CareMore Health

Manager

• Serve as the expert for provider contract language, ensuring compliance and scalability
• Use standardized contract templates and partner with Legal and Configuration teams
• Enable strong provider relationships while supporting Medicare and Medicaid requirements
• Manage exception and alternative language frameworks with appropriate controls
• Evaluate contract terms for efficiency across operations such as Configuration and Claims
• Educate stakeholders on contract language implications and best practices
• Present recommendations confidently to governance committees
• Contribute to enterprise contract management processes and tools

Provider Contract Manager

• Collaborates in a patient care process to assess, plan, facilitate, coordinate, monitor, and evaluate options and services to meet member's health needs.
• Supports member or their representative in regard to care, care transitions, and changes in health status.
• Implements a comprehensive clinical case management plan for each patient.
• Obtains input from providers, patient, and family as appropriate, and evaluates and revises the plan as needed.
• Analyzes patient variances from the plan and initiates the appropriate steps to resolve variances.
• Performs admission and concurrent stay reviews on hospitalized patients.
• Develops and implements discharge planning for patients in conjunction with hospital based case managers.
• Performs telephonic, fax and/or on-site reviews with skilled nursing facilities, home health agencies or other contracted service agencies to determine need for continued care.

Clinical Case Manager, RN

Medical Director

• Serve as the clinical expert responsible for advancing CareMore Health’s risk adjustment strategy
• Guide providers in accurate and complete documentation of patient complexity and chronic conditions
• Ensure compliance with CMS requirements while supporting enterprise revenue integrity
• Focus on healthcare provider education, data-driven interventions, and cross-functional collaboration
• Maximize risk score accuracy, reduce audit exposure, and align risk adjustment with clinical and business objectives

Provider Contract Manager

Clinical Case Manager, RN

Medical Director – Risk Adjustment