Jobs at GlobalHealth Holdings, LLC

Supervises Clinical Quality Specialists and oversees HEDIS-related quality initiatives, provider/member outreach, record audits, data entry, and medical record review to ensure compliance with CMS measures. Maintains PHI confidentiality and coordinates substantial travel for on-site audits.

Provide telephonic case management for complex, high-risk Medicare Advantage members: assess needs, coordinate care and community resources, perform transitions of care, complete SNP MOC activities (HRA, ICP, ICT), educate members and caregivers, and monitor outcomes while ensuring HIPAA compliance.

Lead clinical Appeals & Grievance (A&G) operations, ensuring regulatory and contractual compliance. Manage staffing, scheduling, coaching, performance, and daily workflows. Monitor metrics, handle member escalations, perform first-round quality-of-care reviews, and drive process improvements.