The analyst will lead the development of business cases for strategic initiatives and capital investments while performing rigorous financial and operational analysis. They will partner with cross-functional teams to translate strategic priorities into actionable proposals and monitor investment performance against forecasted outcomes.
The Market Expansion & Implementation Manager leads cross-functional activities for new market entries and service area expansions within the Medicare Advantage plan. This role coordinates operational, clinical, and regulatory readiness to ensure successful market launches and post-launch stabilization.
The Vendor Manager oversees the performance, governance, and strategic management of third-party vendors supporting Medicare Advantage health plans. They serve as the primary relationship manager, ensuring services meet contractual, regulatory, and organizational standards while driving operational excellence.
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 Health Coach and Educator will conduct home and virtual visits to provide wellness coaching, education, and support to seniors and their families. They will collaborate with clinicians to develop action plans and assist patients in accessing community resources to address social determinants of health.
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 Telehealth Coordinator manages inbound and outbound calls in the Virtual Care Center, including scheduling appointments and processing referrals. They also support providers with administrative tasks and assist in training new hires on internal systems.
The Implementation Manager leads the end-to-end planning, execution, and operational deployment of strategic technology solutions and third-party vendor integrations. This role serves as the primary liaison between internal business teams, IT, and external partners to ensure projects meet regulatory, budgetary, and operational objectives.
The AVP provides executive leadership for enterprise Risk Adjustment performance strategy, overseeing prospective, concurrent, and retrospective programs. This role is accountable for achieving annual RAF performance objectives while managing provider engagement, coding operations, and financial forecasting.
The manager is responsible for identifying, designing, and deploying scalable automation and AI-enabled workflow solutions to improve operational efficiency. They will partner with operational teams to implement tools like RPA, low-code platforms, and APIs while ensuring compliance with security and governance standards.
The Supervisor leads a team of specialists in managing digital member communications and reimbursement processing functions. They are responsible for coaching staff, ensuring regulatory compliance, and optimizing operational workflows to enhance member experience.
The Senior Actuarial Analyst is responsible for advanced actuarial analysis, financial modeling, and data-driven insights across reserves, risk adjustment, and pharmacy analytics. This role collaborates with cross-functional teams to evaluate healthcare trends, develop forecasts, and assess financial risk.
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 Remote Outreach Concierge Navigator provides outreach and support to members, helping them navigate their healthcare benefits and provider networks. They act as a liaison to coordinate care, resolve member issues, and ensure access to necessary medical services.
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 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.
The Remote Regional Concierge Navigator provides outreach and support to members, helping them navigate their healthcare benefits and coordinate care. They act as a liaison between providers, health plan operations, and members to ensure quality care and issue resolution.
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.
Deliver compassionate and seamless service to seniors and individuals with disabilities by resolving inquiries regarding benefits and eligibility. The role involves owning the member experience end-to-end and documenting all interactions to ensure continuity of care.
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.
Conduct in-home assessments, medication reviews, and health screenings for senior members to prevent unnecessary hospitalizations. Coordinate care plans with Regional Medical Officers, PCPs, and a multidisciplinary clinical team.
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.
Drive the strategy, development, and execution of technical products from ideation through launch within a healthcare payer context. Bridge the gap between technical engineering teams and business stakeholders to ensure regulatory compliance and business value.
Design and maintain high-volume data pipelines connecting Oracle Cloud Financials to the enterprise data ecosystem and analytics platforms. Ensure financial data integrity, security, and compliance for executive reporting and regulatory submissions.
Responsible for the design, administration, and optimization of the Oracle EPM environment to support financial planning, budgeting, and forecasting. This role ensures data integrity between ERP and EPM systems while delivering advanced analytics and executive reporting for Finance leadership.
Lead the end-to-end implementation and operational management of the Oracle Cloud Financials platform. Act as the strategic bridge between Digital Technology Services and Finance to ensure scalable, compliant financial systems architecture.
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.
Develop and execute network strategies and manage provider contracts to create efficient healthcare delivery systems. Lead the implementation of reimbursement models and manage staff to support market growth and operational success.
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 Physician Advisor optimizes the use of institutional and outpatient services for all patients while ensuring quality of care through clinical reviews for medical necessity and treatment appropriateness. Responsibilities include processing second-level reviews, acting as a liaison between medical staff and payers, and providing clinical leadership for quality projects.
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.
