Provide telephonic case management for medically complex and chronically ill members by conducting health assessments and creating individualized care plans. Coordinate care with internal and external partners while educating members on disease management and monitoring their progress.
The Scheduling Specialist provides outreach and support to ensure members have access to clinical programs and assists in navigating their healthcare journey. Responsibilities include managing inbound and outbound calls, scheduling appointments, and maintaining accurate member data in company systems.
The Sr. Data Quality Analyst leads strategic initiatives to improve the accuracy, integrity, and governance of provider data across the organization. This role collaborates with cross-functional teams to implement data quality frameworks, monitor directory performance, and ensure regulatory compliance.
The Customer Experience Specialist provides compassionate, end-to-end support to members by resolving inquiries regarding benefits, eligibility, and services. They are responsible for documenting interactions accurately and proactively addressing member concerns to ensure high-quality service and continuity of care.
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 Customer Experience Specialist provides compassionate, seamless service to members by resolving inquiries regarding benefits, eligibility, and support services. They are responsible for documenting interactions, managing complex situations with professionalism, and advocating for members to ensure a positive experience.
The AI Automation Engineer will design, build, and deploy intelligent AI systems and automated workflows to improve operational efficiency and member care. They will collaborate with cross-functional teams to integrate machine learning models and automation into production-grade enterprise solutions.
The Principal defines and executes the technical architecture for enterprise data governance, including metadata, master data, and data quality platforms. They collaborate with engineering teams to embed governance controls directly into data pipelines and ensure production-grade performance and auditability.
The inpatient review nurse performs utilization reviews for complex medical cases to ensure appropriate, cost-effective care. They collaborate with healthcare teams to coordinate patient discharge planning and manage referrals to ancillary service providers.
The UM Coordinator assists with managing daily census, admissions, and discharge planning while retrieving and attaching medical records to authorizations. They are responsible for entering referral requests using ICD-10 and CPT coding and maintaining accurate member records.
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 transformation, improve payment accuracy, and reduce reliance on retrospective recovery.
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 advocating for members to ensure high-quality care.
The Supervisor oversees the SNP Care Coordination team to ensure compliance with program requirements, including health risk assessments and care plan development. They are responsible for mentoring staff, managing workflows, and collaborating with management to improve departmental performance.
The RN Case Manager provides telephonic case management for medically complex members, conducting health assessments and creating individualized care plans. They coordinate care with internal and external partners while educating members on disease management and monitoring progress.
The Financial Operations Manager will lead the evolution of FP&A by integrating operational performance data with financial outcomes. This role involves modernizing budgeting and forecasting processes while driving cross-functional collaboration to ensure alignment between financial goals and operational realities.
The SVP provides executive leadership for the Transformation and Execution Office, overseeing vendor management, enterprise implementations, and operational excellence. They are responsible for the enterprise roadmap, capital planning, and ensuring all transformation initiatives align with clear financial or operational outcomes.
The Health Coach & Educator conducts home and virtual visits to provide wellness coaching, support, and education to patients and their families. They collaborate with clinical teams to develop action plans and assist patients in accessing community resources to address social determinants of health.
The manager leads strategic operational initiatives to improve customer experience, call center performance, and first call resolution. They are responsible for cross-functional collaboration, process optimization, and managing team performance to ensure high-quality member interactions.
The Clinical Pharmacist I will manage Medicare Part D coverage determinations, appeals, and prior authorizations while ensuring compliance with CMS regulations. Additionally, the role involves conducting Medication Therapy Management (MTM) services and comprehensive medication reviews to improve patient outcomes and adherence.
The Actuarial Analyst II performs actuarial analyses supporting Medicare Advantage pricing, forecasting, reserving, and risk adjustment. They also develop models and reporting while collaborating with cross-functional teams to identify financial risks and trends.
The Care Coordinator conducts high-volume outbound telephonic outreach to members following hospital and skilled nursing facility discharges to coordinate follow-up care. They are responsible for engaging members, scheduling appointments, managing referrals, and maintaining accurate documentation in the case management system.
Supervise member experience and call center teams, oversee proactive outreach, and ensure strong service levels, member retention, satisfaction, and engagement. Monitor agent performance and quality, manage assignments and schedules, coach employees, support hiring and onboarding, and protect member privacy and data security.
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 support corrective action plans related to audit findings.
The Vice President of Clinical Operations is responsible for the strategic development and continuous improvement of clinical programs within value-based care arrangements. This role oversees a large, multidisciplinary team to optimize patient outcomes, reduce avoidable hospitalizations, and ensure alignment with corporate and regulatory goals.
The Director of Analytics & Reporting is responsible for executing the analytics strategy through scalable capabilities and disciplined delivery. This role leads a team of professionals while actively participating in solution design, complex analysis, and executive reporting.
The Senior Analyst will design, administer, and optimize the Oracle EPM environment to support financial planning, budgeting, and forecasting. They will also manage data pipelines between ERP and EPM systems while ensuring data integrity and regulatory compliance.
The Senior Director is responsible for the tactical delivery and operational management of CAHPS and HOS programs to achieve 5-Star ratings. This role involves translating enterprise strategies into actionable provider interventions and maintaining a consistent field presence to drive performance improvements.
The Senior Director of Implementation leads the strategic and operational execution of the implementation function, overseeing regulatory, technology, and vendor workstreams. They are responsible for portfolio delivery, team leadership, governance standards, and ensuring operational readiness across the organization.
Conduct daily in-home visits to provide wellness coaching, health education, and support for behavior change. Partner with clinical teams to develop member action plans and connect individuals with community resources.
The Resolution Specialist manages and resolves complex healthcare insurance claims and member issues to ensure prompt and satisfactory outcomes. They also serve as a subject matter expert for escalated calls and identify process improvement opportunities within the member engagement department.
