The AI Architect III leads the design and integration of scalable Generative AI solutions while ensuring alignment with enterprise strategy and data governance. They collaborate with cross-functional teams to evaluate AI tools and provide architectural oversight for AI-related initiatives.
The Medical Director provides clinical consultation, case reviews, and prior authorization services to support staff and members. They also participate in quality improvement initiatives, policy development, and provider education to ensure compliance with regulatory standards.
The Medical Director provides clinical leadership and subject matter expertise for neonatal utilization management, care management, and quality improvement programs. They collaborate with internal stakeholders and external providers to ensure compliance with clinical standards and improve transitions of care for NICU members.
The Director of Employee Relations leads the enterprise strategy, governance, and resolution of workplace matters while serving as a strategic advisor to executive leadership. This role oversees investigations, policy standardization, and data-driven initiatives to foster a high-performing and compliant work environment.
The Manager oversees Integrated Care Duals Product Teams to coordinate member care, service delivery, and health benefits while ensuring compliance with state and accreditation requirements. They are responsible for monitoring clinical outcomes, managing staff performance, and collaborating with community partners to optimize resource utilization.
The Enterprise Quality Statistician leads quality and performance improvement initiatives by integrating quality improvement science with advanced statistical methodologies. They are responsible for designing statistical models, conducting epidemiological studies, and communicating analytical findings to support population health and quality decision-making.
The Quality Analyst III analyzes complex healthcare data to provide insights that drive quality performance and strategy. They are responsible for generating comprehensive reports and dashboards while collaborating with cross-functional teams to refine analytics requirements.
The Supervisor provides front-line management and support to Clinical Care Managers, ensuring adherence to departmental protocols and effective care coordination. They are responsible for recruiting, onboarding, and coaching staff while collaborating with internal and external partners to improve service quality.
The role leads the development, design, and execution of the Marketplace product portfolio strategy and roadmap. It involves cross-functional collaboration to ensure product alignment with market needs, regulatory requirements, and enterprise growth objectives.
The analyst manages day-to-day information security risks and ensures compliance with organizational policies and risk tolerance limits. They are responsible for monitoring risk mitigation plans, conducting vendor risk reviews, and reporting findings to management.
The Health Partner Network Manager is responsible for executing contracting strategies, managing provider recruitment, and ensuring compliance with regulatory requirements. They also analyze financial data to establish reimbursement rates and negotiate contracts with various healthcare providers.
The Community Health Worker coordinates care for members by engaging with them in various settings and assisting with care plan goals. They also provide health education, gather information for assessments, and support members in managing their health and wellness.
The Clinical Care Reviewer II processes medical necessity reviews for healthcare service authorizations and coordinates care transitions for members. They also monitor the delivery of healthcare services and provide clinical guidance to non-clinical and LPN staff.
The Integrated Care Program Operations Manager supports the implementation and standardization of Dual eligible and LTSS models by collaborating with market teams to execute operational strategies. This role also involves monitoring program performance, managing operational risks, and advocating for integrated care models through legislative and governmental engagement.
The Utilization Management Market Operations Manager oversees operational activities, including policy development, team metrics, and statutory reporting for specific lines of business. They drive process improvement, mentor clinical staff, and manage relationships with internal and external partners to ensure adherence to regulatory and accreditation standards.
The Community Partnership Specialist develops and maintains relationships with community stakeholders to support recruitment and engagement within targeted geographical areas. They also provide research and analysis on community needs to inform leadership and ensure effective program delivery.
The Health Plan Data Analyst III is responsible for extracting, analyzing, and reporting provider data to support business functions and strategic initiatives. They act as a subject matter expert to drive operational effectiveness, perform cost-benefit analyses, and mentor peers on project execution.
The Managing Actuary leads a team to ensure compliance with actuarial standards while overseeing pricing, forecasting, and reserving processes. They develop strategic recommendations for leadership and manage actuarial models to support business goals and financial reporting.
