The Supervisor of Clinical Review manages daily operations for nurse reviewers to ensure contract deliverables and quality standards are met. They are responsible for assessing workloads, identifying training needs, and acting as a liaison for provider customer service issues.
The Development Manager will supervise developers and oversee the delivery of application support and maintenance for assigned projects. They are responsible for providing technical leadership, managing administrative employee functions, and ensuring coding standards and best practices are enforced.
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.
Conduct administrative and process-based reviews of medical records for Applied Behavior Analysis services to ensure compliance with contractual requirements. Act as a liaison for providers and manage review queues to support the prior authorization program.
The Project Manager leads complex, high-risk strategic projects by overseeing end-to-end planning, execution, and delivery while managing teams of up to 100 employees. They are responsible for maintaining project budgets, tracking performance metrics, and fostering strong relationships with clients to ensure contractual obligations are met.
The Systems Analyst will analyze system requirements, develop technical design documentation, and create flowcharts to define automation needs. They are also responsible for troubleshooting production issues, managing code releases, and collaborating with team members to ensure system reliability.
The Provider Educator develops and delivers training programs to ensure compliance with Medicaid regulations and the WV IDDW Policy Manual. They also provide technical assistance, conduct provider audits, and manage quality improvement initiatives.
The Case Manager RN provides personalized care coordination and management for beneficiaries across various health services. They collaborate with a multidisciplinary team to ensure optimal outcomes, regulatory compliance, and effective care delivery.
The Quality Assurance Analyst evaluates interaction quality across voice and digital channels using AI tools to drive continuous improvement. They also facilitate calibration sessions, analyze performance data, and provide actionable insights to leadership to ensure contractual compliance.
The Clinical Operations Manager oversees daily clinical review and leave administration functions, ensuring compliance with FMLA and organizational policies. This role leads clinical teams, monitors operational performance, and serves as a liaison between stakeholders to drive process improvements and business outcomes.
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 Operations Director manages day-to-day business or system operations for assigned programs, ensuring quality service and effective stakeholder coordination. They are responsible for directing maintenance activities, implementing process improvements, and overseeing client-specific SLAs to meet operational goals.
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 Training and Education Coordinator develops and implements provider training programs and quality assurance activities to support Utilization Management services. This role conducts audits, monitors compliance trends, and collaborates with leadership to improve operational performance and service excellence.
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 BCBA Clinical Reviewer conducts administrative and process-based reviews of medical records to ensure Applied Behavior Analysis (ABA) services meet contractual and medical appropriateness criteria. The role involves managing review queues, collaborating with stakeholders, and serving as a liaison for providers to facilitate resolution of service issues.
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.
The Developer, Specialist will design and implement complex software 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 the software development lifecycle.
The Program Director manages and oversees complex healthcare programs to ensure they are executed effectively, on time, and within budget. They serve as a primary point of contact for stakeholders and collaborate with cross-functional teams to improve program efficiency and outcomes.
Lead day-to-day business operations for provider screening, enrollment, and monitoring while managing a team of 35-50 resources. Ensure compliance with client Service Level Agreements (SLAs) and drive continuous improvement initiatives to enhance organizational performance.
Provide comprehensive tele-mental health EAP services, including direct counseling and outreach to employees and their families. Manage a clinical caseload while collaborating with stakeholders to optimize product enhancement and ensure high-quality client care.
Oversee daily provider network recruitment and enrollment operations while maintaining internal databases and client communications. Manage a multi-disciplinary team of up to 15 coordinators and specialists to ensure contract deliverables and deadlines are met.
The VP of Strategic Pricing will set the vision for the pricing function and lead the development of complex cost models and pricing strategies for RFP responses. This role involves partnering cross-functionally to ensure competitive, compliant, and profitable pricing aligned with enterprise objectives.
Responsible for the logical design and functional behavior of complex information systems for Provider Payments using Oracle Financials. The role involves eliciting requirements from stakeholders, developing 'to-be' operating models, and ensuring alignment with strategic business visions.
The AI Engineer will productize AI Proof of Concepts by building production-grade LLM services, RAG pipelines, and agentic workflows. They will also implement evaluation guardrails, MLOps practices, and ensure healthcare-grade security and observability.
The Case Manager provides trauma-informed, person-centered care coordination for individuals with behavioral health or functional needs. Key duties include developing service plans, coordinating across medical and social service systems, and ensuring compliance with OHA and CMS regulations.
Design, develop, and maintain scalable data pipelines to integrate healthcare and enterprise data from various sources. Transform raw data into meaningful insights while ensuring data quality, integrity, and compliance with healthcare regulations.
Review medical records to make standard of care determinations and provide quality improvement recommendations. Reports must discuss clinical disease processes, published guidelines, and overall care provided.
The Systems Analyst Specialist provides advanced expertise in Medicaid software products to deliver technical solutions and improve processes for complex business requirements. They act as a subject matter expert throughout the software development lifecycle, coordinating implementation and providing technical support to global teams.
Review medical records to make standard of care determinations and provide quality improvement recommendations. Reports must discuss clinical disease processes, published guidelines, and overall care provided.
Develop and analyze pricing strategies, cost models, and financial estimates to support profitable growth and competitive positioning. Collaborate with cross-functional teams to create compliant pricing solutions for government healthcare proposals and contract modifications.
The Case Manager evaluates beneficiary needs to develop individualized care plans and coordinates with healthcare teams to optimize outcomes. They manage caseloads and ensure all documentation adheres to regulatory requirements and CMSA principles.
Perform needs-based eligibility determinations and level of care assessments for Medicaid-funded patients. Conduct comprehensive assessments with youth and guardians to ensure appropriate service delivery based on clinical needs.
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 adhering to all corporate policies, including HIPAA regulations.
The Clinical Social Worker will conduct comprehensive, needs-based eligibility assessments for individuals applying for Medicaid-funded personal care services. They will evaluate level-of-care criteria and collaborate with treatment teams to ensure appropriate service delivery while maintaining privacy and documentation standards.
The Clinical Reviewer uses clinical expertise during beneficiary interaction to communicate medical appropriateness while meeting production goals and quality assurance standards. Responsibilities include assessing daily workload, collaborating on quality monitoring, acting as a liaison for providers, and maintaining current knowledge of review processes.
