The EDI Technical Product Manager will define the vision, roadmap, and execution of enterprise data exchange capabilities while ensuring regulatory compliance and system reliability. They will act as a bridge between technical teams, trading partners, and business units to drive product development and operational efficiency.
The intern will provide support on special projects, initiatives, and specific activities that vary by assignment. They will also participate in seminars to network with company leaders and gain real-world professional experience.
The CAHPS & HOS Program Lead is responsible for the strategy, governance, and delivery of CAHPS and HOS programs to ensure regulatory compliance and performance improvement. This role integrates work across business and technical functions while providing mentorship and leadership to cross-functional teams.
The HR Business Partner III acts as a strategic advisor to senior leadership, aligning HR initiatives with business goals and organizational culture. They are responsible for managing employee relations, driving organizational effectiveness, and collaborating with HR Centers of Excellence to support talent development and succession planning.
The Business Analyst IV leads enterprise-level business analysis strategy, driving alignment between organizational objectives and technology-enabled solutions. This role partners with senior leadership to define business value, manage complex requirements, and oversee large-scale transformation initiatives.
The Data Scientist II designs and validates predictive and machine learning models to inform business processes across various organizational departments. They are responsible for mining large datasets, developing algorithms, and communicating analytical insights to key stakeholders.
The Manager of Population Health leads strategic initiatives to improve member care outcomes, access, and quality through team-based navigation and data-driven interventions. This role also manages staff performance, ensures regulatory compliance, and collaborates with internal and external partners to advance community and provider engagement.
Collaborate with inter-disciplinary teams to develop and implement person-centered care plans that address physical, behavioral, and social determinants of health. Facilitate care coordination, conduct psychosocial assessments, and monitor member progress to ensure effective utilization of healthcare resources.
The role involves developing complex reports, dashboards, and data pipelines to support LTSS and Dual Eligible programs while driving operational efficiency. You will collaborate with cross-functional teams to translate business requirements into actionable insights using advanced statistical and BI tools.
The Associate Vice President provides strategic leadership and operational oversight for integrated care management programs across multiple high-volume markets. This role collaborates with cross-functional leadership to ensure regulatory compliance, improve member outcomes, and drive financial performance through standardized operating models.
The Director of Market Quality Improvement is responsible for directing quality improvement programs, ensuring compliance with NCQA and state requirements, and monitoring quality outcomes. They also oversee performance improvement projects, analyze member risk data, and collaborate with stakeholders to achieve organizational quality goals.
The Community Based Care Coordinator manages and coordinates integrated health services for dual-eligible beneficiaries by conducting assessments and developing individualized care plans. They act as a liaison between healthcare providers and community resources to ensure seamless care transitions and improved health outcomes.
Collaborate with inter-disciplinary teams and community organizations to facilitate person-centered care plans and improve health outcomes for members. Conduct psychosocial assessments, manage care coordination, and monitor member progress while ensuring adherence to clinical standards and regulatory requirements.
The Member Health Assessor conducts health risk assessments and coordinates care plans for members to address their unique health needs. They maintain professional relationships with members and stakeholders while ensuring accurate documentation and process improvements within the care management program.
The Clinical Care Manager provides community-based care management for dually-eligible enrollees with complex medical and social needs. They lead interdisciplinary care teams, perform clinical assessments, and coordinate with healthcare providers to ensure seamless care transitions and improved health outcomes.
The Community Based Care Manager facilitates inter-disciplinary care team meetings and coordinates person-centered care plans to address the physical, behavioral, and social determinants of health. They engage members in various settings to monitor progress, manage barriers, and ensure effective utilization of healthcare resources.
The Community Health Worker coordinates care for members by engaging with them in various settings and assisting with care plan goals. They also gather information for assessments, provide health education, and maintain accurate documentation within program guidelines.
The developer will design and deploy lightweight AI-enabled applications using low-code platforms to operationalize generative and agentic AI solutions. They will collaborate with data teams to integrate model outputs into business workflows while ensuring performance, accessibility, and compliance standards.
The Care Guide coordinates care for members by serving as a primary point of contact to identify needs, manage barriers, and facilitate transitions between care settings. They collaborate with inter-disciplinary teams to implement interventions, educate members on resources, and document all activities in compliance with company policies.
The intern will support actuarial tasks such as reserving, forecasting, benefit pricing, and rate analysis while completing a summer-long project. They will also collaborate with cross-functional teams to develop AI-enabled actuarial solutions to optimize financial performance.
The Medicare Sales Representative II is responsible for executing sales strategies and enrollment goals for Medicare Advantage products within an assigned territory. They serve as a subject matter expert, conducting community outreach and educational presentations while maintaining compliance with state and federal regulations.
The Director of Digital Strategy will lead the development and execution of digital roadmaps to drive innovation and enhance member and provider experiences. They will manage cross-functional teams and external partners to implement personalized digital solutions and omni-channel strategies.
The Business Analyst IV leads enterprise-level initiatives by shaping business strategy and driving alignment between organizational objectives and technology solutions. This role provides strategic oversight across programs, mentors staff, and leverages data to influence decision-making and business outcomes.
The Clinical Care Manager provides community-based care management for dually-eligible enrollees with complex medical and social needs. They lead interdisciplinary care teams to develop holistic care plans and coordinate services to improve health outcomes and prevent hospital readmissions.
The Nurse Care Manager provides comprehensive care coordination, including in-home assessments, service authorization, and the development of patient-centered service plans. They collaborate with interdisciplinary teams and families to ensure safe, cost-effective care across various healthcare settings.
The Senior Director oversees the administration, performance, and strategy of supplemental vendor relationships and enhanced benefit programs across all markets. They are responsible for ensuring regulatory compliance, managing vendor performance metrics, and collaborating with internal stakeholders to optimize benefit offerings.
The Sales Strategy & Operations Manager will drive enrollment growth by developing market-specific strategies, managing sales analytics, and optimizing field execution. The role involves collaborating with cross-functional teams to improve sales productivity and ensuring the successful implementation of strategic initiatives.
The Customer Care Specialist resolves routine service inquiries regarding claims, benefits, and eligibility while ensuring compliance with HIPAA and regulatory requirements. They are responsible for maintaining accurate documentation and building strong relationships with members and providers.
The Data Scientist III designs and validates predictive and machine learning models to improve business processes across various organizational departments. They also mentor junior staff, collaborate with cross-functional teams, and communicate analytical insights to key stakeholders.
The Director oversees provider network operations, including value-based purchasing, risk adjustment, and network performance to ensure financial and quality goals are met. They also lead strategic initiatives, manage provider relationships, and supervise support teams to drive operational excellence.
The Director manages relationships with health partners to ensure contract specifications and financial targets are met while leading a team to drive network strategy. They are responsible for overseeing performance improvement, regulatory compliance, and cross-functional collaboration to enhance health partner satisfaction and quality outcomes.
The Rural Health Liaison conducts outreach activities and serves as a resource for members, providers, and community organizations to address rural health needs. This role facilitates education programs, supports policy development, and fosters relationships to improve health equity and outcomes.
The Integrated Care Program Manager is responsible for managing large-scale portfolio programs, ensuring successful delivery of LTSS and Dual Eligible programs. They will lead cross-functional teams, manage program budgets and risks, and ensure alignment with business strategy.
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 membership growth goals within their assigned territory.
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 membership growth goals within their assigned territory.
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 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 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 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 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 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 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 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 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.
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 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.
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.
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 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.