The Managing Actuary leads a team to ensure compliance with actuarial standards while overseeing pricing, forecasting, and reserving processes. They provide strategic recommendations to leadership and manage actuarial models to support business goals and rate filings.
The associate serves as a dedicated operational advocate for brokers and agencies, managing complex pre and post-enrollment issues and service escalations. They are responsible for researching member inquiries, processing broker requests, and educating prospective members on health plan benefits and enrollment.
The developer will analyze, design, code, and test software applications while ensuring adherence to technical specifications and coding standards. They will also perform code reviews, monitor software performance, and collaborate with cross-functional teams to resolve system issues.
The Manager, Complex Health - Clinical oversees the operational management of clinical and non-clinical staff to ensure high-quality care coordination and service delivery for complex health populations. They are responsible for maintaining regulatory compliance, monitoring performance indicators, and collaborating with internal and external stakeholders to improve member outcomes.
The Community Health Worker supports enrollees by addressing social drivers of health and connecting them to medical, behavioral, and substance use resources. They conduct in-person and virtual visits, develop care plans, and collaborate with interdisciplinary teams to improve member outcomes.
The Capture & Proposal Director manages the full life cycle of procurement strategies to win new and existing Medicaid business. They lead cross-functional teams to develop compliant, high-quality proposal content and ensure all project milestones are met.
The Program Manager will oversee day-to-day operations across National Network programs by managing deliverables, maintaining documentation, and coordinating information flow across teams. They are responsible for establishing integrated workplans, tracking progress against milestones, and facilitating recurring program cadences to ensure timely execution of initiatives.
The role involves owning enterprise adoption, analytics, and toolchain integration to support consistent requirements delivery across federated teams. It requires building decision-oriented dashboards, driving standards adoption, and leveraging AI-enabled tools to improve delivery predictability and executive storytelling.
The Senior Director of Actuarial Science sets strategic direction and oversees pricing, forecasting, and financial performance monitoring. They lead a team of actuaries to ensure compliance with standards while driving innovation in statistical modeling and supporting business goals.
The Director of Actuarial Science guides strategic direction, oversees pricing and forecasting, and drives innovation through statistical modeling and AI-enabled solutions. They are responsible for ensuring regulatory compliance, managing actuarial teams, and providing insights to senior management to support corporate goals.
The Member Health Assessor conducts health risk assessments and coordinates care plan goals for members. They maintain professional relationships with members and stakeholders while ensuring accurate documentation within the care management program.
The Care Guide acts as a single point of contact to coordinate care for members, identifying needs and implementing interventions to improve health outcomes. They collaborate with care managers and providers to facilitate transitions of care and ensure members are supported and informed throughout their treatment journey.
The Actuarial Analyst I provides accurate data analysis and actionable recommendations to support corporate initiatives and improve operational efficiency. They are responsible for calculating IBNR reserves, evaluating government reimbursement risks, and identifying opportunities to improve medical loss ratio results.
The Director leads the strategy, development, and operationalization of enterprise AI and machine learning solutions to support health plan operations. They oversee the end-to-end MLOps lifecycle, manage engineering teams, and ensure compliance with healthcare regulatory standards.
Collaborate with inter-disciplinary teams to develop and implement person-centered care plans that address the physical, behavioral, and social determinants of health. Facilitate care coordination through regular assessments, provider communication, and community resource engagement to improve member health outcomes.
The Care Guide Plus serves as a single point of contact for care coordination, engaging with members in various settings to identify needs and close gaps in care. They collaborate with Care Managers and providers to facilitate transitions of care and ensure members feel informed, empowered, and supported.
The Market Development Partner cultivates strategic relationships with healthcare providers and community organizations to drive Medicare beneficiary enrollment. They are responsible for executing outreach plans, conducting educational presentations, and meeting assigned membership growth goals.
