Jobs at Community Health Options

Provides administrative and clinical documentation support for utilization, case, disease, and transition-of-care management programs. Manages authorization records, eligibility assessments, fax and phone queues, provider follow-up, documentation updates, and call triage. Follows established workflows, maintains confidentiality, supports quality and productivity standards, and adapts to changing operational priorities.

Provides utilization management and clinical decision-making support for health plan members. Reviews acute and subacute cases using evidence-based criteria, determines medical necessity, coordinates services and discharge planning, manages transitions in care, and refers complex cases to medical directors. The role also coordinates community resources, collaborates with care management teams and providers, documents reviews, supports quality improvement, and maintains confidentiality while working remotely.

Leads the enterprise PMO and business integration functions, aligning project portfolios with strategic goals and overseeing governance, methodology, reporting, change adoption, business process improvement, business analysis, configuration, and vendor management. Drives cross-functional initiatives, procurement, vendor performance, executive reporting, process optimization, and technology-related business changes across health plan operations.