Teams at GlobalHealth Holdings, LLC

Manages Medicare Advantage member experience and quality improvement initiatives to achieve and maintain strong CMS STAR ratings and NCQA accreditation. Oversees CAHPS and HOS surveys, vendor performance, provider outreach, AWV/HRA programs, training, reporting, and cross-functional improvement efforts. Develops educational and wellness materials, monitors quality measures, presents updates to provider groups, and supports compliance with HIPAA and healthcare quality standards.

Maintains provider data integrity and directories, evaluates network access, resolves provider inquiries, supports provider onboarding and education, and collaborates with internal and external stakeholders. The role also assists with CMS guidelines and NCQA accreditation standards while protecting confidential business information and PHI. It is remote, requires strong Microsoft Office and NPPES data skills, and involves no travel or supervisory duties.

Provides telephonic case management for complex, high-risk Medicare Advantage members. Assesses needs, coordinates care and community resources, monitors outcomes, communicates with providers and care teams, advocates for members, provides education and crisis support, and completes SNP Model of Care and transition-of-care activities, including health risk assessments, individualized care plans, medication reconciliation, and follow-up coordination.