Curana Health

Manager

• Provide comprehensive care management services for patients enrolled in Advanced Primary Care Management, Chronic Care Management, and other value-based care programs
• Review electronic health records for long-term care nursing facility patients to identify gaps in care
• Review and approve initial and ongoing health questionnaires completed by care management team members
• Conduct scheduled monthly telephone outreach to patients and/or caregivers
• Develop patient-centered care plans
• Educate patients and their durable medical power of attorney on APCM or CCM benefits
• Support quality gap closure through clinical discovery
• Facilitate orders, referrals, and prior authorizations through the virtual care support team
• Escalate abnormal diagnostic test results to Curana providers
• Collaborate with providers to deliver coordinated, patient-centered care
• Communicate patient health updates to Curana providers
• Communicate treatment plans and health updates to caregivers effectively and caringly
• Serve as the primary liaison between providers and the administrative support team
• Perform other duties as assigned

Care Manager, LPN

Paralegal

• Assist the General Counsel, Deputy General Counsel, and Legal Department attorneys with legal support for the Board of Directors, executive leadership, management, and business stakeholders
• Draft, file, and maintain corporate governance documents, entity records, organizational charts, annual reports, and related records
• Coordinate entity formations, dissolutions, foreign qualifications, amendments, mergers, acquisitions, and other corporate transactions
• Assist with due diligence, document collection, and regulatory filings for corporate transactions and reorganizations
• Maintain calendars and tracking systems for corporate filings, registrations, annual reports, and governance requirements
• Draft, review, revise, and manage commercial contracts and legal forms
• Manage contract lifecycle processes, including intake, routing, execution, storage, renewal tracking, and reporting
• Support implementation and administration of contract lifecycle management systems and legal technologies
• Provide regulatory support for Medicare Advantage plans and affiliated healthcare organizations
• Assist with health plan licensure, CMS audits, state insurance department examinations, regulatory investigations, filings, notices, and attestations
• Monitor federal and state legislative and regulatory developments affecting healthcare operations
• Prepare summaries, analyses, and tracking reports on healthcare laws, regulations, guidance, enforcement actions, and industry developments
• Support regulatory inquiries, corrective action plans, government requests, and compliance projects
• Support drafting, organization, and management of provider, delegated entity, administrative services, pharmacy-related, and vendor agreements
• Assist with litigation, arbitration, mediation, subpoenas, claims, grievances, investigations, and complaint responses
• Coordinate document preservation, collection, production, litigation holds, and outside counsel activities
• Assist with privacy and data security matters, HIPAA compliance, incident investigations, documentation, and regulatory reporting
• Manage legal intake and matter management systems, departmental records, filing systems, templates, and knowledge resources
• Create reports, dashboards, and metrics regarding contracts, regulatory matters, litigation, and legal activities
• Identify process improvement opportunities and lead Legal Department efficiency initiatives
• Assist with special projects and strategic initiatives assigned by Legal Department leadership

Corporate Paralegal

Strategy

• Lead high-impact, cross-functional strategic initiatives from concept through implementation
• Drive organizational transformation efforts and strategic priorities across the Medical Group
• Develop project roadmaps, implementation plans, communication strategies, and governance structures
• Facilitate stakeholder alignment and executive decision-making
• Own strategy, oversight, and performance management for Curana's Care Management portfolio, including CCM, APCM, BHI, and future care management initiatives
• Identify opportunities to improve, scale, and optimize care management programs and operational processes
• Partner with clinical, operational, finance, and technology leaders to improve program performance and outcomes
• Support growth and innovation within Curana's value-based care model
• Lead cross-functional workgroups and implementation teams
• Develop initiative playbooks, communication plans, and change management strategies
• Monitor key performance indicators (KPIs) and business outcomes
• Drive process improvement and organizational effectiveness initiatives
• Analyze large and complex clinical, operational, financial, and business datasets
• Develop operational, financial, forecasting, and scenario models to support strategic decision-making
• Build compelling executive presentations and business cases
• Translate complex data into clear, actionable insights and recommendations
• Identify opportunities to leverage AI, automation, predictive analytics, and emerging technologies to improve operational performance and business outcomes
• Partner closely with executive leadership on strategic priorities and organizational initiatives
• Prepare executive-level presentations, business cases, and recommendations
• Facilitate leadership meetings and strategic planning discussions

