The Wellness Health Coach performs telephonic assessments to determine clinical risk and develops personalized wellness care plans for members with chronic conditions. They provide ongoing coaching, education, and support while coordinating with healthcare providers to ensure high-quality, clinically sound care outcomes.
The Care Navigator develops and coordinates personalized care plans for foster care members to improve healthcare outcomes and access. They conduct telephonic outreach, assess member needs, and facilitate connections to community resources and healthcare providers.
Lead the strategy, planning, development, and deployment of care management products, translating customer and market needs into product visions, roadmaps, requirements, and priorities. Coordinate cross-functional delivery, guide product managers, manage trade-offs and timelines, and oversee customer communications, feature verification, and market testing.
Direct enterprise privacy and security culture, training, and awareness programs, leading multiple teams and ensuring programs support workforce competence and behavior change across privacy, security, responsible AI, and operational resilience. Govern program standards, metrics, audit evidence, vendors, and continuous improvement while partnering with leaders to address workforce risks and strengthen enterprise culture.
Lead strategic and tactical planning for the development and deployment of care management products, translating customer and market needs into product strategy, roadmaps, requirements, and priorities. Coordinate cross-functional teams, communicate product releases and value to customers, and oversee delivery, business verification, and market testing of new features.
Own product strategy from concept through production, translating customer and business needs into requirements, priorities, and actionable work for Care Management solutions. Manage the product backlog and delivery plans, collaborate with technical and business teams, test and approve features, and communicate progress, changes, and risks.
Serve as a clinical liaison to providers and internal and external teams, reviewing behavioral health and substance use records and services. Analyze program results, support provider education and reporting discussions, address operational issues, and contribute to utilization, quality improvement, and case management initiatives.
Lead outstanding claims recovery and accounts receivable operations, managing inventory, aging, collections, provider offsets and refunds, and financial recovery results. Direct fraud, waste, and abuse investigations and staff, while coordinating cross-functional initiatives, monitoring operational controls and metrics, and improving recovery processes and outcomes.
Perform day-to-day contract implementation duties, including UAT testing and auditing provider setup to ensure accurate claims processing. Troubleshoot system configuration issues and communicate new contract terms to relevant departments.
The role serves as a clinical liaison between operations and external providers to assess behavioral health records and interpret program metrics. It involves partnering with regional leadership to educate providers, resolve operational issues, and drive quality improvement initiatives.
The analyst will perform data analysis to link business needs with objectives and identify implementation barriers for new systems. They will also lead problem-solving efforts, coordinate between business units, and assist in formulating departmental policies.
The Behavioral Health Clinical Liaison serves as a bridge between operations and external providers to review clinical records and ensure quality behavioral health services. They also analyze program data to drive improvements and facilitate provider education regarding health plan reporting and quality incentives.
The Senior Site Reliability Engineer leads projects to maintain platform infrastructure performance, reliability, and security using SRE practices and observability tools. They also develop automated procedures for monitoring and lead teams through deployment processes and incident resolution.
The Lead Quality Program Strategist identifies quality performance trends and develops strategic initiatives to improve quality rating system performance. They collaborate with stakeholders to determine root causes of business issues and ensure the successful implementation of quality-driven programs.
The manager will support analytic data needs for the business unit, handle complex requests, and mentor a team of analysts. They will also coordinate development initiatives, perform clinical and trend analysis, and ensure the delivery of quality healthcare data.
This role leads the Supplemental Data organization, managing a team of managers to support clinical data collection and HEDIS gap closure. The position also involves initiating companywide data process improvements and managing large-scale analytic projects across functional teams.
The Project Manager will lead complex integration processes by collaborating with internal and external stakeholders to ensure alignment with company goals. They are responsible for managing the full project life cycle, including planning, budgeting, resource allocation, and the creation of high-quality project deliverables.
The specialist will support data management and quality improvement initiatives, including the development of health services data reports. They will also assist in managing databases, conducting performance audits, and reporting outcomes to management.
Analyze integrated healthcare datasets to extract insights that optimize medical spend and improve clinical outcomes. Lead large-scale projects and collaborate with stakeholders to translate business goals into actionable data-driven solutions.
The Manager of Clinical Pharmacy Operations directs clinical pharmacy activities and staff to enhance pharmaceutical care quality and cost-effective drug utilization. They are responsible for developing and maintaining clinical programs, including formulary management, drug utilization review, and compliance with regulatory standards.
The manager will oversee and conduct risk-based internal audits, including strategic, financial, operational, compliance, and IT audits. They are responsible for developing audit plans, managing staff, and providing executive reports on findings and recommendations to senior management.
The Enrollment Coordinator educates prospective members on health plan benefits and facilitates the enrollment and recertification processes. They also conduct outreach, participate in community marketing events, and ensure compliance with regulatory guidelines.
Manage daily provider data management operations, including data entry, validation, and the resolution of complex data issues. Lead team workflows, monitor performance against quality benchmarks, and mentor staff to ensure accurate claims payment and directory display.
The manager will lead a team to investigate fraud, waste, and abuse while ensuring compliance with state and federal billing requirements. They are responsible for developing educational materials, managing post-payment recovery cases, and preparing financial savings reports.
Resolve escalated member and provider complaints and inquiries, document and track cases, and coordinate with contact center and other departments to ensure timely solutions. Analyze complaint trends and root causes, support recommendations to improve customer experience, and research basic claims payment errors when needed.
Plan and manage programs and projects throughout their full life cycle, including gathering requirements, creating schedules, coordinating resources, and overseeing execution and deployment. Maintain program documentation and deliverables, monitor quality and operational outcomes, communicate status to stakeholders, and resolve issues and risks.
The Program Manager serves as a strategic partner to senior leadership, coordinating initiatives and ensuring effective execution across the organization. They manage multiple projects through the full life cycle while identifying opportunities for operational efficiency and regulatory compliance.
Develops and facilitates complex care management activities, including personalized care plans and education for members and their families. Coordinates with providers and community resources to address unmet needs while monitoring member status and progress toward goals.
The Senior Compliance Analyst will assist in maintaining the corporate compliance program by performing regulatory interpretation, reporting, and auditing. They will also manage ethics projects, coordinate with regulatory agencies, and provide guidance on compliance policies and procedures.
The Senior Manager oversees business operations and strategies to ensure performance aligns with organizational and state standards. They are responsible for leading strategic planning, driving process improvements, and managing high-performing teams to achieve operational excellence.
