Leads a team of analysts to drive high-priority finance initiatives, business cases, and cross-functional workstreams. Translates complex financial and operational data into actionable insights and executive-ready communications for senior leadership.
The Business Systems Analyst evaluates, designs, and implements FACETS configuration change requests to support health plan initiatives. They serve as a technical consultant to service operations and ensure accurate system modifications through rigorous testing.
The Coordinator Member Wellness provides health coaching and education to members to promote healthy behaviors and wellness initiatives. They also coordinate care by triaging clinical issues to appropriate management programs and connecting members to local wellness resources.
The Director of ICT Care Coordination leads the strategic direction and operational execution of population health and care coordination programs. They oversee clinical staff, ensure regulatory compliance, and drive performance improvement initiatives to enhance member health outcomes.
The Senior Medical Policy Specialist is responsible for developing and maintaining clinical claim payment policies and edits to ensure accurate payment determinations. They act as a liaison between internal teams and vendors to implement, test, and troubleshoot reimbursement policies while ensuring compliance with state and federal regulations.
The HEDIS Analyst manages the full lifecycle of HEDIS measures, ensuring data accuracy and interpreting results into actionable recommendations. They collaborate with internal departments and external vendors to support quality initiatives and prepare for audits.
The Behavioral Health Utilization Management Reviewer conducts medical necessity reviews for inpatient and outpatient services using clinical knowledge and management guidelines. They coordinate care opportunities and ensure treatment is delivered in the least restrictive and most appropriate manner.
The Manager of Business Systems oversees the operational health and governance of collaboration platforms like SharePoint and Microsoft 365 to support enterprise growth and proposal development. This role also provides direct supervision to staff, manages consultant lifecycles, and translates complex business needs into scalable technology solutions.
The Senior Salesforce Developer will design, develop, and implement complex system integrations and Salesforce features to support Member CRM solutions. They are responsible for analyzing technical requirements, ensuring adherence to enterprise architecture standards, and collaborating with the team to deliver high-quality healthcare IT solutions.
The specialist serves as the primary point of contact for youth, families, and providers, managing intake documentation and resolving inquiries. They are responsible for routing calls, maintaining consistent procedures, and providing high-quality customer service.
The Member Services Specialist serves as the primary point of contact for youth, families, and providers, managing incoming calls and resolving inquiries. They are responsible for completing intake documentation, processing authorizations, and addressing member complaints according to established procedures.
The Manager of IT, Enterprise Data Governance & Quality, will lead the development and operationalization of enterprise-wide data governance and quality frameworks. This role involves defining strategic roadmaps, ensuring data protection, and collaborating with business and IT stakeholders to drive data management maturity.
The Graphics and Production Strategist develops high-quality, brand-aligned visual materials for government healthcare proposals to strengthen storytelling and evaluator comprehension. This role collaborates with cross-functional teams to manage design workflows, maintain visual assets, and ensure all proposal deliverables meet compliance and quality standards.
The Data Engineering Architect is responsible for automating report production in BI systems and integrating them with databases and data warehouses. They will design, develop, and test ETL and BI solutions while collaborating with IT staff to ensure data model consistency.
The Care Connector supports integrated care management and utilization management programs by processing calls from members and providers. They identify care gaps and assist members in accessing plan benefits and community resources to improve health outcomes.
The Production Copy Editor is responsible for copy editing, proofreading, and ensuring editorial quality and style consistency for RFx responses and proposal materials. This role collaborates with cross-functional teams to ensure all deliverables are compliant, clear, and aligned with brand standards and solicitation requirements.
The Network Contractor is responsible for negotiating provider contracts to ensure an adequate, compliant, and marketable network. They also support network development strategies and assist with provider satisfaction, education, and communication initiatives.
The Account Executive is responsible for developing and maintaining strong relationships with healthcare providers to drive performance and network strategy. They will also handle provider education, resolve disputes, and support contracting efforts across various product lines.
The Senior Account Executive is responsible for developing and maintaining strong relationships with providers to drive performance in risk-based and value-based care arrangements. They also oversee network development, provider education, and the resolution of complex provider disputes.