Director of Strategic Initiatives

Care Navigator

• Address patient and durable power of attorney (DPOA) inquiries via telephone
• Respond to patient or caregiver messages received via the Curana Patient Portal
• Assist patients with scheduling follow-up appointments with Curana Providers or specialists
• Manage electronic health records (EHR) and ensure accurate and up-to-date patient records
• Coordinate documents needed for review or signature by a provider
• Facilitate provider orders and escalate findings
• Maintain patient rosters for APCM and GUIDE programs
• Support provider scheduling
• Assist with prior authorizations
• Obtain patient records and diagnostic test results
• Answer and manage incoming calls professionally and courteously
• Collaborate with the Curana Interdisciplinary Care Team to ensure seamless communication within the health network
• Perform other duties as assigned

Actuary

• Lead CMS bid development and HPMS filings for Medicare Advantage plan years
• Build and maintain IBNR reserve modeling and support monthly close and financial reporting cycles
• Perform risk adjustment modeling, HCC analysis, and CMS payment reconciliation
• Monitor and respond to CMS data systems including HPMS, MARx, and RAPS/EDPS
• Support RADV audit preparation and encounter data quality review
• Develop and maintain Part D pricing models and support reconciliation processes
• Translate actuarial findings into clear, actionable insights for non-actuarial stakeholders
• Partner cross-functionally with finance, clinical, compliance, and network teams
• Manage multiple deliverables across competing deadlines, including bid season and CMS filing cycles
• Support or lead the CMS bid submission cycle
• Deliver accurate, actionable insights from risk and financial modeling
• Strengthen reserve modeling and reporting processes
• Provide clear, executive-ready recommendations

Actuary – CMS Regulatory, Bid Pricing

Financial Planning and Analysis

• Create and deliver monthly financial performance reporting, including P&L analysis, utilization trends, healthcare spend analysis, and gainshare/risk-share performance results
• Develop financial storylines and recommendations for executive leadership and stakeholders
• Prepare executive-ready summaries, presentations, dashboards, and ad hoc analyses
• Monitor performance across health plan products and affiliated risk-bearing facilities
• Own facility-level risk agreement calculations and performance incentive reporting
• Lead monthly capitation and membership reconciliation processes
• Investigate variances, identify root causes, and coordinate issue resolution
• Analyze healthcare claims, medical expenses, utilization patterns, and cost drivers
• Evaluate accrual methodologies and support healthcare cost forecasting
• Review denied claims, high-cost claims, and payment variances
• Maintain Part D funds-flow documentation and support pharmacy and healthcare-cost analysis
• Track recoveries, recoupments, and reimbursement adjustments
• Support internal and external audits, financial schedules, documentation, and regulatory submissions
• Coordinate and analyze vendor data for accounting, reporting, and prefunding
• Assist with CMS-related financial reporting and compliance
• Support budgeting, forecasting, long-range planning, and cash-flow analysis
• Assist with MLR reporting, Medicare Bid development, and CMS deliverables
• Partner with Data Operations and Reporting teams to maintain financial and operational reporting
• Provide strategic financial guidance for growth initiatives and business planning

Senior Financial Analyst

Analyst

• Manage and maintain accurate compensation databases and records to ensure that providers are compensated in accordance with their employment agreements
• Research, analyze, and interpret data to calculate compensation for providers based on encounter productivity
• Work collaboratively with the Payroll Department to provide timely and precise payments in compliance with state and federal requirements
• Communicate effectively with other departments and providers to explain compensation processes and to resolve payroll inquiries
• Contribute to process improvements that make compensation and productivity management more efficient and transparent for all users
• Provide reporting and insight to leadership to support business decisions and provider satisfaction

Provider Compensation Analyst

General

• Responds to Member/Provider questions via telephone and written correspondence regarding Medicare benefits, enrollment questions, change requests, eligibility, and claims.
• Analyzes problems and provides information/solutions.
• Utilizes internal systems to obtain and extract information, documents information, activities, and changes in the database.
• Thoroughly documents inquiry outcomes for accurate tracking and analysis.
• Develops and maintains positive member/provider relations and coordinates with various functions within the company to ensure requests and questions are handled appropriately and in a timely manner.
• Researches and analyzes data to address operational challenges and member/provider service issues.
• Requires knowledge of health insurance benefits.
• Seeks, understands, and responds to the needs and expectations of internal and external customers.
• Create and manage documentation specific to contact center.
• Other duties as assigned.

