The Senior Manager will serve as the primary clinical architect for claim edit and audit pipelines, conducting research to originate automated payment integrity logic. They will lead cross-functional policy development and oversee the end-to-end rollout of clinical concepts across various healthcare settings.
The Medical Director will lead utilization management programs, perform clinical reviews, and conduct peer-to-peer discussions to ensure high-quality, evidence-based care. They will also provide clinical leadership, mentor teams, and collaborate across departments to optimize resource allocation and health plan objectives.
The Senior Manager of Operational Transformation leads change readiness by bridging strategy and execution across all Guide-facing teams. They are responsible for building durable tools, managing cross-team dependencies, and ensuring operational changes are successfully adopted.
Conduct comprehensive telehealth and occasional home-based assessments to provide high-quality preventative primary care to members. Collaborate with a multidisciplinary team including physicians, nurses, and social workers to develop and implement effective care plans.
The Clinical Pharmacist will manage chronic conditions through personalized care plans and conduct comprehensive medication therapy management reviews. They will also drive clinical quality measures and collaborate with interdisciplinary teams to optimize patient outcomes.
The Clinical Pharmacist will manage chronic conditions through personalized care plans and conduct comprehensive medication therapy management reviews. They will also drive clinical quality measures and collaborate with interdisciplinary teams to optimize patient outcomes.
The Clinical Pharmacist will manage chronic conditions through personalized care plans and conduct comprehensive medication therapy management for members. They will also drive clinical quality measures and mentor the team on pharmacotherapy while utilizing AI-enabled clinical tools.
The Clinical Pharmacist will manage chronic conditions through personalized care plans and conduct comprehensive medication therapy management reviews. They will also drive clinical quality measures and mentor the team on pharmacotherapy while utilizing AI-enabled tools for documentation.
The Provider Network Performance Manager drives provider performance across the New Jersey market by analyzing data to identify improvement opportunities and executing targeted performance plans. This role involves leading provider partnerships, managing joint operating committees, and aligning contracting strategies to meet cost, quality, and access goals.
Provide comprehensive virtual primary care visits, including chronic disease management, preventive screenings, and acute care interventions. Collaborate with a multidisciplinary team to coordinate diagnostics, specialist referrals, and individualized care plans.
The Sr. Manager will lead a hybrid team to ensure end-to-end accuracy of provider data and directory compliance with CMS requirements. They will also partner with cross-functional teams to evolve directory tools and improve care navigation initiatives.
The Senior Manager will lead cross-functional initiatives across agency onboarding, compliance analysis, and partnership enhancements to drive scalable operational solutions. They will manage project portfolios, influence stakeholders without direct authority, and ensure compliance while supporting top agency partners.
Provide empathetic support to members across multiple channels including voice, chat, and SMS to resolve benefit issues and navigate healthcare needs. Conduct proactive clinical outreach and maintain operational excellence by documenting solutions accurately within internal systems.
The provider will conduct virtual assessments and develop treatment plans for patients with chronic conditions like hypertension and diabetes. They will also manage prescription refills and lab results while utilizing AI-assisted clinical tools to improve patient care efficiency.
The Advanced Practice Provider will conduct virtual patient assessments, manage chronic conditions, and handle prescription refills and lab results. They will also collaborate with a cross-functional team to deliver care using digital platforms and AI-assisted clinical tools.
The Advanced Practice Provider will conduct virtual patient assessments and manage chronic conditions such as hypertension, hyperlipidemia, and diabetes. They will also handle prescription refills, manage lab results, and collaborate with a cross-functional team to deliver holistic care.
Provide empathetic clinical care through real-time chat and digital channels while managing patient medical needs and documentation. Collaborate with interdisciplinary teams to ensure continuity of care and facilitate escalations when patient needs exceed digital capabilities.
Provide holistic clinical care to patients through real-time chat and digital channels while managing concurrent patient conversations. Collaborate with interdisciplinary teams to ensure continuity of care and maintain accurate documentation in the electronic health record.
Provide empathetic clinical care through real-time chat and digital channels while managing patient medical needs and coordinating with broader healthcare teams. Maintain accurate digital documentation and ensure clinical safety by escalating complex cases when necessary.
The Advanced Practice Provider will deliver virtual acute care by diagnosing complex conditions, ordering diagnostic tests, and establishing collaborative care plans. They will also coordinate with multidisciplinary care teams and provide feedback on the electronic health information system.
The provider will perform virtual acute care visits, including diagnosing complex medical conditions and ordering diagnostic tests. They will collaborate with a multidisciplinary care team to establish and implement effective patient care plans.
The Director will own the clinical pharmacy Star Ratings performance strategy, driving outcomes through data-driven insights and cross-functional execution. They will serve as the enterprise subject matter expert, interpreting regulatory changes and leading initiatives to improve medication adherence and clinical quality.
The primary responsibility is to provide supervision for mid-level providers (APRNs) to meet Georgia state requirements. This includes conducting quarterly meetings and performing monthly chart reviews to ensure clinical care aligns with evidence-based guidelines.
The primary responsibility is the supervision of mid-level providers (APRNs) to satisfy South Carolina state requirements. You will also ensure clinical care is consistent with evidence-based guidelines and participate in biannual meetings.
Conduct comprehensive telehealth assessments and provide evidence-based preventative care to improve member health outcomes. Collaborate with an interdisciplinary team to manage chronic conditions and coordinate whole-person care plans.
The role involves conducting high-volume outbound outreach via phone and SMS to help members navigate healthcare needs and improve medication adherence. Responsibilities include enrolling members in support programs, coordinating with clinical teams, and documenting interactions accurately.
