The analyst manages the quality review process for provider-led care management programs by conducting audits and clinical case reviews. They also analyze program data to identify trends, ensure contractual compliance, and coordinate training to address staff knowledge gaps.
Lead and conduct internal audits, develop audit criteria and testing procedures, review workpapers, and report findings and corrective-action progress. Maintain audit methodology, contribute to organizational risk assessments, and advise, mentor, and train audit staff while building relationships with management and external stakeholders.
The Manager of Quality Improvement leads the operational management of the QI program, ensuring alignment with regulatory requirements and accreditation standards. They oversee performance improvement projects, quality analytics, and cross-functional collaboration to drive measurable improvements in member outcomes and health equity.
The position involves designing, implementing, and reporting on program evaluations to ensure services meet funding requirements and quality standards. It also requires analyzing complex data sets and collaborating with internal departments to promote continuous quality improvement.
The Care Manager coordinates integrated, person-centered care for individuals with special health needs across physical, behavioral, and social domains. They are responsible for conducting assessments, developing care plans, monitoring service delivery, and ensuring compliance with state and Medicaid requirements.
The clinician manages a 24-hour behavioral health crisis line by conducting telephonic screenings, triage, and referrals for individuals in need. They also provide crisis service authorizations and coordinate with community first responders to ensure caller safety.
The CRM Solution Architect designs, governs, and optimizes enterprise CRM solutions while ensuring alignment with business strategy and technical standards. They collaborate with cross-functional teams to manage integrations, maintain architectural documentation, and support the Salesforce Center of Excellence.
The Actuarial Associate will analyze financial data, model risk, and manage IBNR calculations to support organizational financial outcomes. They will also serve as a subject matter expert, presenting complex statistical insights to internal and external stakeholders.
The Provider Network Evaluator leads clinical quality reviews and oversight assessments to ensure contracted providers adhere to regulatory standards and best practices. They also provide technical assistance, conduct peer reviews, and monitor corrective action plans to ensure safe and effective service delivery.
The Care Manager II provides transitional care management and physical health consultation for members in various facility settings. They are responsible for developing post-discharge transition plans, facilitating clinical handoffs, and coordinating with care teams to ensure member integration into the community.
The specialist will manage the configuration, testing, and maintenance of healthcare management software while serving as a liaison between IT, business units, and vendors. They are responsible for designing workflows, performing end-to-end testing, and documenting technical characteristics to ensure system integrity.
The Software Support Analyst serves as a subject matter expert for the Alliance Claims System, bridging the gap between end users and the application development team. Responsibilities include troubleshooting SQL Server stored procedures, managing support tickets, and assisting with system configuration and maintenance.