Member Services Specialist – Part Time

• Responds to Member/Provider questions via telephone and written correspondence regarding Medicare benefits, enrollment questions, change requests, eligibility, and claims
• Analyzes problems and provides information/solutions
• Utilizes internal systems to obtain and extract information, documents information, activities, and changes in the database
• Thoroughly documents inquiry outcomes for accurate tracking and analysis
• Develops and maintains positive member/provider relations and coordinates with various functions within the company to ensure requests and questions are handled appropriately and in a timely manner
• Researches and analyzes data to address operational challenges and member/provider service issues
• Requires knowledge of health insurance benefits
• Seeks, understands, and responds to the needs and expectations of internal and external customers
• Create and manage documentation specific to contact center
• Other duties as assigned

Member Services Specialist

Learning and Development

• Design, develop, and maintain high‑quality self‑paced clinical learning, including e‑learning modules, short instructional videos, assessments, job aids, and tip sheets
• Translate clinical workflows, expectations, and standards into learning experiences that are clear, practical, and usable in real provider contexts
• Apply adult learning and instructional design principles in a pragmatic way to improve retention, confidence, and on‑the‑job behavior
• Structure learning content so it is durable and easy to update over time, balancing stable core training with flexible, updateable supporting resources
• Facilitate select virtual and live learning experiences such as orientation sessions, case‑based discussions, cohort learning, and office hours
• Use facilitation intentionally to reinforce self‑paced learning, support application and discussion, and surface areas of confusion or opportunity
• Support high‑impact learning moments where live interaction meaningfully improves understanding or adoption
• Partner closely with teammates across Learning & Development to support learning priorities and shared standards
• Share learning design best practices, templates, and approaches that improve consistency and quality across learning assets
• Collaborate with subject matter experts, Clinical Leadership, CDI/Coding, Compliance, Product/IT, and other stakeholders to ensure learning content is clinically accurate and operationally realistic
• Build and publish courses in Curana’s Learning Management System (LMS), ensuring learning is trackable and reportable
• Use completion data, assessment results, and learner feedback to continuously refine and improve learning experiences
• Partner with Learning Operations to support reliable tracking, reporting, and learner experience

Clinical Instructional Designer – NP/PA

• Investigate and resolve member and provider appeals and grievances in a professional, accurate, and timely manner while meeting all contractual and regulatory timeframes.
• Maintain a clear understanding of the differences between medical necessity appeals and claim appeals and apply appropriate processes accordingly.
• Manage appeals and grievance cases from intake through final resolution, including receiving, logging, tracking, monitoring, documenting, requesting supporting documentation, investigating, auditing, resolving, and reporting on cases.
• Respond to member and provider appeals and grievances independently and with minimal supervision.
• Interface with members and providers regarding the status, process, and outcomes of complaints, appeals, and grievances.
• Prepare all appeal and grievance-related correspondence, including acknowledgment letters, determination letters, outcome notifications, and correspondence for escalated levels of review.
• Prepare, attend, and present appeals and grievances documentation for plan hearings, regulatory reviews, audits, and other compliance-related activities as needed.
• Accurately document all appeal and grievance activities, follow-up actions, and final outcomes in designated systems while maintaining comprehensive and secure case files.
• Generate reports, identify trends, and provide recommendations for quality improvement initiatives and operational enhancements.
• Communicate detailed risk management concerns and compliance-related issues to leadership within established timeframes.
• Review appeal and grievance correspondence and proactively obtain additional information from appellants, providers, or other stakeholders as necessary.
• Partner closely with member advocates and internal stakeholders to facilitate effective grievance resolution and an exceptional member experience.
• Assist in coordinating peer review activities involving internal Physician Advisors and external review vendors.
• Collaborate with Utilization Management, Claims, Provider Network, Legal, Compliance, and other business partners to ensure appeal and grievance decisions align with all regulatory, contractual, and organizational requirements.
• Work with leadership and external vendors to resolve complex, high-profile, and escalated appeals and grievance cases.

