The Business Intelligence Developer designs, develops, and maintains enterprise-level reporting solutions, dashboards, and semantic models to support organizational analytics. This role collaborates with stakeholders to translate business requirements into actionable insights while ensuring data quality, governance, and performance optimization.
The Case Manager will evaluate beneficiary needs, develop individualized care plans, and coordinate healthcare team members to ensure optimal outcomes. They are responsible for managing caseloads, maintaining accurate documentation, and facilitating integrated disease management activities.
The Case Manager provides personalized care coordination and management for beneficiaries, ensuring compliance with payer standards and regulatory requirements. They collaborate with a multidisciplinary team to address social, physical, and behavioral health needs while advocating for beneficiary preferences.
The Clinical Pharmacist is responsible for performing prior authorization reviews, developing clinical criteria, and providing consultation to support call center operations. They also ensure the accuracy of medication-related software components and assist in training other employees.
The Nurse Case Manager evaluates beneficiary needs to develop and implement individualized care plans while coordinating with healthcare teams. They manage caseloads to ensure compliance with regulatory requirements and facilitate integrated case management activities to improve health outcomes.
The Medical Claims Reviewer is responsible for auditing claims, medical records, and billing information to ensure compliance with coding standards and reimbursement policies. They also provide technical assistance, resolve provider disputes, and support operational improvements through data analysis and policy interpretation.
The Training Coordinator manages training operations by performing accurate data entry in health record systems and coordinating training sessions. They also maintain stakeholder relationships and collaborate with subject matter experts to develop training materials.
The Clinical Reviewer utilizes clinical expertise to review medical records against contract requirements and criteria. They also act as a liaison for providers, manage daily review queues, and ensure compliance with HIPAA and corporate policies.
The Operations Supervisor leads program operations and directly supervises call center or non-clinical support staff to ensure quality service. They are responsible for developing departmental procedures, monitoring business metrics, and managing program coordination and issue resolution.
The Clinical Director oversees all clinical program activities, including utilization management, case management, and quality improvement initiatives. They are responsible for ensuring operational efficiency, regulatory compliance, and effective leadership of clinical staff.
The Senior Test Automation Engineer will lead the design, implementation, and optimization of enterprise-level automation frameworks across complex healthcare systems. This role involves mentoring team members, driving the migration to modern AI-augmented platforms, and ensuring alignment with quality and compliance standards.
Review medical records against clinical criteria and contract requirements, ensuring accurate and timely case processing. Manage daily workloads, support quality monitoring, resolve provider service issues, maintain current clinical knowledge, and cross-train to meet customer needs.
The Vice President of IHS Delivery provides executive leadership for the relationship and coordinated delivery of Global Delivery Organization services to Integrated Health Solutions. They are responsible for translating business needs into clear delivery requirements and ensuring alignment between IHS and GDO capabilities.
The Account Manager will serve as the primary contact for managing and supporting multi-agency federal contracts while ensuring deliverables meet performance standards. They will also facilitate operational activities, manage stakeholder communications, and identify new business opportunities within the federal client base.
The Provider Relations Coordinator manages provider recruitment, enrollment, and onboarding while serving as a liaison between providers, clients, and internal teams. They are responsible for resolving claims and payment disputes, maintaining accurate provider records, and conducting provider education and training.
The EAP Consultant performs clinical telephonic assessments and provides expert consultations for employees and their families. They also offer management consultation services and ensure diligent follow-up while adhering to HIPAA privacy and security regulations.
The Psychiatrist provides clinical leadership for peer and utilization review activities, including conducting medical necessity reviews for state Medicaid plans. They also perform peer-to-peer consultations and represent the organization in state appeal processes.
Review medical center applications against federal standards for risk management, credentialing, and quality improvement. Maintain consistent communication with staff and adhere to strict compliance and security protocols regarding HRSA data systems.
The Clinical Operations Manager supervises and mentors case review teams to ensure quality, contract deliverables, and regulatory compliance. They oversee daily operations, manage workloads, and foster a caring philosophy while facilitating communication across the healthcare team.
The Care Coordinator Supervisor provides leadership and oversight to a team of care coordinators, ensuring effective service delivery and adherence to program requirements. This role monitors team performance, manages escalations, and implements workflow improvements to enhance member experience and operational efficiency.
The Senior Cybersecurity Analyst will provide security status tracking and briefing for cloud service provider systems while ensuring adherence to FedRAMP High and HIPAA guidelines. They will also serve as a liaison between program managers and senior leadership to analyze security posture and manage remediation activities.
The Senior Health Intelligence Analyst serves as the primary point of contact for the analytics department, managing client contract requirements and report delivery. They are responsible for analyzing healthcare data to identify business opportunities, performing quality checks, and facilitating ad hoc reporting for technical teams.
The Medical Coder is responsible for reviewing inpatient medical record documentation to ensure the accuracy, completeness, and clinical validity of diagnoses and procedures. They evaluate DRG assignment, reimbursement impact, and regulatory compliance while identifying and documenting audit findings.
The Community Outreach Supervisor oversees staff executing statewide community outreach plans for Medi-Cal recipients. This role coordinates activities with providers and case management to ensure compliance with state guidance and Medicaid regulations.
The senior programmer will develop, enhance, and maintain core data processing platforms while creating data models for actionable reporting. They will also collaborate with stakeholders to build data pipelines and troubleshoot complex SQL queries and ETL processes.
The Community Engagement Coordinator builds relationships with local healthcare providers and community organizations to support members in transitions of care. They also develop engagement strategies to ensure beneficiaries have timely access to services and resources.
