Our teams

Access Call Center

Our Access Call center team is available 24 hours a day, 7 days a week, and 365 days a year. If you are a member or caregiver who wishes to start receiving services, you can call us anytime. If you are having a crisis, have questions about coverage, or need help finding a provider, call our team to get help.

Care Coordination

Working directly with members and their families to coordinate treatment needs and partnering with providers of youth services and other community stakeholders, the Care Coordination team is at the core of our mission. These individuals help identify and secure housing and treatment for children, their families, and adults, all living with unique needs.

Clinical Operations

With oversight of all clinical utilization, our Clinical Operations team designs organizational strategies based on utilization patterns and trends to improve outcomes for our members. This team is also responsible for providing prior approval for services, eligibility and enrollment, appeals and denials, data analytics, and follow-up after inpatient admissions.

Community Operations

Our Community Operations team focuses on engaging our members and communities. Our team promotes awareness around the unique needs of the people we serve by working with key community partners for outreach, education, and training. We also help people with navigating the public health care system and provide free health education to help prevent increased health risks.

Community Relations

These regional teams serve as the primary representative of our organization in the communities we serve. These teams work with our community advisory boards, county leaders, elected officials, and key community stakeholders to ensure we are engaged with and responsive to our communities.

Cultural Competence

The Cultural Competence team designs and implements policies, programs, education, and training, both internally and externally, to ensure that our members have access to culturally competent and safe care. If you are a network provider learning to communicate effectively in cross-cultural situations, speak to our Cultural Competence team. Learn about reducing language and cultural barriers.

Ethics and Compliance

The Ethics and Compliance Department ensures that we comply with all applicable federal and state laws, regulations, policies, and procedures. It also champions the highest ethical standards in all organizational operations and activities. The department has four units: Compliance and Privacy, State Compliance, Internal Audit, and Program Integrity.

Finance

Our finance teams oversee all financial operations of the organization, including budgeting, accounts payable and receivable, financial reporting, payroll, and reimbursement rates.

Medical Department

Network Management

Our team of Network Specialists support our network of providers to comply with and maintain network status. Each contracted provider is assigned a Network Specialist for support with application and enrollment, credentialing, re-credentialing, and termination.

Service Center

Our Service Center team focuses on customer service to our contracted providers for claims processing, payments, and provider enrollment and contracting. If you are a provider and have questions about payments and claims, contact our Service Center team.

Quality Management

Our Quality Management (QM) team makes sure the quality of care provided to our members meets or exceeds federal and state standards and regulations. The QM team oversees all internal and external quality improvement activities, including Cardinal Innovations’ National Committee for Quality Assurance (NCQA) accreditation. Our member, provider and stakeholder grievance process is also managed by our QM team.