Support DME Navigator implementation efforts
• Collaborate with clients to understand operational needs and priorities
• Maintain a working understanding of client business needs
• Use performance reports and operational data to monitor account health
• Record and maintain organized CRM documentation
• Support standard client updates and changes
• Participate in client meetings and regular touchpoints
• Partner with the Account Management Service Operations team
• Manage client requests and escalations

Account Manager – DME

• Own strategic leadership for a focused portfolio of accounts, establishing a multi year vision and success metrics that drive retention, upsell, and growth in alignment with client and company objectives.
• Serve as the primary executive advisor for assigned accounts, cultivating trusted, C suite level relationships that support long term retention, expansion, and partnership growth.
• Apply client business models, contractual agreements, and financial models to proactively identify strategic risks, growth opportunities, and value creation initiatives.
• Create and manage account planning that supports growth, communicates value, and guides renewals, pricing, and expansion.
• Leverage advanced financial modeling, performance analytics, and market insights to assess profitability and optimize value for both the client and organization.
• Provide strategic governance over account execution, ensuring cross functional teams deliver outcomes aligned with client commitments and contractual agreements.
• Act as executive sponsor for client initiatives, guiding scope, priorities, and outcomes while influencing senior leaders across operations, clinical, product, and technology.
• Lead high impact negotiations, escalations, and risk mitigation efforts, defining resolution strategies that protect organizational relationships, external partnerships, and long term client trust.
• Translate client strategy into organizational internal priorities, aligning leadership teams to coordinated execution and accountability.
• Lead and facilitate executive level client JOCs and forums, including strategic planning sessions, governance reviews, and organizational business reviews
• Analyze market trends and performance issues to deliver insights that inform client strategy and business decisions.
• Manages implementation efforts by coordinating across internal and external stakeholders, tracking deliverables, and escalating risks.
• Provides mentorship to Lead and Senior Account Managers by setting best practices, advancing strategic and financial capabilities, and influencing Account Management standards.

Account Management Director – DME

Compliance

• Monitor and analyze federal and state laws and guidance impacting CareCentrix’s government programs (e.g., Medicare Advantage and Managed Medicaid) and communicate updates clearly through written and verbal channels to relevant business areas.
• Provide cross-functional guidance in developing policies, procedures, and operational changes to ensure compliance with legal requirements, and support implementation across operational teams.
• Coordinate and support compliance audits, including Medicare Part C program audits, reporting, and managed Medicaid audits, ensuring timely and accurate responses.
• Assist with onboarding new government program customers, ensuring compliance requirements are integrated into operational processes.
• Drive continuous improvement initiatives to enhance compliance tracking, trending, and reporting tools for greater efficiency and accuracy.
• Conduct internal audits to assess compliance effectiveness and identify opportunities for improvement.
• Design and deliver training programs that promote a clear understanding of compliance requirements across the organization.

Medical Director

Accounts Payable Representative

Account Manager – DME

Account Management Director – DME

Analyst III – Regulatory Compliance, Government Programs