The Practice Performance Advisor supports the Provider Network Management team by producing performance reports and collaborating with providers to improve quality metrics and care outcomes. They are responsible for interpreting claims data, identifying performance gaps, and developing intervention strategies to strengthen provider partnerships.
The Provider Network Coordinator provides operational and administrative support to the Provider Network Management team by managing provider data and resolving network issues. They also assist with departmental initiatives related to provider satisfaction, education, and communication.
The Behavioral Health Caseworker manages and coordinates care for members with behavioral health conditions, serving as the primary point of contact for the care team. They develop and monitor individualized care plans, facilitate transitions of care, and conduct face-to-face visits to assess needs and provide education.
The Community Health Navigator supports the development and execution of member outreach strategies to improve health outcomes and engagement. They cultivate relationships with members, providers, and community stakeholders through phone, email, and in-person home or community visits.
The LTSS Reviewer is responsible for evaluating requests for inpatient and outpatient services using evidence-based assessment knowledge and clinical judgment. They coordinate with service providers to ensure appropriate service authorization while maintaining compliance with medical guidelines and regulatory standards.
The Associate Actuary will build pricing analytics for traditional FFS and Value-Based Contracts while supporting medical and pharmacy cost trend identification. They will also assist in financial forecasting, risk adjustment, and communicating key results to stakeholders.
The Service Coordinator will identify, evaluate, and manage the needs of Medicaid participants by performing face-to-face assessments and telephonic follow-ups. They will lead the participant-centered planning process to ensure access to necessary medical, social, and long-term support services.
The Service Coordinator will perform face-to-face assessments to identify and manage the physical, behavioral, and social needs of Medicaid participants. They are responsible for leading the participant-centered planning process and ensuring access to necessary long-term services and supports.
The Service Coordinator identifies and manages the long-term care needs of Medicaid participants through face-to-face assessments and ongoing coordination. They lead the participant-centered planning process and ensure all services align with Community Health Choices requirements.
The Care Connector supports the daily operations of integrated care management programs by processing calls from members and providers. They work under clinical direction to provide educational materials and implement strategies to increase healthcare adherence and reduce barriers to care.
The Compliance Manager oversees the organization's internal and regulatory corrective action processes to ensure timely and sustainable compliance. This role involves tracking compliance issues, preparing executive-level reports, and collaborating with stakeholders to promote operational accountability.
The Product Manager drives the strategy, design, and delivery of clinical technology products to support utilization management, care management, and quality operations. They act as the bridge between clinical operations, data engineering, and technology to ensure scalable, compliant, and data-enabled product solutions.
The Senior Outcomes Specialist evaluates internal clinical programs and develops predictive models to guide evidence-based population health management. They are responsible for conducting advanced statistical analyses to quantify business performance, calculate ROI, and design new methodologies.
The Care Manager facilitates access to behavioral health and therapeutic services for youth by creating integrated service plans. They are responsible for making timely intensity of service determinations and managing crisis or emergency calls.
The Clinical Investigator performs comprehensive investigations to identify and correct fraudulent or abusive billing and coding practices. They manage caseloads from referral to resolution, coordinate with internal departments, and conduct on-site provider audits.
The SIU Auditor conducts comprehensive investigations into suspected fraud, waste, and abuse involving company products. They perform data mining, analyze billing patterns, and prepare detailed investigative reports while maintaining liaison with law enforcement and public officials.
The Senior Strategic Finance Project Analyst leads cross-functional finance projects and portfolio workstreams from planning through execution. They synthesize financial and operational data into actionable insights and prepare executive-ready materials to support senior leadership decision-making.
The Account Executive develops and maintains strong relationships with healthcare providers to drive performance and ensure provider satisfaction. They are responsible for provider education, resolving disputes, and supporting network development strategies within assigned regions.
The Senior Proposal Quality and Editing Specialist performs critical quality and copy editing reviews for managed care proposals while managing project timelines and internal process updates. They collaborate with the Copy Editing Manager to ensure team alignment, provide research support, and act as a subject matter expert for language and style standards.
