The Senior EAP Consultant provides expert management and clinical consultation to support employee well-being and organizational health. Responsibilities include conducting clinical risk assessments, managing high-risk cases, and delivering training sessions in a virtual environment.
The Clinical Care Coordinator will facilitate care coordination and advocacy for patients while conducting medical record reviews to assess medical necessity. They will also collaborate with interdisciplinary teams and ensure compliance with regulatory standards like NCQA and URAC.
The CAP POC Reviewer is responsible for evaluating Home and Community-Based Services waiver requests and Plans of Care to ensure compliance with Medicaid policies. They also document findings, identify documentation gaps, and support process improvement initiatives.
The role involves conducting clinical reviews of service plans and medical records against Medicaid policies and clinical criteria. The reviewer is responsible for ensuring accurate case determinations and maintaining compliance with regulatory standards.
The Clinical POC Reviewer evaluates Home and Community-Based Services waiver requests, Plans of Care, and medical records against clinical criteria and Medicaid policies. They ensure accurate case determinations, maintain productivity standards, and serve as a clinical resource for internal and external stakeholders.
The Senior Test Automation Engineer will lead the design, development, and maintenance of enterprise-level automation frameworks while mentoring junior team members. They are responsible for driving the migration to modern, AI-augmented platforms and ensuring automation aligns with healthcare compliance and security standards.
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.
The Supervisor of Clinical Review manages daily operations for nurse reviewers to ensure contract deliverables and quality standards are met. They also act as a liaison for providers and implement continuous learning plans for the clinical review team.
The Clinical Reviewer utilizes clinical expertise to review medical records against contract criteria and requirements. They also act as a provider liaison for customer service issues and maintain quality monitoring activities.
The Manager of Portfolio Execution maintains operational rigor and visibility across the Operations portfolio by driving cadence and tracking initiative health. This role translates complex operational data into actionable insights for leadership and coordinates cross-functional dependencies to ensure successful delivery.
The Medical Claims Reviewer is responsible for auditing claims, medical records, and billing documentation to ensure compliance with Medicaid and program regulations. They also investigate billing irregularities, resolve provider disputes, and provide operational analysis to support program effectiveness.
The Customer Service Representative is responsible for answering incoming calls and resolving customer inquiries while adhering to internal policies and HIPAA regulations. They will also perform data entry, investigate provider issues, and serve as a liaison between internal and external partners.
The Scheduler is responsible for coordinating assessment and follow-up appointments while managing complex calendars across multiple assessors. They also handle data entry into the Atrezzo system, monitor shared inboxes, and maintain professional relationships with stakeholders and families.
The Clinical Quality Manager oversees training and quality assurance activities for the Colorado Medicaid Utilization Management contract. They are responsible for performance monitoring, staff management, and collaborating with stakeholders to implement process improvements.
The Program Director provides strategic and operational leadership for a comprehensive Care Coordination program, overseeing program design, daily operations, and workforce performance. They collaborate with clinical and operational teams to ensure regulatory compliance, quality outcomes, and effective service delivery for high-risk populations.
The Business Analyst is responsible for analyzing complex business problems, identifying gaps, and developing technical solutions for Provider Enrollment and screening subsystems. They act as a bridge between IT teams and clients, managing the end-to-end requirements lifecycle and facilitating design sessions.
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 Business Analyst Specialist is responsible for the logical design and functional behavior of complex information systems, specifically for provider payments and Oracle Financials. They collaborate with stakeholders to elicit requirements, develop technical solutions, and ensure alignment with strategic business visions.
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 EAP Consultant provides comprehensive tele-mental health services, including direct counseling, outreach, and referrals to employees and their families. They are responsible for maintaining clinical case records, managing high-risk cases, and collaborating with internal and external stakeholders to ensure high-quality service delivery.
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 Business Operations Manager leads day-to-day operations for provider screening, enrollment, and monitoring while ensuring compliance with client service level agreements. They oversee functional teams, manage vendor relationships, and drive continuous improvement initiatives to enhance organizational performance.
The Provider Enrollment Manager oversees daily provider network operations, recruitment, and enrollment programs while maintaining accurate internal and external databases. They act as the primary point of contact for providers, ensuring compliance with contract deliverables and managing a multi-disciplinary team.
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 Pricing Manager is responsible for developing, analyzing, and supporting pricing strategies and cost estimates to ensure profitable growth and competitive positioning. This role involves collaborating with cross-functional teams to build accurate financial models and ensure compliance with government contracting regulations.
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.
Conduct comprehensive, needs-based eligibility assessments for individuals applying for Medicaid-funded personal care services. Ensure assessments are completed within established timeframes while maintaining privacy and dignity standards.
Conduct comprehensive needs-based eligibility assessments for Medicaid-funded patients and determine level of care requirements. Ensure assessments are completed within established timeframes while maintaining privacy and dignity standards.
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 Banking Operations Analyst manages daily cash flow, treasury functions, and payment processing to ensure financial integrity. They also serve as a primary liaison with banks and fiscal offices while maintaining compliance with financial regulations and internal controls.
The Senior Compensation Analyst will design and administer compensation programs, including base pay, incentives, and sales commissions, to align with company objectives. They will also conduct market research, maintain job architecture, and provide guidance to HR and management on pay decisions.
The Operational Readiness Professional ensures that systems, processes, and workflows are fully prepared for launch and aligned with CMS contract requirements. They lead readiness assessments, manage milestone plans, and collaborate with cross-functional teams to mitigate risks and ensure operational success.
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.
