The Technical Delivery Lead is responsible for overseeing release and environment management, ensuring reliable software delivery through governance and technical leadership. They will drive the development lifecycle, implement AI-enabled capabilities, and establish best practices for deployment automation and system architecture.
The Clinical Care Manager provides monitoring, follow-up, and clinical care management to dually-eligible enrollees with complex medical, behavioral, and social needs. They lead interdisciplinary care teams to develop holistic care plans and coordinate services across community and healthcare settings.
The AI Solution Consultant acts as a strategic bridge between business units and the AI Platform team, managing the intake and triage of AI initiatives. They are responsible for defining high-value use cases, modeling ROI, and guiding business leaders through the implementation of generative and agentic AI solutions.
The Manager of Enterprise Engineering Solutions leads a team of IT professionals to design, deliver, and support scalable enterprise technology solutions. This role drives operational excellence, manages project delivery, and implements AI-enabled capabilities to improve productivity and business outcomes.
The SVP will lead customer care, grievance and appeals, and digital strategy functions to ensure operational effectiveness and regulatory compliance. They are responsible for developing strategies to align technology with business needs and driving digital transformation across the organization.
The AI Analyst II designs, builds, and optimizes AI solutions and agents using tools like Copilot and Power Automate to support business processes. They also collaborate with cross-functional partners to ensure AI solutions align with governance, compliance, and measurable business outcomes.
The Compliance Analyst III supports the compliance program by conducting risk assessments, monitoring activities, and managing corrective action plans. They also provide expert guidance on regulatory requirements and collaborate with internal and external stakeholders to ensure adherence to government and contractual standards.
The Manager, Medicare STARS is responsible for developing enterprise-wide strategies and processes to improve performance across Medicare Quality Measures and regulatory requirements. They lead cross-functional efforts to track HEDIS metrics, manage quality improvement initiatives, and report performance data to senior leadership.
The intern will assist with data collection, analysis, and the identification of patterns in claim payments while collaborating on provider contract modeling. They will also prepare materials for stakeholder meetings and leverage AI tools and automation to enhance analytical workflows.
The intern will gather stakeholder requirements for reports and tools while identifying process and system pain points. They will also use SQL and Power BI to extract data, generate reports, and analyze information to support clinical operations.
The intern will assist in the development and support of software solutions using SQL Server, C#, and Python to meet business needs. They will also participate in API design, testing, and the application of AI technologies to enhance user experiences.
The AI Compliance Analyst II designs, builds, and administers AI solutions and agents while ensuring they align with governance and business objectives. They are responsible for monitoring performance metrics, validating outputs, and collaborating with cross-functional teams to optimize AI-enabled service journeys.
The Clinical Care Reviewer II processes medical necessity reviews for healthcare services and coordinates care transitions for members. They also monitor the delivery of healthcare services and provide clinical guidance to staff.
The Clinical Care Reviewer II processes medical necessity reviews for healthcare services and coordinates care for members, including discharge planning and transitions. They also monitor the delivery of healthcare services and provide clinical guidance to non-clinical and LPN staff.
The Application Security Developer III supports the security program by performing application security testing, analyzing tool outputs, and documenting findings. They also design and develop software to automate security processes and collaborate with development teams to integrate security solutions.
The Care Manager collaborates with an inter-disciplinary team to facilitate person-centered care planning and coordinate services for members. They conduct psychosocial assessments, manage care plan goals, and educate members on treatment options to improve health outcomes and access to resources.
The Integrated Care Clinical Manager provides community-based clinical care management to dually eligible enrollees with complex medical and behavioral needs. This role involves leading interdisciplinary care teams, conducting assessments, and coordinating community resources to improve health outcomes.
The Integrated Care Clinical Manager provides community-based clinical care management to dually eligible enrollees with complex medical and social needs. This role involves leading interdisciplinary care teams, performing clinical assessments, and coordinating services to improve health outcomes and quality of life.
The Integrated Care Clinical Manager provides monitoring, follow-up, and clinical care management to dually eligible enrollees with complex medical, behavioral, and social needs. They lead interdisciplinary care teams to create holistic care plans and coordinate services across healthcare providers and community resources.
Collaborate with inter-disciplinary teams and community organizations to facilitate person-centered care planning and improve member health outcomes. Conduct psychosocial assessments, manage care plan goals, and provide clinical oversight to ensure effective utilization of healthcare resources.
The Integrated Care Clinical Manager provides clinical care management and monitoring for dually eligible enrollees with complex medical and behavioral needs. They lead interdisciplinary care teams to develop holistic care plans and coordinate community resources to improve health outcomes.
The Integrated Care Clinical Manager provides clinical care management and monitoring for dually eligible enrollees with complex medical and behavioral needs. They lead interdisciplinary care teams and coordinate with community resources to ensure seamless care transitions and improved health outcomes.
The Accountant II is responsible for preparing journal entries, account reconciliations, and financial statements in compliance with GAAP and STAT standards. They also perform cost and revenue analysis, manage internal controls, and assist with regulatory audits and reporting.
The intern will support M&A activities by analyzing costs, identifying process efficiencies, and evaluating AI and automation solutions to improve the transaction lifecycle. They will also collaborate with cross-functional stakeholders to develop tools and present strategic recommendations to senior leadership.
The reviewer is responsible for conducting medical record audits, making payment decisions on complex claims, and identifying potential fraud, waste, or abuse. They also collaborate with internal departments to resolve claim issues and prepare audit summaries for medical director review.
The Clinical Care Reviewer II is responsible for conducting medical necessity reviews for behavioral health services and coordinating care for members. They also facilitate discharge planning and engage with collaborative care partners to ensure appropriate transitions in care.
The Lead Investigator manages the Special Investigations Unit's regulatory communications and leads efforts to identify and mitigate fraud, waste, and abuse. This role involves conducting complex investigations, mentoring team members, and collaborating with state and federal agencies to ensure program integrity.
Process and document authorization, level-of-care, and disenrollment requests, verifying eligibility, provider network status, and benefit coverage while routing clinical reviews as needed. Communicate request status and outcomes to providers, members, and care teams, support timely processing, and assist with reporting and cross-market operations.
Coordinates and reviews members’ transitions between nursing facility, respite, and home- and community-based waiver services, including eligibility, clinical documentation, and level-of-care determinations. Collaborates with care teams and providers to support safe discharge planning, maintain benefit eligibility, meet regulatory requirements, and escalate care or quality concerns.
The Clinical Care Reviewer processes medical necessity reviews for healthcare services and assists with discharge planning and care coordination. They also monitor the delivery of healthcare services and provide guidance to clinical and non-clinical staff.
