The Senior Manager will serve as the primary clinical architect for claim edit and audit pipelines, researching and developing automated payment integrity logic. They will lead cross-functional policy initiatives and validate clinical hypotheses using data analysis across various healthcare settings.
The manager will lead and develop a team of Digital Care Coordinators to ensure high-quality, empathetic member support via chat. They are responsible for operational performance, including queue management, staffing models, and continuous workflow improvement.
The Clinical Nurse Specialist performs complex clinical reviews for pre-service, concurrent, and post-service cases while serving as a subject matter expert for medical necessity and regulatory compliance. They also analyze trends to identify systemic issues and provide coaching to clinical staff on documentation and review best practices.
The manager will oversee clinical data acquisition by developing strategies to improve data availability and usability across healthcare systems. They will collaborate with internal and external stakeholders to implement technical integrations and ensure data quality through effective KPIs.
You will build and manage AI-powered systems to monitor and improve the quality of member interactions across frontline teams and AI agents. This role involves defining performance standards, creating coaching workflows, and partnering with leadership to drive actionable insights and operational excellence.
The Senior Associate manages the operational execution of member claim processing for Medicare Advantage, ensuring accuracy, timeliness, and compliance. They handle complex claims, monitor inventory aging, and collaborate with technical teams to resolve processing errors.
The Digital Marketing Associate will build and deploy multi-channel digital marketing campaigns while coordinating with external vendors and internal creative teams. They are responsible for tracking channel performance using data tools and ensuring all marketing materials are compliant and error-free.
The Member Flex Guide serves as a primary bridge for English and Spanish-speaking members, helping them navigate healthcare complexities with empathy and precision. Responsibilities include engaging across multiple communication channels, conducting proactive clinical outreach, and maintaining accurate documentation while adhering to regulatory compliance.
Guides act as the primary connection for members, helping them navigate healthcare complexities through inbound service, proactive outreach, and digital support. They must maintain operational excellence by leveraging AI tools and internal systems while adhering to HIPAA and compliance standards.
The Pharmacy Guide manages high-volume outbound calls to help members overcome barriers to medication adherence and access necessary care programs. They are responsible for building trust, investigating member issues, and coordinating with clinical teams to ensure continuity of care.
Manage high-volume outbound phone calls to engage members in medication adherence and health support programs. Investigate member issues, identify root causes, and coordinate with clinical teams to resolve needs.
The Clinical Guide performs prospective, concurrent, and retrospective utilization reviews to evaluate medical necessity and appropriate level of care for inpatient and post-acute services. They collaborate with medical directors on complex cases and ensure all documentation complies with CMS and Medicare Advantage regulatory standards.
The Palliative Care Social Work Case Manager provides supportive counseling and care coordination for patients with complex needs and life-limiting illnesses. Responsibilities include conducting psychosocial assessments, facilitating goals of care discussions, and collaborating with an interdisciplinary team to eliminate socioeconomic barriers.
The Business Operations Senior Manager oversees the daily health of payment integrity operations, including monitoring turnaround times and clearing backlogs. They are responsible for designing and launching scalable cross-functional workflows while integrating AI solutions to improve operational efficiency.
The nurse will provide virtual, home-based palliative care through telephonic and video engagement while managing patient panels and coordinating care with interdisciplinary teams. Responsibilities include performing triage, conducting routine health check-ins, and supporting palliative education initiatives.
The Medical Director will design and lead the clinical architecture for a national Musculoskeletal (MSK) program, integrating AI-driven workflows with high-touch patient care. This role involves building and managing a clinical team, defining care pathways, and measuring outcomes to ensure high-quality, scalable MSK services.
The specialist is responsible for identifying, negotiating, and executing provider contracts within an assigned geographic region to support network adequacy. They will partner cross-functionally with internal teams to manage workflows and ensure accurate documentation of provider agreements.
Conduct comprehensive telehealth assessments and provide evidence-based preventative care for members. Collaborate with an interdisciplinary team to manage chronic conditions and coordinate whole-person care plans.
The Operations Manager will oversee regulatory compliance, manage documentation, and handle operational due diligence for Special Needs Plans. They will also drive process improvements and translate changing CMS and Medicaid requirements into effective operational workflows.
The Senior Associate oversees the analysis, mapping, testing, and implementation of claims benefit configurations to ensure accurate member cost sharing and provider payments. They also lead annual readiness projects and develop quality control procedures to streamline configuration operations.
Own provider data accuracy and directory compliance end to end, including validation, verification, remediation, audit readiness, and regulatory responses. Lead and scale a hybrid onshore/offshore team, improve data-quality operations and reporting, and partner with product, engineering, and network leaders to advance directory strategy and automate manual work.
The Community Outreach Specialist will build strategic relationships with community influencers to secure prospecting venues and orchestrate sales and marketing events. They will also collaborate with Broker Managers to align outreach strategies and provide mentorship to external agents on lead-generation techniques.
The Practice Associate will support the administrative needs of Devoted Medical programs through process design and infrastructure maintenance. Responsibilities include managing provider relationships, overseeing supply procurement, and handling employee onboarding and offboarding.
Serve as the medication and pharmacy informatics subject matter expert for the Orinoco EHR, guiding clinical workflow design, regulatory compliance, and adoption of best practices. Maintain e-prescribing integrations and medication mapping tools, and lead testing and certification activities to ensure medication processes are safe and functional.
