The Complex Care RN serves as the clinical center of a virtual care pod, managing the member journey and coordinating care for high-acuity Medicare Advantage members. Responsibilities include conducting medication reconciliations, managing transitions of care, and facilitating cross-disciplinary communication to ensure cohesive care delivery.
The UM Coordinator manages daily census, retrieves medical records, and assists with discharge planning for inpatient care. They are responsible for entering referral requests and authorizations while maintaining accurate member records and facility documentation.
The Associate Vice President owns the enterprise strategy for identifying and remediating systemic issues that cause incorrect claim payments. This role leads cross-functional teams to drive operational excellence, improve data accuracy, and reduce reliance on retrospective recovery.
The Associate Vice President leads the encounter data function, ensuring accurate and timely Part C and Part D submissions to CMS. They are responsible for designing the operating model, managing cross-functional accountability, and remediating systemic data defects.
Assess, coordinate, implement, and monitor care plans for members with complex or chronic needs, ensuring access to appropriate, cost-effective services across the care continuum. Collaborate with providers, members, and families to coordinate authorizations and referrals, resolve care issues, and evaluate outcomes.
The inpatient review nurse assists patients through the continuum of care by collaborating with physicians and facility staff to ensure appropriate, cost-effective medical services. They perform inpatient reviews, manage referrals, and coordinate care activities while maintaining safety and quality standards.
The Customer Experience Specialist provides compassionate, seamless service to members by resolving inquiries and building caring connections. They are responsible for documenting interactions, managing complex situations, and supporting outreach initiatives to improve member engagement.
The Customer Experience Specialist provides compassionate, seamless service to members by resolving inquiries and building caring connections. They are responsible for documenting interactions, managing complex member issues, and supporting outreach initiatives to improve the overall member experience.
The Senior HR Business Partner acts as a strategic advisor to senior leaders, translating business goals into workforce capability and organizational design. They own the People & Organization Operating Plan and drive integrated talent strategies to support company growth and scaling.
The Vice President of Payment Integrity will lead the enterprise strategy for payment accuracy, affordability, and medical cost performance. This role involves managing vendor partnerships, overseeing prepay and postpay programs, and driving the transition toward prospective payment prevention.
Build and maintain collaborative relationships with physician practices to improve performance metrics such as quality, growth, and utilization. Conduct provider onboarding, education, and serve as a primary point of resolution for operational issues.
The Principal serves as the technical authority for enterprise data governance, designing and implementing platforms for metadata, master data, and data quality. They collaborate with engineering and architecture teams to embed governance controls into data pipelines and ensure automated, scalable, and auditable data management.
The Advanced Practice Clinician conducts in-home assessments, medication reviews, and health screenings for patients to prevent unnecessary hospitalizations. They also collaborate with a multidisciplinary team to develop and implement effective care plans for seniors.
The RN Case Manager coordinates comprehensive care for members with complex and chronic needs by developing treatment plans and facilitating referrals. They also provide education and self-management support while maintaining effective communication with patients, caregivers, and interdisciplinary care teams.
The MRA Coding Auditor performs quality assurance audits on internal coding teams and vendors to ensure accurate data submission to CMS. They also analyze audit results to identify opportunities for clinical documentation improvement and provide training to staff.
The HCC Coding Analyst monitors and implements coding strategies to ensure accurate data submission to CMS while conducting ongoing audits. They also develop educational tools for providers and support the Risk Adjustment Management team in compliance and training activities.
Build and maintain collaborative relationships with physician practices to improve performance metrics such as quality, growth, and utilization. Conduct provider onboarding, education, and serve as a point of resolution for operational issues while documenting engagement activities.
The Medical Director performs clinical reviews for medical necessity and compliance while collaborating with the healthcare services team to optimize institutional and outpatient service utilization. They also provide clinical leadership for quality projects, oversee interdisciplinary teams, and manage the claim denial and appeals process.
The Remote Outreach Concierge Navigator provides specialized support to members by assisting with healthcare navigation, benefit education, and care coordination. They act as a liaison between members, providers, and health plan operations to ensure quality care and issue resolution.
The Regional Medical Officer provides strategic and operational direction for clinical performance and financial outcomes within a designated region. They are responsible for managing clinical divisions, developing provider relationships, and overseeing clinical staff including Advanced Practice Clinicians.
