The Medical Director provides clinical oversight to advance quality outcomes, utilization management, and provider engagement across the network. They lead quality improvement initiatives, manage utilization review processes, and collaborate with operational leaders to ensure evidence-based care delivery.
The Pharmacy Technician assists the clinical team with medication management programs, quality program maintenance, and patient outcome improvements. They also handle drug authorization requests, document clinical activities in EHR, and communicate with providers and patients to address gaps in care.
The Senior Accountant is responsible for managing month-end close processes, including journal entries, reconciliations, and financial reporting. They also support internal audits, process improvements, and provide analytical insights to business partners.
The Data Analyst Lead acts as an internal consultant to develop complex healthcare, clinical, and financial data sets for reporting and decision support. They are responsible for mining data, identifying cost and utilization patterns, and training team members on analytical tools and processes.
This role manages the day-to-day operations of the credentialing function, ensuring compliance with health plan and NCQA requirements. It also involves providing leadership to the credentialing team and overseeing delegated credentialing processes for affiliated entities.
The analyst is responsible for maintaining and validating provider data to ensure accuracy across internal systems, payer platforms, and regulatory submissions. They will also manage credentialing data, create health plan provider rosters, and develop analytical reports to monitor performance.
The Health Navigator supports clinical staff by coordinating care and assisting members in accessing medical, social, and behavioral services. Responsibilities include documenting care gaps, facilitating communication between patients and providers, and providing guidance through the healthcare continuum.
The Accounting Manager oversees the financial accounting process, including general ledger maintenance, monthly closes, and financial reporting for all AHS entities. They are also responsible for establishing internal controls to prevent fraud and assisting the Controller with the annual budget process.
The Senior Actuarial Analyst will generate and distribute reports to support risk adjustment calculations and financial reporting, while also conducting complex revenue analysis. This role involves collaborating with various departments to provide business intelligence and analytics.