The Community Based Care Coordinator manages and coordinates care for dual-eligible beneficiaries by integrating health services and community resources. They conduct comprehensive assessments, develop individualized care plans, and collaborate with interdisciplinary teams to improve health outcomes.
The Clinical Care Manager coordinates complex medical, behavioral, and social care for dually-eligible enrollees by conducting home visits and leading interdisciplinary care teams. They act as a liaison between healthcare providers and community resources to ensure seamless care transitions and improved health outcomes.
The Provider Relations Account Manager is responsible for managing and maintaining relationships with network providers to drive operational excellence and satisfaction. This role acts as a liaison between providers and internal stakeholders to ensure compliance, facilitate education, and resolve operational issues.
Collaborates with inter-disciplinary teams to develop and implement person-centered care plans for mothers and babies. Coordinates healthcare services, manages barriers to care, and ensures effective utilization of community and medical resources.
Lead specialized contracting efforts and negotiations for the Ohio market while managing a team of direct reports. Responsible for tracking priorities, developing strategic directions, and coordinating with internal business partners to ensure timely contract implementation.
Develop and manage complex data sets and interactive dashboards to track KPIs for LTSS and Dual Eligible programs. Collaborate cross-functionally to optimize business processes and provide actionable insights for executive leadership.
Drive end-to-end process transformation in Claims Operations by leveraging AI and automation to improve efficiency and reduce costs. Manage the full lifecycle of the automation pipeline, from intake and design to implementation and value realization.
Develop and optimize provider reimbursement strategies using advanced data analysis, financial modeling, and AI tools. Evaluate payment methodologies and conduct contract repricing to provide actionable insights for contracting decisions.
Manage and negotiate assigned contracts while conducting financial impact analyses to inform decision-making. Lead a team of direct reports and cross-functional workgroups to ensure network adequacy and timely implementation of provider contracts.
The Medical Director provides clinical consultation, prior authorization reviews, and training for staff and providers. They are also responsible for quality improvement initiatives, policy development, and ensuring regulatory compliance for member safety.
The VMC Nurse Practitioner provides medical decision-making, diagnostics, and treatment for patients seen by Mobile Integrated Healthcare services. They serve as the clinician of record, prescribing short-term treatments and documenting encounters via telehealth technologies.
The Triage Nurse will utilize evidence-based guidelines to assess and direct members to the appropriate level of care for physical and behavioral health needs. They will also act as a patient advocate, providing education and facilitating access to healthcare resources while maintaining accurate documentation.
The Care Manager collaborates with an inter-disciplinary care team, providers, and community organizations to improve quality of life for members through culturally competent care delivery. This involves facilitating communication, coordinating services, conducting strength-based assessments, and developing/evaluating person-centered care plans to address behavioral, physical, and social determinants of health needs.
The Managing Actuary will provide leadership and direction to achieve team goals, overseeing key actuarial processes such as pricing, forecasting, and reserving for assigned lines of business. This role involves developing and communicating strategic recommendations to leadership and managing the development and maintenance of actuarial models.
The Medical Director supports staff by providing training, clinical consultation, and clinical case review for members, which includes conducting prior authorization medical reviews and participating in peer-to-peer discussions. Essential functions also involve conducting clinical reviews for appeals cases, participating in fraud/abuse investigations, and contributing to policy and quality improvement initiatives.
The Care Navigator conducts telephonic outreach to members and providers to confirm service details, coordinate scheduling, and ensure accurate documentation of care coordination activities. This role also involves serving as a support resource for requests and escalations, and collaborating with the care team to ensure smooth communication and continuity of care.
The Medicare Sales Representative will empower the community by developing educational opportunities and engaging with seniors about Medicare options. They will also build relationships with stakeholders to drive enrollment and sales success.
The Virtual Medical Control Physician provides medical decision making for patients seen by instED's Mobile Integrated Healthcare service. They serve as the clinician of record, prescribe treatments, document encounters, and communicate follow-up needs to the care team.
