Provide telephonic clinical triage and advice to members while coordinating their care across various healthcare services. Monitor patient portal messages and deliver telehealth support to ensure members receive the appropriate level of care.
You will own member retention and lifecycle strategies, building the intelligence and systems required to personalize engagement across multiple channels. You will lead the engagement operations team to optimize testing, targeting, and decisioning capabilities to improve member outcomes.
The manager will oversee the performance and optimization of payment integrity programs, ensuring accurate claims processing and effective vendor management. They will also lead cross-functional initiatives to implement scalable operational improvements and resolve complex performance issues.
The Payroll Administrator is responsible for processing bi-weekly payroll, ensuring data integrity within Workday, and managing payroll-related inquiries. They also oversee tax filings, garnishments, and collaborate with the finance and people teams to support organizational payroll functions.
The Digital Care Coordinator provides real-time support to members through chat portals, ensuring accurate benefit guidance and empathetic care navigation. They collaborate with clinical and cross-functional teams to resolve member needs while managing multiple concurrent conversations in a fast-paced environment.
Care coordinators act as advocates for complex members by connecting them with healthcare resources, appointments, and durable medical equipment. They also conduct outreach, review health risk assessments, and collaborate with clinical teams to ensure member needs are met.
The Integrations Manager will own the end-to-end lifecycle of system integrations, including design, development, testing, and monitoring of data exchanges. They will partner with cross-functional teams to scale workflows, manage vendor relationships, and implement AI-driven automation to improve operational efficiency.
The Senior Manager will serve as the final escalation authority for complex provider claims disputes and lead root cause investigations to implement systemic fixes. They will also partner with cross-functional teams to ensure regulatory compliance and provide clear briefings on trends and risks to leadership.
The manager will lead a team of outreach supervisors and coordinators to optimize engagement workflows and ensure high-quality patient support. They are responsible for performance management, data-driven process improvements, and collaborating with cross-functional teams to scale operations.
The Medical Director will lead utilization management programs, perform clinical reviews, and conduct peer-to-peer discussions to ensure high-value, evidence-based care. They will also mentor clinical teams and collaborate across departments to improve health plan efficiency and quality outcomes.
The provider will deliver direct nephrology care to chronic kidney disease patients, focusing on medication optimization, electrolyte management, and dialysis planning. They will collaborate with an interprofessional team to coordinate holistic care plans and perform comprehensive patient assessments.
Guides serve as the primary point of connection for members, helping them navigate healthcare benefits and clinical needs across various digital and voice channels. They must maintain operational excellence by leveraging AI tools, adhering to HIPAA compliance, and flexing between different service workflows as business needs evolve.
You will resolve member grievances by conducting thorough investigations and identifying root causes to ensure regulatory compliance. Additionally, you will communicate effectively with members to provide solutions while collaborating with internal teams to improve processes.
The Director will lead operational strategy and execution for a 150+ person organization, focusing on standardizing workflows and scaling efficiency. They will partner with cross-functional leaders to translate business needs into operational programs while fostering a high-performing team culture.
Perform medical record audits and clinical documentation improvement reviews to ensure coding accuracy and compliance with CMS guidelines. Provide education and training to providers and staff regarding diagnostic documentation and coding trends.
The CDCES will manage a panel of members with diabetes, providing education and counseling via virtual visits to improve clinical stability. They will collaborate with a multidisciplinary team to develop care plans, optimize medication regimens, and help members achieve SMART health goals.
The Clinical Guide will manage a panel of members with diabetes, providing virtual education, counseling, and care coordination to improve clinical outcomes. They will collaborate with a multidisciplinary team to develop personalized care plans and influence positive behavioral changes in members.
The physician will deliver virtual care to high-risk patients using an AI-enabled platform while leading interdisciplinary teams to improve clinical outcomes. They are responsible for managing complex geriatric conditions, monitoring performance metrics, and iterating on the clinical model to enhance patient care.
The physician will deliver virtual care to high-risk patients using an AI-enabled platform while leading interdisciplinary teams to manage complex geriatric conditions. They are responsible for monitoring clinical outcomes, optimizing performance metrics, and acting as a change agent to improve the clinical model.
The Utilization Management Coordinator manages intake, prior authorization workflows, and clinical coordination to support care transitions. They also communicate with members and providers while maintaining accurate case documentation and supporting clinical teams.
The Advanced Practice Provider will manage the clinical trajectory of complex geriatric patients through interdisciplinary collaboration and telehealth visits. Responsibilities include conducting comprehensive assessments, adjusting care plans, and coordinating with specialists and support systems to ensure whole-person support.
The Director will own the Health System Escalation function, driving operational improvements and cross-functional alignment to resolve provider issues. They will manage performance through rigorous metrics and lead the design of scalable, AI-enabled workflows to enhance service quality.
The Senior Manager of Security Operations will lead and mentor a team of engineers while overseeing the implementation and enhancement of critical security tools. They will drive the maturity of detection and response programs and manage high-severity security incidents through cross-functional coordination.
The Clinical Reviewer performs first-level clinical reviews of dental claims and pre-treatment estimates using established guidelines and clinical expertise. They also collaborate with cross-functional teams to ensure accurate, compliant utilization management and support high-quality provider communications.
The Social Work Case Manager will coordinate whole-person clinical and social support for complex patients while collaborating with an interdisciplinary team. Responsibilities include developing personalized care plans, facilitating end-of-life discussions, and assisting patients in navigating socioeconomic barriers.
The Senior Treasury Manager will lead treasury and cash management activities, including international banking, debt management, and liquidity forecasting. They will also build treasury infrastructure to support commercial expansion and manage internal and third-party banking relationships.
The role involves performing comprehensive psychosocial assessments and providing short-term clinical interventions to support members transitioning between care settings. You will collaborate with an interdisciplinary team to manage complex cases and ensure patient-centered care while documenting all interactions in the electronic health record.
The Operations Manager will oversee regulatory compliance, manage documentation, and drive process improvements for Special Needs Plans. They will also collaborate cross-functionally to translate CMS and Medicaid requirements into effective operational workflows.
The Senior Manager will design and implement workforce management systems, including capacity planning, scheduling models, and staffing ratios. They will also lead cross-functional initiatives to optimize operational performance, monitor real-time metrics, and ensure service level agreements are met.
The Manager for Workforce Management will oversee capacity planning, scheduling, and real-time operational performance to ensure service levels are met. They will also build scalable processes and collaborate with cross-functional teams to align staffing with budget and member demand.
