The Utilization Management Nurse Consultant reviews clinical information to support coverage determinations and coordinates healthcare services across the continuum of care. They collaborate with providers and care teams to facilitate appropriate treatment planning and connect members with necessary healthcare resources.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Provide patient education and maintain clinical documentation using an intuitive digital workflow.
The Associate Manager oversees quality staff, focusing on team development, performance monitoring, and the implementation of high-performing workflows. They collaborate with functional area managers to ensure regulatory compliance and facilitate effective problem resolution within the appeals team.
Conduct in-home health evaluations for health plan members, including physical assessments, medication reviews, and medical history documentation. Provide diagnostic and preventive services while building trusted relationships to help bridge gaps in patient care.
The analyst will support the Enterprise Risk Management program by maintaining quantitative models and performing complex data analysis. They will collaborate with cross-functional teams to interpret business data and ensure the accuracy and integrity of risk-quantification tools.
The Lead Director will define and execute the strategic roadmap for the Health100 App's open platform benefits experience, including managing client partnerships and integrations. This role involves leading cross-functional product teams to deliver intuitive, user-centric digital solutions while fostering a culture of continuous discovery and evidence-based decision-making.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and facilitate connections to appropriate care based on individual health needs.
The Transition of Care Coach manages care coordination for members transitioning from inpatient or emergency settings to ensure safe and effective post-discharge outcomes. They facilitate interdisciplinary care team meetings, conduct outreach calls, and assist with medication management and community resource navigation.
The Behavioral Health Care Manager will conduct comprehensive clinical assessments and develop individualized care plans for members with complex needs. They will also provide crisis intervention and collaborate with internal teams to ensure cost-effective, high-quality care delivery.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Build trusted relationships with patients to provide personalized health education and support their wellness journey.
The Lead Director will develop and execute state-specific Medicaid strategies to drive business growth and align with healthcare policy objectives. They will serve as a key liaison to government affairs teams and build relationships with community stakeholders, providers, and advocacy groups.
The Medical Director provides oversight for medical policy implementation and manages clinical programs to address member needs. They are responsible for utilization review, quality assurance, and acting as a clinical liaison to network providers.
You will own the end-to-end delivery of software features, including implementation, testing, and deployment within a cloud-native environment. Additionally, you will contribute to AI-enabled workflows and modernize existing patient-facing applications and APIs.
The Care Management Associate evaluates patients to identify needed medical services and coordinates care plans under the direction of medical staff. They also perform non-medical research, manage case documentation, and provide support by handling provider and member inquiries.
The analyst will focus on quarterly forecasting, monthly valuation, and modeling financial risks for Medicare Part D products. They will collaborate with cross-functional teams to analyze legislative impacts and provide analytical support for business decision-making.
The Senior Data Scientist translates complex clinical and EHR data into actionable performance measures and analytical frameworks. They collaborate with cross-functional teams to support quality, utilization, and population health initiatives across various clinical assets.
The Senior Analyst will manage financial reporting, payment integrity products, and operational performance analysis. They will also collaborate cross-functionally to develop data models and support strategic initiatives for employer groups.
Conduct telephonic assessments to identify member needs and develop personalized care plans to support wellness. Collaborate with healthcare providers and multidisciplinary teams to remove barriers to care and improve health outcomes.
The Senior Analyst supports the end-to-end financial consolidation of the Network P&L and manages the operational cadence of the Finance management process. They are responsible for aggregating revenue, COGS, fees, and credits while coordinating deliverables for close, budget, and forecast cycles.
The Case Manager will work telephonically with patients and care teams to apply clinical guidelines and manage care plans for insured clients. They are responsible for performing medical necessity reviews and utilizing motivational interviewing to engage members and address complex health needs.
The nurse consultant assesses and coordinates healthcare services by applying clinical criteria to render coverage determinations. They also communicate with providers and identify opportunities to promote quality effectiveness in benefit utilization.
Conduct in-home health evaluations, including medication reviews, medical history assessments, and physical examinations for health plan members. Provide patient education and facilitate connections to appropriate care services to improve health outcomes.
The Senior Manager will lead software engineering teams to develop highly scalable enterprise applications and web services within the Signify Health ecosystem. They are responsible for driving product direction, mentoring junior engineers, and implementing security best practices across the development lifecycle.
The AI Engineer will design, build, and deploy AI-powered features using large language models and machine learning pipelines. Responsibilities include prompt engineering, model evaluation, and integrating models into scalable services through APIs.
The Senior Manager will lead clinical informatics efforts for Virtual Care and Retail Health, focusing on Epic workflow design, optimization, and digital integration. They will collaborate with cross-functional teams to conduct user acceptance testing and implement innovative technology solutions to improve care delivery.
The Senior Claim Benefit Adjuster is responsible for adjudicating complex medical claims, including self-funded, fully insured, and specialized claim types. They also manage provider refunds, handle appeals, and ensure all processing adheres to company compliance and medical necessity guidelines.
The consultant coordinates and documents utilization management for Medicare and dually eligible members using clinical judgment and evidence-based guidelines. They collaborate with interdisciplinary teams to facilitate treatment plans, discharge planning, and continuity of care for complex member needs.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Facilitate connections to appropriate care and maintain accurate clinical documentation using provided digital tools.
The consultant coordinates and manages behavioral health utilization for Medicare and dually eligible members using evidence-based clinical guidelines. They collaborate with interdisciplinary teams to assess treatment plans, facilitate transitions of care, and ensure cost-effective resource utilization.
The Scrum Master Manager will lead complex, enterprise-wide digital transformation and technology modernization initiatives. They will serve as the primary liaison between technology and business teams to ensure project alignment, execution, and delivery.
