Partner with stakeholders to analyze business needs and translate operational challenges into functional requirements for CRM enhancements. Support the full software development lifecycle, including process documentation, UAT execution, and change management support.
CenterWell
34 Remote Job Openings at CenterWell
The Senior Informaticist identifies unique insights and solves complex challenges using various data sources. They provide reporting and analytics solutions to optimize performance and improve member experience.
Oversee data processing architectures to convert structured and unstructured data into enterprise-scale insights. Lead the development of the PCO Analytics data warehouse using Medallion architecture and establish governed information architecture processes.
Lead the design and optimization of specialty provider networks and value-based care programs across multiple markets. Drive financial sustainability through advanced modeling and serve as a strategic partner to executive leadership.
The E-Referral Specialist manages the initial contact point for clients and referral sources to ensure continuity of care. Responsibilities include monitoring e-referral systems, verifying patient eligibility, and coordinating with leadership for referral decisions.
Analyze and measure the effectiveness of existing business processes to develop sustainable and quantifiable improvements. Research best practices and utilize information technology to enhance safety, productivity, and cost reduction.
Own the end-to-end design and maintenance of drug- and market-level utilization forecasts for Medicaid states. Translate complex quantitative results into executive narratives and diagnose drivers of variance when actuals diverge from expectations.
The Lead Data Product Owner manages the lifecycle of pharmacy data products, translating business needs into high-quality user stories and a prioritized backlog. The role focuses on productizing data during the migration to Databricks while ensuring alignment with enterprise governance and stewardship models.
Manage daily worklists to troubleshoot and complete medication prior authorization requests for specialty medications. Coordinate directly with provider offices and insurance companies to ensure compliance with quality standards and departmental protocols.
Risk Management Professional 2 (Licensed Nurse Required)
CenterWell
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Full Time
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5 days ago
CenterWell
Lead and execute quality audits within the Utilization Management program to ensure compliance with CMS and NCQA standards. Utilize Power BI and Power Apps to analyze audit data, identify risks, and communicate actionable insights to leadership.
Accurately fill and count medications while performing administrative and customer support assignments. Manage inventory levels in coordination with the supply team to ensure adequate dispensing capabilities.
Provides operational support to clinical pharmacists by translating clinical strategies into operational systems, drug lists, and benefit requirements. Ensures accuracy and compliance for utilization management criteria and maintains policies for external accreditation bodies.
Supports pharmacists in the preparation and dispensing of Specialty Rx medications while performing administrative and operational tasks. Ensures adherence to operational processes and communicates with patients and providers to optimize health outcomes.
Responsible for monitoring branch operations within an assigned market to ensure financial, clinical, and quality standards meet government and corporate regulations. Develops strategic business plans, manages budgets, and leads Branch Directors to achieve growth and operational success.
Assess and evaluate member health conditions via telephonic interactions to ensure wellness and medication adherence. Develop comprehensive care plans and provide medication education while reviewing prescriptions for accuracy and safety.
Handle intake calls from patients, pharmacies, and providers while performing administrative and computational tasks. Coordinate medication therapy management programs and schedule review sessions with consultative pharmacists.
The Informatics Lead solves complex business problems by analyzing customer journeys and diverse data sources to provide strategic insights for decision-makers. They lead the delivery of reporting and data science solutions to optimize performance and improve member experiences.
Lead process improvement initiatives and Kaizen events to optimize operational efficiency and patient experience. Develop measurement frameworks to track and report quantifiable cost savings and ROI.
The Senior BI Engineer solves complex business problems by analyzing internal and external data to provide insights for decision-makers. They are responsible for influencing department strategy and making independent technical decisions for project components.
The Senior Product Manager identifies and develops high-value automation and AI-enabled solutions to improve operational efficiency across CenterWell healthcare segments. This involves analyzing workflows, mapping user journeys, and collaborating with cross-functional teams to implement scalable automation in a regulated environment.
The Nurse Practitioner will call members to discuss care gaps, place necessary orders, and manage patient records within Athena. They will also coordinate social needs and transportation to facilitate gap closure for patients.
Principal, Clinical Strategy and Program Development
CenterWell
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Full Time
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24 days ago
CenterWell
Lead the strategic direction and execution of Care Integration programs, focusing on High Risk Patient Management and Transitions of Care. Collaborate with IT, Product, and Analytics teams to develop and manage the tooling and platforms that support care delivery for high-complexity senior patients.
The role focuses on analyzing consumer experience data and translating insights into actionable improvements for end-to-end customer journeys. It involves collaborating with cross-functional partners and providing guidance to other CX professionals to drive consumer-centered outcomes.
The pharmacist will manage medications for high-risk patients with chronic conditions and collaborate with multidisciplinary healthcare teams to optimize patient outcomes. Key duties include conducting medication reconciliations, providing disease state education, and supporting CMS Stars and HEDIS quality measures.
The pharmacist will manage medications for high-risk patients with chronic conditions and collaborate with multidisciplinary healthcare teams to improve patient outcomes. Responsibilities include conducting medication reconciliations, providing patient counseling, and supporting quality measures like CMS Stars and HEDIS.
The Lead Product Manager identifies and develops automation opportunities across CenterWell segments to improve operational and clinical outcomes. This involves designing AI-enabled solutions, mapping processes to find inefficiencies, and partnering with cross-functional teams to implement scalable capabilities.
The Business Intelligence Engineer solves complex business problems by analyzing raw data from internal and external sources to provide insights for decision-makers. They are responsible for describing tools and practices used to create insightful business information aligned with organizational strategy.
Manage a sales territory in Washington to influence physicians to route specialty drug prescriptions to Humana Specialty Pharmacy. Build relationships with medical clinic staff and provide education on pharmacy benefits and patient options.
The pharmacist evaluates pharmacotherapy for high-risk patients with chronic conditions and collaborates with multidisciplinary teams to optimize patient care. Responsibilities include medication reconciliation, patient counseling, and supporting CMS Stars and HEDIS quality measures.
Analyze and forecast financial and economic data to support strategic decisions and business intelligence. Lead the pricing and analysis of value-based care contracts within the home health space while ensuring data integrity.
Provide data-based strategic direction and business intelligence to support CenterWell's Primary Care, Home, and Pharmacy segments. Lead structured problem-solving, financial modeling, and the translation of high-level strategy into measurable operating results and implementation plans.
The analyst will support, monitor, and optimize revenue cycle systems while acting as a liaison between internal teams and external business partners. Responsibilities include managing EDI transactions, ensuring regulatory compliance, and identifying process improvements to reduce denials and improve billing efficiency.
The Physical Therapist will plan and administer personalized rehabilitation programs for patients in their homes to improve strength and mobility. They are responsible for documenting patient progress, overseeing PTAs and aides, and collaborating with the care team to ensure effective treatment.
The role involves administrative, operational, and customer support tasks, including performing computations and resolving prescription issues that prevent fulfillment. Responsibilities also include communicating with physician offices and hospitals via phone or fax to research and update clarifications and denials on patient profiles.
