The role involves designing and developing ETL and BI solutions for clinical supplemental data while managing data governance and acquisition efforts. The architect will collaborate with stakeholders to ensure data accuracy and alignment with quality measurement standards like HEDIS and CMS.
The Vice President of AI Transformation leads the enterprise AI/ML strategy, overseeing governance, investment portfolio management, and the operational execution of AI initiatives. This role coordinates across clinical, technical, and business stakeholders to ensure AI investments deliver measurable financial and operational outcomes.
The Manager leads a team of analysts to deliver reporting and analytics that support LTSS business objectives and operational performance. They are responsible for translating complex business priorities into actionable analytic solutions while coaching team members on technical and professional development.
The Appeals & Grievance Case Resolution Specialist manages the full life cycle of member and provider appeals and grievances, including intake, investigation, and documentation. They serve as a liaison between internal departments and external stakeholders to ensure resolution aligns with federal, state, and accreditation standards.
The Care Connector conducts health risk assessments and develops individualized care plans to support member health goals. They manage a caseload of members by providing ongoing education, monitoring progress, and addressing barriers to care.
The Maternal Care Manager assesses and coordinates care for members to achieve optimal health through personalized care plans and medication management. They act as a single point of contact and advocate, ensuring high-quality services while collaborating with providers and community partners.
The Director of the Special Investigations Unit leads enterprise-wide strategies for the prevention, detection, and investigation of healthcare fraud, waste, and abuse. They manage investigative teams, oversee case lifecycles, and collaborate with cross-functional departments to ensure regulatory compliance and financial recovery.
Analyze market, enterprise, and line-of-business medical and pharmacy expense and revenue trends, and develop analytics, executive presentations, and metrics for Total Cost of Care reviews. Collaborate with business teams to identify high-value savings or revenue opportunities and validate savings methodologies and estimates.
The Pharmacy Technician I provides front-line customer support by handling inbound inquiries from members, pharmacies, and prescribers. They are responsible for educating prescribers on processes, entering customer data, and ensuring contact handling accuracy.
The Regulatory Reporting Technical Specialist leads the development and implementation of technical solutions to improve reporting efficiency and data integrity. They serve as a technical lead, coordinating project phases and providing guidance to staff while ensuring accurate regulatory compliance.
The Care Connector supports integrated care management program interventions by processing calls from members and providers in a contact center environment. They identify members with care gaps and assist them in accessing plan benefits and community resources under the direction of clinical staff.
The Care Manager II manages and coordinates care for members with complex health needs by serving as the primary point of contact for the care team. They develop and update care plans through collaboration with providers and members to improve health outcomes and ensure compliance with treatment protocols.
The Behavioral Health Caseworker manages and coordinates care for members with complex behavioral health needs by developing individualized care plans and facilitating access to community resources. They conduct face-to-face assessments, monitor progress, and ensure effective communication between members, providers, and the care team.
The Pharmacy Director will oversee clinical and operational aspects of the pharmacy benefit, collaborating with PBMs and state regulators to improve outcomes for LTSS members. They are responsible for monitoring pharmacy trends, implementing process improvements, and ensuring compliance with state and accreditation standards.
The Director of IT is responsible for overseeing strategic planning, IT operations, and infrastructure while managing business and clinical partner relationships. They will lead high-performing teams, manage complex projects, and ensure compliance with healthcare regulations like HIPAA and HITECH.
The Clinical Training Specialist facilitates clinical, operational, and professional-skills training for internal and external audiences. They are responsible for developing training materials using the ADDIE model and evaluating training effectiveness through performance data and stakeholder feedback.
Develops complex analyses and predictive models to solve operational problems and quantify competitive performance. Defines business problems, applies advanced mathematical concepts, and creates reports to measure organizational performance.
The Prior Authorization Tech I interprets clinical criteria to approve or process pharmacy authorization requests while maintaining productivity and quality standards. They also handle inbound and outbound calls to gather necessary information and assist with appeals processing.
The Prior Authorization Tech I interprets clinical criteria to process and approve pharmacy and medical authorization requests. They also handle inbound and outbound calls, assist with appeals, and coordinate with pharmacists and clinical programs.
The Corporate Director of Accreditation and Compliance provides strategic leadership for accreditation readiness, regulatory compliance, and quality governance across the organization. This role oversees NCQA accreditation, manages audit readiness, and drives continuous improvement through cross-functional partnerships and risk mitigation.
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 Technical Analytics Product Manager will drive the development and enhancement of the analytics product portfolio by collaborating with cross-functional teams. They are responsible for defining product requirements, conducting user acceptance testing, and monitoring performance metrics to inform future enhancements.
The Senior Manager IT leads the enterprise Master Data Management and Reference Data Management strategy, architecture, and delivery across member and provider domains. They are responsible for managing cloud migrations, optimizing data platforms, and ensuring compliance with healthcare industry regulations.
The Senior Clinical Quality Performance Specialist oversees and implements quality initiatives, utilizing data analytics to drive clinical and service improvements. They manage accreditation activities, HEDIS and CAHPS reporting, and collaborate with stakeholders to identify and resolve process barriers.
The Network Contractor is responsible for negotiating provider contracts to ensure an adequate, compliant, and marketable network. They also support network development strategy and manage provider satisfaction through education and communication.
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, resolve provider disputes, and implement educational programs to support network management strategies.
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 assessments in various community and clinical settings.
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 technology teams to drive continuous quality improvements.
