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 quality outcomes.
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 Director leads cross-functional initiatives to improve operational performance, scalability, and efficiency across the organization. They partner with business leaders to redesign processes, implement sustainable solutions, and drive strategic transformation efforts.
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 auditor conducts provider and coder level reviews to ensure accurate risk adjustment data submission to CMS. They also monitor coding prevalence, manage tracking tools, and oversee corrective action plans related to audit findings.
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 Enterprise Data Architect designs and governs the data architecture to support clinical and business workflows across Medicare Advantage lines of business. This role integrates complex healthcare data sources and establishes governance frameworks to ensure data quality, security, and regulatory compliance.
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 Auditor conducts risk-based Utilization Management and Case Management audits to ensure delegated entities comply with regulatory and contractual requirements. They also facilitate communication with delegated providers, validate corrective action plans, and report findings to support organizational performance improvement.
The supervisor oversees the member experience team, monitoring agent performance and ensuring high-quality service delivery for healthcare members. They are responsible for optimizing procedures, managing daily assignments, and conducting performance coaching to meet organizational goals.
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 Health Coach and Educator conducts home and virtual visits to provide wellness coaching, support, and education to seniors and chronically ill patients. They collaborate with clinical teams to develop action plans and assist patients in accessing community resources to improve health outcomes.
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.
The Business Solutions Engineer identifies operational challenges and designs, implements, and supports technology and process solutions to improve business performance. This role partners with cross-functional teams to deliver scalable workflows, data products, and integrations that enhance operational efficiency.
The Health Coach & Educator conducts home and virtual visits to provide wellness coaching, support, and education to patients and their families. They collaborate with clinicians to develop action plans and assist patients in accessing community resources to address social determinants of health.
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 Data Scientist will develop analytical models and predictive tools to support pharmacy strategy and Medicare Advantage Part D Star measures. They will collaborate with leadership to translate business problems into actionable insights and deploy scalable, production-ready analytical solutions.
The Sr. Director leads the value-based contracting strategy, negotiating complex provider arrangements to drive total cost and quality performance. They are responsible for managing the full contracting lifecycle, analyzing medical claims data, and leading a team of contracting professionals.
The Sr. Director of CDO Strategic Growth is responsible for driving membership growth, enrollment performance, and market expansion across four key markets. This role leads a growth team and collaborates with internal and external stakeholders to execute multi-channel strategies that convert physician partnerships into sustained enrollment.
The manager oversees the day-to-day operations of an integrated care management team to ensure compliance with CMS Model of Care requirements. They are responsible for monitoring performance metrics, driving quality outcomes, and collaborating with cross-functional teams to support Medicare Advantage SNP members.
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 Provider Lifecycle Director is responsible for defining and executing a multi-year strategy to improve provider operations across the health plan. This role leads cross-functional transformation initiatives to enhance operational performance, compliance, and provider experience through process redesign and technology enablement.
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 Director leads the data analysis team to define end-to-end data requirements and ensure the quality and interoperability of data across the Medicare Advantage platform. This role manages data operations, resolves production issues, and collaborates with cross-functional stakeholders to drive trusted analytical outcomes.
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 Provider Engagement Specialist builds and maintains relationships with provider offices to improve network performance and quality metrics. They serve as the primary point of contact for provider education, onboarding, and resolution of operational issues.
The clinician will conduct in-home medical assessments, medication reviews, and health screenings for senior patients. They will also coordinate care plans with a multidisciplinary team to prevent unnecessary hospitalizations and manage chronic diseases.
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 Vice President leads the implementation of Medicare Advantage health plan expansions and enterprise technology initiatives to ensure operational scale and regulatory compliance. This role manages cross-functional teams to drive market launch readiness, system integration, and organizational performance goals.
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 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 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 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 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 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 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 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.
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.
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 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.
The Complex Care RN manages the clinical journey for high-acuity Medicare Advantage members within a virtual care pod. Key duties include coordinating transitions of care, performing medication reconciliations, and escalating clinical concerns to providers.
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.
Serve as the technical subject matter expert for Oracle Cloud Financials' General Ledger and Financial Close environment to ensure stability and optimization. Manage system configurations, automate close processes, and ensure financial reporting meets US GAAP, SOX, and CMS regulatory standards.
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.