The Advanced Practice Provider will deliver virtual acute care to members, including diagnosing conditions, ordering diagnostic tests, and establishing collaborative care plans. They will work closely with a multidisciplinary team to coordinate care and provide feedback on the electronic health information system.
Lead outcome-oriented product strategy by developing roadmaps focused on operational outcomes like cost reduction and clinical quality. Collaborate with cross-functional teams including Engineering, Data Analytics, and Clinical to execute initiatives and communicate progress to senior stakeholders.
The Quality Assurance Manager will oversee the quality assurance program for retrospective coding and auditing, including managing vendor teams and internal policies. They will analyze coding trends, facilitate education, and partner with technology teams to optimize risk adjustment tooling and accuracy.
The Pharmacy Care Coordinator supports clinical outreach campaigns by managing member appointments and coordinating medication therapy changes with providers and pharmacies. They also manage an assigned caseload to address clinical gaps, medication concerns, and cost-saving opportunities for members.
The Senior Stock Plan Administrator will own and manage the company's equity plan operations, including grant processing, cap table management, and liquidity events. They will also lead the implementation of equity tools, ensure tax compliance, and provide guidance to employees regarding their equity compensation.
The Employee Benefits Manager will oversee the day-to-day administration of health, welfare, and retirement programs while focusing on enhancing the employee experience. Responsibilities include managing open enrollment, ensuring data integrity with HRIS/payroll, and creating engaging communications to maximize benefit participation.
The Senior Manager oversees daily operations and long-term strategy for inbound correspondence and outbound print production. This role acts as a bridge between membership operations and core health plan functions while managing vendor relationships and departmental budgets.
The Senior Associate will manage complex retroactive enrollment and payment corrections while ensuring data integrity across health plan operations. They will also develop durable, self-serve tooling and coordinate downstream remediation to ensure members are made whole.
You will conduct telehealth video visits to perform comprehensive clinical assessments and manage chronic conditions for members. You will also collaborate with an interdisciplinary team to develop and implement individualized, whole-person care plans.
The physician will provide direct virtual care to high-risk patients recently discharged from acute settings to prevent readmissions. Additionally, the role involves clinical supervision of interdisciplinary teams, leading rounds, and driving quality improvement through AI-enabled tools.
The Clinical Associate acts as a liaison between healthcare services and members, coordinating care, managing medical records, and facilitating appointments. They support clinicians by identifying care gaps, communicating with providers, and providing high-touch telehealth support to ensure positive health outcomes.
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.
Conduct thorough virtual assessments and develop individualized treatment plans for patients with diabetes in collaboration with an interprofessional team. Provide clinical advice, monitor quality of care metrics, and utilize electronic health systems to ensure continuity and holistic patient care.
Provide remote telehealth care and manage patients in a virtual observation unit to improve health outcomes. Supervise and teach a team of advanced practice providers while fostering a collaborative clinical environment.
The manager will provide clinical care to patients while overseeing the clinical and operational performance of the Transitions of Care APP team. Responsibilities include performance management, KPI tracking, process improvement, and team leadership to ensure clinical excellence.
The manager evaluates drug cost, safety, and integrity opportunities across Part B and Part D to identify and solve patterns of waste or inefficiency. They build clinical and financial cases for viable opportunities and collaborate with internal functions to implement solutions.
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 Advanced Practice Provider will provide virtual clinical care for patients during the 30-day post-discharge window to prevent readmissions. Responsibilities include conducting comprehensive medical assessments, developing individualized care plans, and collaborating with an interdisciplinary team.
The Provider Network Performance Manager will drive provider performance across the New York market by analyzing data to identify gaps and developing improvement plans. This role involves leading provider partnerships, managing Joint Operating Committees, and aligning contracting strategies to meet cost, quality, and access goals.
The Senior Statutory Reporting Accountant will prepare monthly, quarterly, and annual statutory financial statements for regulatory authorities and the NAIC. The role also involves supporting insurance audits, managing reinsurance accounting, and assisting in the development of financial reporting processes.
The Transitions of Care APP will provide virtual clinical care for patients within 30 days of hospital discharge to prevent readmissions. Responsibilities include performing comprehensive medical assessments, medication reconciliation, and collaborating with an interdisciplinary team to develop individualized care plans.
The Senior Treasury Manager will partner with the Treasury Director to lead cash management, debt portfolio oversight, and treasury infrastructure development. This role involves managing international banking relationships, liquidity forecasting, and ensuring compliance with financial regulations and internal controls.
The Pharmacy Benefits Senior Manager will own the pharmacy trend for the commercial book of business, managing PBM relationships and contract negotiations. They will also lead complex pharmacy projects, including formulary changes and plan-design rollouts, while ensuring financial and performance guarantees are met.
The Senior Director of Interoperability will define the multi-year vision for data exchange and lead the operational teams responsible for clinical data integration and compliance. This role involves aligning cross-functional stakeholders, managing multi-million-dollar vendor partnerships, and representing the organization's interests with regulatory and industry partners.
The Internal Audit Manager will lead end-to-end operational and financial audits while maturing the department's methodology and risk-based assurance. This role involves coaching audit staff, managing stakeholder relationships, and applying data analytics and AI to enhance audit efficiency and quality.
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 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 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.
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 documentation. Collaborate with interdisciplinary teams to ensure continuity of care and facilitate escalations when patient needs exceed digital capabilities.
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.
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 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.
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 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.
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.
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.
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.
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.
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 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.
