The Inside Sales Representative performs telesales functions to educate, qualify, and sell Government Programs products to beneficiaries. They are responsible for meeting enrollment and retention goals while ensuring compliance with CMS guidelines and federal regulations.
Resolve complex clinical complaints, grievances, and appeals by reviewing clinical records, applying relevant criteria and policies, coordinating with clinicians, and documenting outcomes. Analyze and recommend improvements to policies and procedures, support legal and audit-related cases, advise Plan personnel, and provide peer training and rotating weekend and holiday coverage.
The solutions architect leads enterprise architecture activities to guide the development and management of a portfolio of technology solutions. They translate business needs into architectural plans and provide subject matter expertise to agile development teams.
The Care Manager coordinates services for members by assessing needs, developing care plans, and monitoring progress to ensure quality and cost-effective outcomes. They serve as a liaison between patients, families, and healthcare providers while managing a caseload of complex medical and behavioral health needs.
The Care Manager coordinates services for members with complex medical and behavioral needs, focusing on education, self-management, and quality care outcomes. They act as a liaison between patients, families, and healthcare providers to develop and implement individualized care plans.
The Value Delivery Manager leads Agile product teams to drive business value, optimize delivery performance, and support the transition to a product-centric operating model. They partner with business and technology leaders to manage dependencies, facilitate planning, and coach teams on Agile and Lean practices.