Appeals and Grievances Specialist

Credentialing Coordinator

• Manage the credentialing and re-credentialing processes for physicians, nurses, and allied health professionals.
• Verify licenses, certifications, education, training, and work history to ensure providers are fully qualified.
• Maintain accurate and complete credentialing files, ensuring all staff are cleared before providing care.
• Stay current on federal, state, and accreditation requirements (CMS, Joint Commission, NCQA, etc.).
• Track expiration dates for licensure, certifications, and accreditations to ensure seamless renewals.
• Safeguard provider and facility compliance with healthcare laws and standards at all times.
• Maintain up-to-date credentialing databases and systems.
• Create reports for leadership and regulatory agencies.
• Ensure confidentiality and compliance with HIPAA and other privacy regulations.
• Serve as the go-to contact for providers, accreditation organizations, and external vendors.
• Partner with HR, Medical Staff Services, and leadership to keep credentialing processes on track.
• Provide updates and proactive recommendations on credentialing status and timelines.

Medical Credentialing Coordinator

• Prepare, submit, and monitor individual and group Medicare revalidations through PECOS.
• Manage Medicare revalidations and enrollment maintenance requests.
• Track PTAN assignments, effective dates, and approval statuses.
• Coordinate electronic signatures and supporting documentation required for Medicare revalidations.
• Maintain compliance with CMS regulations and Medicare Administrative Contractor (MAC) requirements.
• Submit revalidation Medicaid applications for both individual providers and provider organizations.
• Coordinate state-specific Medicaid enrollment requirements and supporting documentation.
• Monitor application status and resolve deficiencies with state Medicaid agencies.
• Develop and maintain tracking systems for all Medicare and Medicaid revalidation activities.
• Monitor revalidation due dates, enrollment expirations, and regulatory deadlines.
• Conduct routine follow-up with Medicare contractors and state Medicaid agencies.
• Ensure all enrollment milestones are documented and reported accurately.
• Escalate delayed or high-risk applications to leadership as appropriate.
• Ensure all activities comply with CMS, Medicare, Medicaid, and organizational requirements.
• Maintain complete and audit-ready enrollment files and supporting documentation.
• Assist with internal audits, accreditation reviews, and regulatory requests.
• Monitor changes in Medicare and Medicaid enrollment policies and communicate impacts to stakeholders.
• Implement process improvements to enhance enrollment efficiency and accuracy.
• Serve as the primary resource for Medicare and Medicaid revalidation guidance.
• Collaborate with Billing, Revenue Cycle, Credentialing, Compliance, and Operations teams.
• Research and resolve enrollment-related billing delays, claim denials, and reimbursement issues.
• Provide status updates and reporting to leadership and operational stakeholders.

Medicare & Medicaid Enrollment Analyst

Operations

• Supervise virtual and on-site care management staff (i.e., licensed practical nurses, registered nurses, and medical assistants)
• Evaluate workload, priorities, and adjust allocation of time and resources to increase efficiency and effectiveness
• Facilitate and lead team weekly meetings to discuss performance, upcoming training, and ensure the team’s alignment on new workflows as applicable
• Review and approve payroll, track attendance, and oversee employee leave, FMLA, and call-offs
• Ensure adherence to evidence-based care coordination practices
• Review and support the development of care plans, ensuring clinical appropriateness
• Collaborate with clinical leaders to align care management activities with organizational goals
• Monitor post-discharge communications to assure continuity of care and prevent unnecessary readmissions
• Partner with the Director of Care Management to ensure adequate staffing and maintain customer satisfaction by implementing and monitoring staff productivity and performance indicators
• Perform quality assurance audits on virtual and on-site staff

Manager, Care Management Operations

• Serve as the first line of support for residents and facility staff after-hours, providing direction and medical care over the phone.
• Use Curana’s telephonic platform to take and place calls, coordinating care between facilities, hospitals, and clinics.
• Deliver high-quality, cost-effective care to patients—addressing acute, chronic, and behavioral health needs in collaboration with physicians and specialty providers.
• Perform comprehensive assessments and document encounters accurately and thoroughly in the EMR, ensuring compliance with CMS requirements.
• Apply Curana’s clinical protocols and practice guidelines to support safe, effective treatment in place whenever possible.
• Participate in mandatory education and training to stay current with standards of care.
• Provide after-hours coverage for skilled nursing and senior living facilities on weeknights, weekends, and holidays.