Community Health Plan of Washington

Executive Assistant

• Provides administrative support to the Chief Operating Officer (COO) for organizational and operational assignments
• Performs both routine and complex administrative support to the COO including scheduling, travel arrangements, and expense account reconciliation
• Assists COO with yearly budget process
• Supports COO and VPs with invoice tracking, coding and submission to Accounts Payable
• Plans, organizes, researches and compiles data/reports for initiatives, projects and meetings
• Performs complex and confidential administrative functions
• Responsible for all aspects of meeting preparation including scheduling, development of agendas and related material
• Plans and manages all arrangements for events under the leadership of the COO

Bilingual

• Responsible for supporting CHPW’s Medicaid, Cascade Select, and Dual Special Needs Plan (DSNP) members
• Conduct new member outreach such as welcome calls and Health Risk Assessments
• Engage members in the Care Management programs
• Schedule and coordinate in-home assessments with Community Health Workers (CHWs)
• Triage inbound calls from members, families, and caregivers
• Provide educational materials via phone, mail, or text as directed by the Care Team
• Participate in Care Team meetings and interdisciplinary team (ICT) conferences
• Access and manage medical records, including uploading documents and maintaining electronic health records

Care Advocate, Bilingual Desired

Operations

• Responsible for the direct supervision of Operations staff, including interviewing, hiring, performance management, time keeping records, training, coaching and employee development
• Building a cohesive, empowered and productive work environment
• Responsible for improving production processes and quality on a continuous basis
• Manage prioritization of system configuration, testing and implementation activities involving claims and encounter data
• Facilitate the development and execution of user acceptance scenarios and scripts for testing system changes and enhancements
• Manage claims and billing Clearinghouse (TPA) for Medicaid programs
• Oversee end‑to‑end claims and billing operations with the TPA for Medicaid programs, ensuring accuracy, efficiency, and alignment with program requirements
• Provide strategic guidance to providers on claims preparation and submission, including developing training materials and enabling process improvements
• Ensure timely and compliant submission of all required program documentation, maintaining strong operational controls
• Lead oversight of clearinghouse claim workflows, including escalation management, technical issue resolution, and root‑cause analysis for provider rejections
• Drive program compliance and performance through rigorous monitoring, reporting, and continuous improvement initiatives
• Regularly monitor departmental contractual compliance with state, CMS, OIC requirements (claims benefit configuration, claims timeliness, claim denials, encounter data submissions, clearing house); including supporting the collection and submission of required operational performance metrics and data reporting requirements
• Provide oversight including SLA reporting and audit to Operations’ assigned vendors
• Lead the analysis and documentation of business process workflows, policies and procedures for Operations
• Act as the subject matter expert for Operations in companywide or specific projects, including configuration on vendor systems
• Monitor the performance of processes within the Operations Department identifying improvement strategies and interventions when targets are not met
• Lead and guide process owners and internal stakeholders in the planning and execution of process improvement activities including identifying suitable strategies, methodologies and interventions necessary to achieve desired outcomes
• Take a leadership role working with project teams to develop and track key performance targets and metrics to effectively monitor improvement activities and interventions
• Regularly report results to management and project owners
• Participate in and oversee the work involved in a variety of audits including TEAMonitor, HEDIS, NCQA, CMS, Internal audit.

Supervisor, Claims BPO Operations

Manager

• Responsible for the operational delivery of the plan’s case management and coordination programs and processes.
• Provides case management services for CHPW members with short term, long term, stable, unstable, and predictable course of illness, and/or highly complex medical/behavioral and social conditions.
• Advocates on behalf of members and facilitates coordination of resources required to help members reach optimum functional levels and autonomy within the constraints of their disease conditions.
• Works within a multi-functional team to connect with providers, members, caregivers, contracted vendors, community resources, and health plan partners to assess the member's health status, identify care needs and ensure access to appropriate services to achieve positive health outcomes.
• Assesses, evaluates, plans, implements, and documents care of members within the organization’s clinical database system, in accordance with organizational policies and procedures.
• Responsible for the assessment of members, including identifying and coordinating access to the appropriate level of care and treatment.
• Initiates a plan of care based on member-specific needs, assessment data and the medical/behavioral plan of care.
• Plans care in collaboration with members of the multidisciplinary team, and considers the physical, behavioral, cultural, psychosocial, spiritual, age specific and educational needs of the member in the plan of care.
• Reviews and revises the plan of care with the interdisciplinary care team to reflect changing member needs based on evaluation of the members’ status, and/or as a result of reassessment.
• Implements the plan of care through direct member care, coordination, and delegation of the activities of the health care team.
• Engages community resources where applicable.
• Document all case activity using the CHPW care management system and follows documentation standards and protocols.

Case Manager I

Actuary

• Responsible for developing and monitoring risk and rating assumptions.
• Lead required state and federal documentation pertaining to actuarial assumptions used in pricing of the products.
• Provide management with analyses, reporting and recommendations on product performance.
• Responsible for calculation/review of reserves and forecasting/trend analysis.

Senior Healthcare Actuary

• Responsible for the operational delivery of the plan’s case management and coordination programs and processes.
• Provides case management services for CHPW Pediatric/Adolescent/NICU/Perinatal members with short term, long term, stable, unstable, and predictable course of illness, and/or highly complex medical/behavioral and social conditions.
• The goal is to improve members' quality of life and ensure cost-effective outcomes by using internal and community-based resources.
• Advocates on behalf of members and facilitates coordination of resources required to help members reach optimum functional levels and autonomy within the constraints of their disease conditions.
• Works within a multi-functional team to connect with providers, members, caregivers, contracted vendors, community resources, and health plan partners to assess the member's health status, identify care needs and ensure access to appropriate services to achieve positive health outcomes.
• Assesses, evaluates, plans, implements, and documents care of members within the organization’s clinical database system, in accordance with organizational policies and procedures.
• Responsible for the assessment of members, including identifying and coordinating access to the appropriate level of care and treatment.
• Uses the assessment information to assign the appropriate risk and complexity level, and create and document a care plan in coordination with the member, family and health team input.

Executive Assistant

Care Advocate, Bilingual Desired

Supervisor, Claims BPO Operations

Case Manager I

Senior Healthcare Actuary

Case Manager I – Pediatric, Adolescent, Youth, NICU, Perinatal