Gravie offers innovative health benefit solutions that put employers’ and employees’ needs at the center of the healthcare ecosystem. Brokers and employers who are interested in learning more about Gravie, should email to info@gravie.com or call us at 844.540.8701.

Gravie

Operations

Create and coordinate health plan operations for Gravie's healthcare solutions.

• Be a key lead to collaborate and bridge the clinical team and health plan operations team to guide care for members and assist with applying benefits according to plan language.
• Utilize your clinical experience in a collaborative way to assess appropriateness of treatment plans, apply evidenced based standards, and build SOPs where appropriate.
• Monitor, evaluate, and coordinate options to facilitate appropriate benefits for members.
• Gather and assess clinical information through medical records, case management, and other source information to apply appropriate clinical judgment for benefits coverage.
• Experience with and a depth of understanding of medical policies so you can help create and standardize operations for medical policies at Gravie.
• Deep understanding of Transition of Care, Continuity of Care, utilization management (UM), Prior Authorizations (PAs), Medical Necessity, appeals, claims reviews, gap exceptions, and application of benefits.
• Lend expertise across the company to consult and provide administration support of UM, PAs, medical necessity, and appeal functions.
• Review pre-certification lists for holistic Utilization Management.
• Work with network Utilization Management/Case Management vendors to reduce errors and improve accuracy for both member and provider experience.
• Use your experience and understanding of Fraud, Waste, and Abuse to perform internal audits of claims and suggest policies and procedures to reduce this risk.
• Understand and suggest cost containment opportunities and strategies.
• Think critically about plan language to clarify coverage and make the member journey as seamless as possible.
• Bring together data and work directly with our Clinical Analytics and Reporting teams to give summaries of work being done and opportunities to intervene and improve.
• Combine your experience of evidenced based practice with being innovative to drive new solutions for the best member experience.
• Create effective relationships, listen, communicate and be a helpful team member across the organization.

Nurse Specialist - Health Plan Operations

Human Resources

• Build out and oversee Carrier Relations team
• Own creation and maintenance of Carrier knowledge management resource
• Develop system for tracking commissions owed to Gravie by carriers
• Work with Marketing to educate carriers on ICHRA
• Oversee Application Coordinator team
• Build out and oversee Payments team
• Develop, roll out, and improve cross-functional processes
• Support development and delivery of onboarding, training, and support materials

Director - ICHRA Operations

Product Manager

• Product strategy setting and implementation
• Creating products for health plan delivery
• Ownership of enabling products including enrollment, claims processing, underwriting, sales, and marketing
• Partnering with TPMs, UX/UI, and Engineering
• Establishing the Product function
• Defining product roadmap and prioritizing features
• Documenting product requirements
• Leading go-to-market strategies and coordination
• Bringing customer-centric thinking and predictability

Gravie Jobs in New York City

Gravie

Nurse Specialist - Health Plan Operations

Gravie

Director - ICHRA Operations

Gravie

Head of Product - Enablement

Gravie