Pharmacy Guides conduct outbound outreach via phone and SMS to help members overcome barriers to medication adherence and healthcare access. They also enroll members in support programs, coordinate with clinical teams, and document interactions within internal systems.
The Director will design and implement organization-wide strategies to improve clinical outcomes and member health through scalable, tech-enabled workflows. They will manage cross-functional teams to translate complex operational goals into actionable interventions and drive performance against key clinical metrics.
The Clinical Associate supports virtual and home-based care teams by managing pre-visit preparations, coordinating post-visit care, and navigating digital workflows. They act as a patient advocate, ensuring seamless communication and continuity of care for members.
The Care Coordinator supports clinical operations by conducting patient outreach, scheduling follow-up appointments, and managing post-discharge documentation. They also assist with telehealth preparation, coordinate diagnostic testing, and ensure clinical results are reviewed by licensed professionals.
The Senior Stock Plan Administrator will own and manage the company's equity plan operations, including grant processing, cap table management, and compliance. They will also lead the implementation of equity tools, manage payroll integrations, and provide guidance to employees regarding equity compensation.
Coordinate care for members newly discharged from hospitals to prevent readmissions and ensure a safe recovery at home. Responsibilities include conducting outreach calls, scheduling follow-up visits, and collaborating with providers and vendors to secure necessary resources.
Provides legal counsel for health plan operations, focusing on claims, network management, and provider contracting. Translates complex regulatory requirements into actionable guidance for business and clinical teams while supporting regulatory audits.
Provide comprehensive virtual primary care, including chronic disease management and acute care interventions via a telehealth platform. Coordinate with multidisciplinary teams for diagnostics and specialist referrals while utilizing electronic health platforms.
Provide virtual primary care visits including chronic disease management, preventive screenings, and acute care interventions via a telehealth platform. Coordinate with multidisciplinary teams for lab work, imaging, and specialist referrals while utilizing an electronic health platform.
Lead a virtual primary care model by managing a patient panel and supervising a team of Advanced Practice Providers. Drive clinical innovation through the development of AI-enabled technology and quality oversight measures.
Manage a longitudinal panel of high-risk patients by providing virtual palliative care, symptom management, and goals of care counseling. Collaborate with interprofessional teams to coordinate seamless transitions of care and reduce hospital readmission rates.
Lead the execution of provider network contracting and deal closing across growth markets for Commercial and Medicare Advantage lines of business. Manage a high-performing team to optimize fee schedules and operationalize agreements within core systems.
Perform clinical reviews for Part A, B, appeals, and quality of care while conducting peer-to-peer discussions. Serve as a clinical subject matter expert and participate in acute and post-acute clinical rounds.
Deliver world-class virtual diabetes care to seniors through focused assessments, individualized treatment plans, and medication management. Collaborate with an interprofessional team and provide clinical escalation support within a virtual specialty clinic.
Coordinate comprehensive care plans for complex patients by addressing socioeconomic and psychosocial needs through interdisciplinary collaboration. Facilitate advanced care planning, resource alignment, and support for both patients and their caregivers.
Manage the clinical trajectory and care plans for complex geriatric patients using a multidisciplinary team approach. Deliver exceptional care through telehealth visits, focusing on symptom management and chronic disease coordination.
Manage the clinical trajectory and care plans for complex geriatric patients using telehealth and a multidisciplinary team approach. Perform comprehensive assessments, medication reviews, and coordinate care with PCPs and specialists to reduce hospital admissions.
Identify, negotiate, and execute provider contracts to build and maintain a high-quality Medicare Advantage network. Coordinate contract execution and partner with internal teams like Legal and Finance to ensure network adequacy and growth.
Perform comprehensive initial post-discharge visits and virtual urgent care assessments to prevent hospital readmissions for medically complex patients. Collaborate with an interdisciplinary team to manage clinical trajectories and contribute to the development of the Transitions of Care program.
Perform comprehensive initial and acute virtual post-discharge visits to prevent hospital readmissions for medically complex geriatric patients. Collaborate with an interdisciplinary team to manage clinical trajectories and contribute to the development of the Transitions of Care program.
The role involves designing and managing the full lifecycle of payment integrity edits and audits to ensure accurate claims payment. This includes converting complex regulatory guidelines into automated software logic and using data queries to validate financial hypotheses.
Conduct telehealth video visits and occasional in-home assessments to provide preventative and proactive primary care for older adults. Collaborate with an interdisciplinary team to manage chronic conditions and create individualized, whole-person care plans.
Design and lead a new Serious Mental Illness care paradigm within a virtual geriatric primary care model. Balance strategic leadership with direct clinical practice as the primary prescriber for high-acuity members.
Lead the design, pricing, and optimization of Medicare Advantage benefit portfolios through complex financial modeling and bid analytics. Develop automated analytical infrastructure using SQL and Python while collaborating with executive leadership on competitive market positioning.
Own the production performance and continuous improvement of core agentic AI workflows for service and experience. This includes monitoring health, diagnosing regressions, and designing scalable evaluation systems to ensure operational safety and quality.
The physician will deliver virtual care to high-risk patients while leading interdisciplinary teams to optimize clinical outcomes. They are responsible for managing complex geriatric conditions and iteratively improving the clinical model through AI-enabled technology.
The primary responsibility involves supervising mid-level providers, specifically Physician Assistants, to meet Colorado state requirements for collaborating physicians. This includes conducting annual in-person meetings and reviewing provided charts on a monthly basis to ensure clinical care aligns with evidence-based guidelines.
The senior manager will lead the development of a new team focused on managing group escalations and centralizing issue intake. They will engage directly with critical provider groups to build trust and resolve issues effectively while driving operational initiatives to improve performance.