The Community Health Navigator engages members through outreach and home visits to address social determinants of health and improve access to care. They collaborate with internal teams and community organizations to coordinate care and provide education on benefits and preventive health programs.
The Medical Director leads the Utilization Management program, ensuring clinical appropriateness of care and adherence to medical policies. They also collaborate with multidisciplinary teams to analyze utilization trends and facilitate peer-to-peer discussions with providers.
The Senior Data & Reporting Analyst designs and develops reporting systems while managing project plans to ensure deliverables meet business and customer needs. They are responsible for analyzing clinical and utilization data to provide actionable recommendations that improve system efficiency and care outcomes.
The Service Coordinator identifies and manages the long-term care needs of Medicaid participants through face-to-face assessments and ongoing coordination. They lead the participant-centered planning process and ensure compliance with Community Health Choices requirements.
The Corporate Director of Network Strategy leads the development and management of an enterprise-wide provider network strategy to optimize total network value. This role collaborates with cross-functional leadership to deploy programmatic solutions, manage operational reporting, and oversee provider experience teams.
The Senior Medical Director oversees clinical care quality, utilization management, and behavioral health programs while ensuring adherence to regulatory and contractual requirements. They lead a team of medical directors, manage medical policy development, and drive continuous quality improvement initiatives.
The Community Educator promotes health programs through site visits and community events while identifying and enrolling potential Medicaid candidates. They are responsible for building relationships with community agencies and providing educational presentations to members and organizations.
Manage and support the Salesforce development and delivery team while overseeing the technical aspects of Member CRM projects. Lead and mentor developers to ensure successful implementation of complex system integrations and Salesforce features.
The role involves overseeing provider data, reimbursement rules, and operational workflows to ensure contractual compliance across various health products. The individual will serve as a subject matter expert, managing provider escalations and collaborating with internal departments to optimize claims processing and network reporting.
The manager will oversee departmental integrity, data management, and compliance with Community HealthChoices Long-Term Service and Support requirements. They are responsible for developing workflows, conducting audits, and coordinating outreach and training for staff and stakeholders.
The manager will oversee departmental integrity, data management, and compliance with Community HealthChoices Long-Term Service and Support requirements. They are responsible for developing workflows, training staff, and managing transitional services while maintaining key performance metrics.
The Personal Care Connector handles inbound and outbound calls to support Medicare members and providers within a call center environment. They are responsible for identifying care gaps, educating members on benefits, and facilitating access to healthcare resources.
The role involves interpreting clinical criteria to review and approve prior authorization requests for pharmacy and medical claims. It also requires handling inbound and outbound calls to gather information and assisting with appeals processing.
The role involves driving the development of the analytics product portfolio by collaborating with cross-functional teams to define requirements and technical specifications. The manager will also monitor performance metrics and conduct UAT to optimize product functionality and customer value.
Oversee and implement clinical quality initiatives by utilizing data analytics to identify root causes and execute improvement plans. Manage activities related to plan accreditation, preventive health, and clinical performance metrics like HEDIS and CAHPS.
Develop and execute outreach strategies to improve health outcomes and member engagement within assigned Michigan territories. Deliver health education, manage community-based programming, and mentor junior Community Health Educators.
Perform daily medical reviews, appeals, and physician peer reviews while implementing evidence-based practice guidelines. Oversee the quality of clinical care and ensure adherence to contractual and regulatory obligations for health plan members.
The Outcomes Specialist will evaluate member care and support programs by developing models and conducting analytic work. They will collaborate with cross-functional teams to provide data-driven insights and manage multiple large projects.
The Market President provides strategic vision and operational leadership for the Ohio health plan, focusing on growth and member retention. They are responsible for full P&L management and cultivating relationships with regulators, providers, and community stakeholders.
Manage and coordinate care for members with acute, chronic, and behavioral health conditions, specifically within the Foster Care program. Act as the primary point of contact for the care team to develop and monitor personalized care plans and facilitate transitions of care.
The Care Connector supports daily operations of integrated care and utilization management programs within a contact center environment. They process calls from members and providers to provide educational materials and strategies to increase healthcare adherence.