The Clinical Manager provides operational and clinical leadership for care coordination and case management programs to ensure high-quality outcomes and contract compliance. They oversee clinical staff, monitor performance metrics, and collaborate with stakeholders to drive process improvements and program effectiveness.
The Customer Service Representative is responsible for answering incoming calls and resolving customer inquiries, complaints, and requests while adhering to internal policies. They will also perform accurate data entry, investigate provider issues, and serve as a liaison between internal and external partners.
The Vice President of Operations Performance & Planning provides executive leadership for enterprise performance, operational planning, and governance across the organization. This role integrates quality management, client experience, and portfolio planning to drive operational excellence and sustainable growth.
The role involves maintaining the Action Code Database by monitoring CMS regulatory updates and collaborating with internal teams and clients. Additionally, the associate performs utilization management by reviewing medical records to determine the medical necessity and appropriateness of requested services.
The Senior Program Director provides strategic and operational leadership for the CA Care Coordination Program, overseeing program design, daily operations, and regulatory compliance. They manage interdisciplinary teams to ensure equitable, person-centered support while monitoring metrics and collaborating with community partners.
The EAP Consultant performs clinical telephonic assessments, provides consultations, and manages referrals for employees and their families. They also offer management consultation services and ensure adherence to HIPAA privacy and security policies.
The Senior Technical Writer manages the creation and maintenance of high-quality documentation while providing leadership and guidance to junior team members. They collaborate with cross-functional teams to ensure all deliverables align with company standards and project-specific requirements.
The Instructional Design and Training Associate is responsible for writing and editing learning content, creating job aids, and developing training materials for end-users. They also facilitate classroom training, maintain training environments, and collaborate with teams to support onboarding and educational initiatives.
The Senior Technical Writer manages the creation and maintenance of high-quality documentation while providing task leadership to junior team members. They collaborate with cross-functional teams to ensure all materials align with company standards and project-specific requirements.
Conduct administrative and process-based reviews of medical records related to Applied Behavior Analysis services to ensure compliance and medical appropriateness. Collaborate with supervisors on quality monitoring and serve as a liaison for providers regarding authorization requests.
The Medical Director provides clinical leadership and physician oversight for California transition-support services, ensuring member safety and adherence to clinical standards. They also consult with multidisciplinary staff, review complex cases, and support the development of clinical protocols and quality improvement initiatives.
The Care Coordinator identifies and coordinates service delivery for clients by matching them with qualified providers and arranging necessary support services. They also document interactions in electronic databases and educate families on available resources to ensure continuity of care.
The Provider Relations Professional serves as a liaison between the company and the provider network, managing outreach and engagement initiatives. They are responsible for maintaining network coverage, responding to provider inquiries, and ensuring accurate documentation of all interactions.
The AI Business Partner identifies and advances practical AI and automation opportunities to improve operational performance and user experience. They translate business needs into defined use cases and coordinate with cross-functional teams to support the discovery, planning, and delivery of AI initiatives.
The AI Business Partner identifies and advances practical AI and automation opportunities to improve operational performance and user experience within healthcare systems. They translate business needs into structured requirements and coordinate with cross-functional teams to support AI initiatives from discovery through delivery.
The Provider Enrollment Manager oversees daily provider network operations, recruitment, and enrollment programs while maintaining accurate internal and external databases. They serve as the primary point of contact for providers, ensuring compliance with contract deliverables and managing a multi-disciplinary team.
Strategically source, engage, and onboard physicians across various specialties for quality of care and utilization management review work. Manage the provider pipeline, negotiate market-specific rates, and ensure compliance with HIPAA and credentialing requirements.
The Psychiatrist will conduct independent medical service appeal reviews and provide expert testimony for behavioral health cases. They are responsible for evaluating medical necessity, ensuring compliance with guidelines, and collaborating with clinical and administrative staff.
Conduct needs-based eligibility determinations for Medicaid-funded personal care services and assess level of care for patients in home or community settings. Manage the assessment process, including interviews with caregivers, service plan reviews, and participation in mediation or appeal processes.
The Physician Medical Reviewer conducts independent medical service appeal reviews and provides expert testimony for state hearings. They ensure compliance with medical necessity guidelines and collaborate with clinical and administrative staff.
The Developer, Specialist performs end-to-end analysis and implements complex business solutions while serving as a technical lead on development projects. They are responsible for creating technical specifications, evaluating new technologies, and guiding the development team through design and implementation phases.
The Case Manager will evaluate beneficiary needs, develop individualized care plans, and coordinate healthcare team members to ensure optimal outcomes. They are responsible for managing caseloads, maintaining accurate documentation, and ensuring compliance with regulatory requirements.
The peer reviewer will conduct medical record reviews to make standard of care determinations and provide quality improvement recommendations. They are responsible for discussing clinical disease processes and published guidelines while adhering to corporate policies and HIPAA regulations.
The peer reviewer will evaluate medical records to make standard of care determinations and provide quality improvement recommendations. They are responsible for discussing clinical disease processes and adhering to corporate policies including HIPAA.
The Provider Educator develops and delivers training programs to ensure compliance with Medicaid regulations and the WV IDDW Policy Manual. They also conduct provider reviews, provide technical assistance, and manage quality improvement initiatives.
The peer reviewer will evaluate medical records to make standard of care determinations and provide quality improvement recommendations. They are responsible for discussing clinical disease processes and adhering to all corporate policies, including HIPAA regulations.
The developer will be responsible for building and maintaining PHP-based applications while managing databases and cloud infrastructure. They will also implement security measures, automate tasks using BASH scripts, and collaborate with the team on project management.