The AVP of Contracting & Network Management leads the strategic development, negotiation, and execution of provider network contracts with a focus on hospital systems. This role drives innovative contracting strategies, optimizes network design, and ensures financial performance and regulatory compliance for Medicare Advantage populations.
The Senior Analyst serves as the technical subject matter expert for Oracle Cloud Financials, ensuring the stability and optimization of the General Ledger and financial close processes. They are responsible for automating close workflows, managing sub-ledger integrations, and ensuring compliance with US GAAP, SOX, and CMS regulatory standards.
The role involves designing and maintaining high-volume data pipelines between Oracle Cloud Financials and the enterprise data ecosystem. The engineer will also serve as a technical escalation point for integration incidents and ensure financial data compliance and security.
The Community Outreach Representative will generate qualified leads by representing the organization at local events and building partnerships with community leaders and healthcare providers. They are responsible for educating prospective members on healthcare benefits and coordinating community engagement initiatives.
Conduct in-home assessments, medication reviews, and health screenings for patients to prevent unnecessary hospitalizations. Collaborate with the medical team to develop care plans and coordinate services with PCPs, specialists, and ancillary providers.
The RN Case Manager provides telephonic case management for medically complex members by conducting health assessments and creating individualized care plans. They also coordinate care with partners, educate members on disease management, and monitor progress to ensure timely interventions.
The Associate Regional Medical Officer provides strategic and operational direction for clinical performance and financial outcomes within the Care as a Service offering. They are responsible for managing clinical divisions, overseeing staff, and ensuring high-quality patient care across hospital, clinic, and skilled nursing settings.
The AVP provides executive leadership for enterprise Risk Adjustment performance strategy, overseeing prospective, concurrent, and retrospective programs. The role is accountable for achieving annual RAF performance objectives, managing vendor partnerships, and driving provider engagement to ensure financial and operational success.
Conduct in-home clinical assessments, medication reviews, and health screenings for senior patients. Coordinate care plans with medical teams and lead a multidisciplinary clinical team to prevent unnecessary hospitalizations.
The Advanced Practice Clinician conducts in-home assessments, medication reviews, and health screenings to provide medical and social support to patients. They also coordinate care with PCPs and specialists while leading a clinical team of nurses, social workers, and care coordinators.
The Director of Provider Enrollment leads end-to-end provider onboarding, contract implementation, and delegated credentialing operations across the health plan. This role ensures regulatory compliance, data accuracy, and operational efficiency while partnering with cross-functional teams to support network readiness.
The Data Scientist will model member survey response and satisfaction behavior to identify operational drivers of CAHPS performance. They will translate these analytical insights into targeted interventions to improve Star Rating outcomes.
The Vice President of Operational Excellence leads enterprise transformation initiatives to drive organizational performance and strategic execution across the Medicare Advantage health plan. This role oversees strategic planning, capital investment governance, and cross-functional process improvement programs to deliver measurable value.
The AI Automation Engineer will design, build, and deploy intelligent AI systems and automated workflows to improve operational efficiency and care quality. They will collaborate with cross-functional teams to integrate production-grade AI solutions, including LLMs and RPA, into enterprise healthcare workflows.
The Advanced Practice Clinician conducts in-home assessments, medication reviews, and health screenings to provide medical and social support to seniors. They also coordinate care with PCPs and specialists while leading a clinical team to develop effective care plans.
The RN Case Manager coordinates comprehensive care for members with complex and chronic needs by developing treatment plans and facilitating referrals. They act as a primary resource for members and their families while collaborating with interdisciplinary teams to resolve barriers to care.
The Implementation Manager leads the end-to-end planning, execution, and operational deployment of strategic technology solutions and third-party vendor integrations. They serve as the primary liaison between internal business teams, IT, and external partners to ensure projects meet regulatory, budgetary, and operational objectives.
The Data Scientist will model member-level health trajectories and identify clinical drivers of HOS measure performance to improve Star Ratings. They will also build analytical pipelines, deploy machine learning models, and collaborate with clinical teams to translate insights into targeted interventions.
Conduct daily in-home visits to provide wellness coaching, health education, and support for behavior change to senior members. Collaborate with clinical teams and social workers to develop action plans and connect members with community resources.
The Vendor Management Director establishes and leads the enterprise vendor management function for the Medicare Advantage health plan, ensuring alignment with regulatory and operational goals. This role oversees strategic partnerships, manages vendor performance, and mitigates operational, financial, and compliance risks.