The role involves serving as a technical consultant to design, test, and implement benefit and payment structure changes within the FACETS application. The analyst will lead complex projects, automate configuration processes, and mentor junior analysts to ensure system reliability.
Lead and coordinate clinical quality reviews of member concerns and medical records using standards of care. Support accreditation, HEDIS activities, and Quality Assessment and Performance Improvement (QAPI) committee processes.
Lead the development and execution of the enterprise strategic plan and annual business plan to advise the CEO and Executive Council. Manage strategic growth initiatives, evaluate M&A opportunities, and lead a team in executing key corporate projects.
The role serves as a Subject Matter Expert providing business analysis support for Member and Provider MDM and ERDM initiatives. Responsibilities include leading requirements management, performing hands-on data analysis using SQL and Databricks, and acting as a liaison between business and technical teams.
Lead the launch, growth, and overall operational performance of the Indiana health plan. Serve as the primary market-facing leader to build relationships with state agencies, providers, and community partners.
The Associate Actuary provides support for rate advocacy, manages financial forecast models, and analyzes medical and pharmacy cost drivers. They are responsible for developing actuarial models and communicating results to various stakeholders while adhering to professional standards.
The Network Contractor is responsible for recruiting, contracting, and re-contracting healthcare providers to ensure a compliant and marketable network. This includes negotiating rates, managing provider satisfaction, and aligning contracts with federal and state regulations.
Manage the end-to-end print and postage process, including mail merges, PDF conversions, and quality control of letter output. Coordinate print projects to meet client SLAs and identify opportunities for production efficiency.
Manage the full life cycle of member and provider appeals and grievance cases through intake, investigation, and documentation. Act as a liaison between internal departments and external stakeholders to ensure timely resolution compliant with federal and state standards.
Develop large reporting layers, executive decks, and metrics to support the Total Cost of Care revenue and expense review process. Collaborate with operational partners to identify high-value opportunities for savings and revenue growth.
Coordinate long-term services and supports for Medicaid participants through face-to-face assessments and participant-centered planning. Manage the delivery of physical, behavioral, and social health services while ensuring participants are informed of their rights and options.
Lead a team of technical leads and architects to oversee critical enterprise integration and API platforms. Drive the modernization of platforms using cloud-native practices, API-first strategies, and AI-driven automation.
Lead the daily operations of the proposal writing team, managing assignments and timelines for state Medicaid managed care bids. Coach writers and personally draft high-visibility sections to ensure compliant, persuasive, and evaluable responses.
Draft and refine narrative sections for state Medicaid managed care bids, translating technical information into compliant and compelling prose. Collaborate with subject matter experts and utilize AI-enabled tools to produce high-quality, evaluable proposal responses.
Lead the development of complex, scenario-based narratives and high-visibility sections for state Medicaid managed care bids. Collaborate with subject matter experts and leadership to translate technical operational details into compelling, compliant, and evaluable prose.
Develop and maintain strong relationships with healthcare providers to drive performance and satisfaction. Support network management strategies, resolve provider disputes, and conduct educational orientation sessions.
Lead the end-to-end execution of high-priority Medicaid proposal efforts, ensuring compliant and compelling responses. Coordinate between capture, solution design, and executive leadership to align strategy and manage risks throughout the RFX lifecycle.
The Manager supports corporate strategy, analytics, and insights by developing deliverables for the CEO and Board of Directors. They lead strategy projects, conduct market research, and mentor analysts to identify strategic opportunities.
Lead the end-to-end execution of Medicaid RFX responses, translating capture strategy into compliant and high-quality proposals. Act as the central integrator across solution design, writing, and production to ensure on-time, error-free submissions.
Process service forms and distribute literature to members while managing provider directories and welcome kits. Research and correct mailing addresses using USPS tools and maintain department production statistics.
Lead the operational areas of the Utilization Management program, ensuring patient care decisions are medically appropriate using national and local criteria. Collaborate with multidisciplinary teams to develop medical policies and analyze utilization trends to improve clinical effectiveness.
