The Supervisor oversees a team responsible for quality assurance, compliance, and documentation reviews of provider-led Tailored Care Management records. They provide operational leadership, performance management, and collaborate with stakeholders to ensure adherence to regulatory and accreditation standards.
The Supervisor II-Transition Support Specialist oversees care transitions between health plans, managing multidisciplinary teams to ensure effective coordination and reporting. They are responsible for staff development, operational workflow, and ensuring compliance with state and organizational regulations.
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 UM Program Integrity Specialist leads the development and implementation of a comprehensive Utilization Management training plan to ensure consistent application of workflows and clinical standards. They also support program documentation, audit readiness, and process improvement initiatives to maintain regulatory and accreditation compliance.
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.