The Senior Director of Capital Planning leads enterprise-wide capital allocation, investment governance, and strategic resource planning for a Medicare Advantage health plan. This role collaborates with executive leadership to optimize investment portfolios, ensure regulatory compliance, and drive financial performance through disciplined underwriting and benefit realization.
The Member Lifecycle Director defines and executes strategies to improve member operations across the entire lifecycle, including acquisition, engagement, and retention. This role leads cross-functional initiatives to redesign processes, implement technology solutions, and establish scalable operating models to enhance business performance.
The Customer Experience Specialist provides compassionate, seamless service to members by resolving inquiries and building caring connections. They are responsible for documenting interactions, navigating complex healthcare systems, and advocating for members to ensure first-call resolution.
The Data Governance Analyst is responsible for executing governance practices, including data quality monitoring, metadata management, and lifecycle tracking. This role involves investigating data anomalies, collaborating with technical teams to resolve quality issues, and ensuring compliance with healthcare regulatory standards.
The provider will conduct in-home assessments and manage complex care plans for high-risk senior patients to prevent unnecessary hospitalizations. They will collaborate with a multidisciplinary team to provide medical and social support while ensuring effective disease management.
The RN Case Manager coordinates care for members with complex and chronic needs by assessing health status and implementing treatment plans. They serve as a primary resource for members and their families while collaborating with interdisciplinary teams to resolve barriers to care.
The UM Coordinator manages daily census, admissions, and discharge planning while coordinating with the case management team. They are responsible for retrieving medical records, entering authorizations using ICD-10 and CPT codes, and maintaining accurate member documentation.
The specialist will build and maintain collaborative relationships with providers to improve performance in quality, growth, and utilization metrics. They will also conduct provider onboarding, education, and serve as the primary point of contact for operational issues.
The Director of Analytics & Reporting leads a team of professionals to execute analytics strategy through scalable capabilities and disciplined delivery. This role partners with cross-functional leaders to convert business needs into actionable insights and analytical solutions.
The Complex Care RN acts as a clinical quarterback for high-risk Medicare Advantage members, managing care transitions and chronic disease management. They collaborate with a multidisciplinary team to provide proactive, member-centered care through virtual engagement.
The VP of Compliance is responsible for leading and evolving the enterprise-wide compliance program, ensuring adherence to CMS and state regulatory frameworks. This role also involves driving compliance monitoring, managing HIPAA privacy governance, and providing strategic regulatory guidance to executive leadership.
The Financial Planning & Analysis Manager assists in budgeting, forecasting, and financial reporting to evaluate business performance. They also build complex financial models and prepare presentations for senior management and investors.
The Senior AI & Automation Engineer will architect and deploy production-grade AI and machine learning systems to improve clinical and operational performance. This role involves leading complex automation initiatives, mentoring junior engineers, and ensuring the scalability and reliability of AI infrastructure within a regulated healthcare environment.
The Vice President of Vendor Management oversees the performance, governance, and strategic alignment of the health plan's vendor ecosystem. This role ensures that all partners deliver high-quality, compliant, and cost-effective services while mitigating operational and financial risks.
The Advanced Practice Clinician conducts in-home assessments for senior patients, including physical exams, medication reviews, and chronic disease management. They work within an interdisciplinary team to coordinate care, identify gaps in treatment, and provide education to patients and their families.
The Senior Director of Healthcare Analytics leads the organization's program evaluation and causal analytics capability to assess clinical and operational interventions. This role establishes analytic standards, quantifies ROI and quality outcomes, and partners with cross-functional teams to drive data-informed decision-making.
The Customer Experience Specialist provides compassionate, end-to-end support to senior members and individuals with disabilities regarding their healthcare benefits and services. They are responsible for resolving inquiries, documenting interactions accurately, and advocating for members to ensure a seamless and supportive experience.
Conduct in-home assessments for senior patients, including physical exams, medication reviews, and chronic disease management. Collaborate with an interdisciplinary team to coordinate care and communicate findings to primary care providers.
The clinician will conduct in-home assessments for senior patients, including physical exams, medication reviews, and chronic disease management. They will work within an interdisciplinary team to coordinate care and provide education to patients and their families.
The VP is responsible for the strategic, operational, and regulatory oversight of member and non-contracted provider appeals and grievances programs. This role drives enterprise-level performance, ensures CMS compliance, and leads a multi-layered team to improve quality and member outcomes.
