Mindoula

Manager

• Conduct meaningful outreach, provide education, and drive member enrollment
• In partnership with the member, create a Service Plan to guide engagement based on member diagnoses, results of screenings, as well as care gaps
• Build measurable goals for members to develop skills and/or strategies for managing challenges and triggers to reduce hospital admissions/readmissions and use of the ER, and record outcomes
• Coordinate community resources for each member to support them in achieving their goals as outlined in their Service Plans, created with an emphasis on meeting behavioral health and medical needs, and closing gaps identified in the social determinants of health
• Act as an advocate and liaison between the care team (family, physician, facilities, and/or agencies) and member
• Schedule appointments, build accountability, and follow-up services for members
• Elevate critical incidents and information regarding any quality-of-care concerns
• Report hospital diversions, productivity, and other outcomes weekly
• Prepare and maintain all required records, reports, consents, and members’ diagnostic records

FL Case Manager

• Address and manage crises by responding promptly to calls and digital requests using active listening, de-escalation techniques, and crisis management skills to reduce distress and promote safety.
• Evaluate risk type and level (e.g. suicidal ideation, self-harm, homicidal ideation, and other safety concerns) in alignment with established risk-stratification guidelines included escalation and contacting emergency services when indicated.
• Gather essential information (Member identity, contact information, current location, and—when applicable—parent/guardian details) to support a safe and effective response.
• Develop collaborative safety plans with the Member, including coping strategies, use of natural supports, linkage to existing behavioral health providers, and clear next steps for maintaining safety.
• Ensure safety plans and crisis resources are sent to the Member promptly and ensure timely communication with leadership and documentation as required.
• Coordinate direct transfer and referrals to appropriate levels of care (e.g., internal, outpatient providers, community resources, mobile crisis teams, emergency departments, inpatient facilities, etc.).
• Involve Member’s other support network including family members, guardians, and emergency contacts when appropriate.
• Complete timely, accurate, and objective documentation of all contacts, risk assessments, safety planning, and follow-up activities in the designated electronic systems.
• Participate in debriefs, case consultations and reviews, and quality-improvement activities related to crisis services.
• Perform Other Duties as assigned.

Crisis Center Case Manager – Thursday to Sunday

Accounts Receivable

• Accurately review denied claims to identify root causes
• Execute appropriate corrective actions, including clinical appeals, corrected claims, and data updates to secure maximum revenue recovery
• Communicate directly with insurance representatives to negotiate settlements on accounts and resolve systemic payment discrepancies
• Monitor denial trends and provide actionable feedback to front-end billing and clinical teams to prevent recurring errors in coding, eligibility, or credentialing
• Follow up on unpaid claims and appeals by tracking unpaid claims, contacting insurance companies to inquire about payment, and appealing denied claims as needed
• Stay current on state and federal regulations to ensure all recovery efforts meet legal and contractual standards
• Document all resolution activities and maintain an organized worklist of accounts, prioritizing those nearing timely filing or appeal deadlines
• Other duties as assigned

Accounts Receivable Representative

Account Manager

• Build strong and enduring relationships with our health plan partners, at multiple levels, to ensure we are exceeding expectations and building on our relationships to grow the business
• Steward health plan relationships post-sales, from onboarding and implementation through to customer support, retention, and cohort/program expansion
• With the support of the GM and Chief Customer Officer, own implementation and on-boarding of new health plan partners
• Develop, schedule, and manage meetings with plan partners to review programmatic delivery/outcomes and address partner needs
• Partner with Program Operations and Data Analytics colleagues to determine optimal monthly/quarterly/annual reporting for all partners and guide creation of customized reports/analytics when required for individual partners
• In partnership with our data analytics and data science team, prepare, deliver, and follow up on in-depth presentations and other reporting with health plan partners about key aspects of our programs, including enrollment, service delivery, health equity, and ROI to demonstrate our value
• Proactively anticipate and address the needs of plan partners to ensure contract renewal and identification of upsell opportunities
• Deeply understand all partner contracts to ensure all obligations are met by Mindoula and our health plan partners
• Maintain CRM to ensure that all partner data/interactions and key obligations are appropriately tracked and can be easily shared with key stakeholders across the organization
• Partner with business GM, Program Operations leaders, and Data Science team to ensure we are delivering the combination of analytics, technology and service required to drive desired clinical outcomes across all of our Specialty Population Health Management Programs for all health plan partners
• In partnership with the GM, CFO, and Program Directors, develop and track key financial metrics for each partner/account to ensure we are meeting all financial goals, to ensure both growth and profitability as we grow and scale the company (including billing and payment)
• Partner with health plans, GM, Program Directors, and other members of the Mindoula leadership team to determine areas for growth and innovation to strengthen and expand our partnerships and grow the company
• Partner with GM, Program Directors, and other leaders to create plans to deliver on new innovations and initiatives for partners
• Manage all other aspects of our relationships with our health plan partners
• Perform other duties as assigned

Vice President, Partner Success, Account Management

TN Case Manager

• The Credentialing Manager leads the end to end credentialing, privileging, and payer enrollment function for the Managed Service Organization.
• Ensure timely, compliant provider onboarding while maintaining high standards of operational accuracy, audit readiness, and service excellence.
• Oversee full lifecycle credentialing, re-credentialing, privileging, and payer enrollment for all providers.
• Manage complex, escalated, or high priority credentialing cases.
• Support compliance and audit readiness practices, maintaining audit ready provider files and documentation standards.
• Provide day to day leadership, coaching, and workload management for credentialing specialists.
• Develop team capabilities through training and process documentation.
• Monitor turnaround times, application status, and enrollment effective dates.
• Partner with cross-functional teams for seamless provider onboarding and resolve credentialing related denials or reimbursement delays.