The Health Coach and Educator conducts home and virtual visits to provide wellness coaching, education, and support to seniors and their families. They collaborate with clinicians to develop action plans and assist patients in accessing community resources to improve health outcomes.
The Broker Account Manager is responsible for driving sales growth within the broker channel by managing relationships, recruitment, and training. They ensure compliance with CMS guidelines and oversee all channel activities including sales production and strategy.
The AVP will lead the strategy and execution of advanced analytics to optimize performance for the Medicare Star Ratings Program. This role involves building predictive models, generating actionable insights, and partnering with cross-functional leaders to drive clinical and operational improvements.
Conduct in-home visits to provide psychosocial assessments, care coordination, and resource navigation for medically complex seniors. Collaborate with an interdisciplinary team to address social determinants of health and develop individualized care plans.
The Provider Engagement Specialist develops and maintains strong relationships with provider offices to improve network performance and satisfaction. They partner with providers on strategies to increase patient retention and growth while driving performance across key quality and utilization metrics.
The Care Management Trainer is responsible for onboarding, training, and developing clinical and non-clinical staff within the Care Management department. This role also involves performing call and chart quality audits to drive compliance and providing targeted coaching to staff.
The Senior Director is responsible for the vision, strategy, and performance of the enterprise delegated oversight function. They ensure delegated partners meet clinical, operational, financial, and regulatory expectations while driving value-based performance.
The Director of AI & Automation Engineering will define and execute the enterprise AI strategy to support Medicare Advantage operations. They will lead a multi-disciplinary team to design and scale intelligent automation solutions that improve clinical quality and operational efficiency.
Lead the end-to-end Medicare Risk Adjustment data ecosystem, ensuring the integrity and completeness of data for submissions and reconciliation. Manage a multidisciplinary team of analysts and engineers to provide actionable insights and maintain audit readiness for senior leadership.
The Lead UM Nurse reviews inpatient and prior authorization requests while overseeing a team of UM Nurses to ensure high-quality medical outcomes. They act as a liaison between management and staff, providing coaching, training, and operational support to maintain program compliance.
Responsible for delivering advanced reporting, predictive insights, and operational intelligence for a 24/7 contact center. The role involves transforming complex data into actionable intelligence to drive service excellence and ensure CMS regulatory compliance.
The Customer Success Lead manages complex and high-visibility member escalations while providing real-time guidance and coaching to frontline Specialists. This role balances direct member interaction with operational oversight to ensure high-quality service recovery and regulatory compliance.
The Regional Concierge Navigator provides outreach and support to members to help them navigate healthcare benefits and access necessary care. They act as a liaison between members, providers, and health plan operations to ensure coordinated care and resolve member issues.
Deliver compassionate, end-to-end service to seniors and individuals with disabilities by resolving inquiries regarding benefits, eligibility, and claims. The role involves managing high call volumes, documenting interactions in real-time, and advocating for members to ensure first-call resolution.
Define the technical strategy and architect enterprise-wide AI capabilities to support healthcare business goals. Lead the research and deployment of advanced ML solutions, including LLM agents and predictive engines, while establishing organizational standards for AI governance.
Provide specialized outreach and support to senior members to help them navigate healthcare benefits and access care. Coordinate between provider networks and members while managing case follow-ups and resolving eligibility or pharmacy needs.
Act as a brand ambassador to generate qualified leads and build partnerships with community organizations to drive Medicare Advantage enrollment. Coordinate outreach events and educate prospective members on plan benefits while maintaining strict CMS compliance.
Lead the member marketing and communications strategy to drive performance improvement across key healthcare programs. Design and execute integrated multi-channel campaigns while collaborating with cross-functional teams to achieve organizational OKRs.
The Sr. Territory Manager is responsible for generating leads and meeting sales goals for new enrollments while retaining existing members. This involves building relationships with contracted providers and community affiliates through local area marketing and presentations.
Partner with RN case managers to support members through transitions of care following hospital or SNF discharges. Responsibilities include scheduling appointments, coordinating home health and DME services, and managing member documentation.
The Medical Director performs clinical reviews for medical necessity and treatment appropriateness while ensuring compliance with Medicare and CMS guidelines. They also collaborate with interdisciplinary teams to optimize service utilization and oversee quality outcomes.
The Provider Engagement Specialist is responsible for developing and maintaining strong relationships with provider offices to improve network performance and enhance provider satisfaction. This role partners with providers on strategies to increase patient retention and growth while driving performance across key quality and utilization metrics.
