You will lead a team of Supervisors and Member Service Guides to ensure high-quality, empathetic support for healthcare members. This role involves balancing people leadership with operational execution, driving continuous improvement, and integrating AI-enabled workflows into daily operations.
The Manager will oversee daily eligibility and enrollment workflows, ensuring compliance with CMS requirements and internal SLAs for HMO, PPO, and SNP products. They will also lead, coach, and develop a team of associates while managing inventory, quality audits, and process improvements.
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 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 managing inbound and outbound communications, conducting clinical outreach, and maintaining accurate documentation while adhering to regulatory compliance.
Guides provide empathetic support to members across multiple channels, helping them navigate healthcare benefits and clinical needs. They must maintain operational excellence by using AI tools and internal systems to document interactions accurately while adhering to compliance standards.
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 Pharmacy Fraud Program Manager is responsible for detecting and investigating fraudulent pharmacy claims while managing the relationship with the pharmacy benefit manager. This role involves validating complex data sets, utilizing AI-driven tools, and coordinating investigative findings with internal and external stakeholders.
The associate will manage day-to-day operational tasks including enrollment, billing, and Medicare/Medicaid data reconciliation to ensure accuracy. They will also identify data discrepancies, maintain audit-ready documentation, and explore AI tools to improve operational workflows.
You will independently develop and deliver complex learning programs and resources to support frontline staff in providing high-quality member care. This role involves managing the full instructional design lifecycle, from identifying learning needs through data analysis to evaluating training impact using Kirkpatrick's levels.
This role is responsible for orchestrating capacity and staffing across internal and vendor teams to ensure operational efficiency. You will lead cross-functional initiatives, establish performance metrics, and build scalable infrastructure to support the organization's growth.
The Transitions of Care Manager leads and supports a team of RN Case Managers to ensure safe post-discharge transitions for patients. They are responsible for coaching staff, optimizing clinical workflows, and collaborating with interdisciplinary leaders to improve patient outcomes.
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.
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.
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 Senior Financial Analyst will architect and scale cost accounting frameworks, including expense allocation and profitability analysis to guide margin optimization. They will also build driver-based financial models and support monthly close processes, regulatory inquiries, and cross-functional continuous improvement initiatives.
The Operations Manager will oversee and coordinate medical record retrieval efforts while managing performance metrics and dashboards to drive process improvements. They will also serve as a key member of the External Audit Program team, supporting the end-to-end management of the audit lifecycle.
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.
You will lead the strategic analysis of the Medicare Advantage portfolio, including product mix, benefit design, and cost utilization. You will also build automated analytical pipelines and present data-backed recommendations to senior leadership.
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 Payroll Analyst will own the end-to-end bi-weekly payroll process, including data analysis, tax compliance, and system integrity within Workday and ADP. They will also serve as the primary point of contact for employee payroll inquiries and support the finance team with reporting and audit preparation.
Serve as the primary point of contact for members, guiding them through healthcare appointments, benefit inquiries, and care coordination needs. Collaborate with clinical teams and internal partners to ensure accurate documentation and efficient resolution of member health concerns.
The Member Service Guide acts as the primary point of contact for members, providing support for healthcare navigation, benefit inquiries, and care coordination. They collaborate with clinical teams to ensure accurate documentation and resolve member needs across phone, chat, and digital channels.
The associate will manage the end-to-end audit file submission process to CMS, ensuring all data is accurate, compliant, and documented. They will also coordinate team activities, conduct quality assurance checks, and partner with technical teams to resolve system issues.
The provider will perform virtual acute care visits, including diagnosing illnesses, ordering diagnostic tests, and establishing collaborative care plans. They will work closely with the patient's care team, including PCPs, specialists, and social workers, to coordinate effective treatment.
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 provider will perform virtual acute care visits, including diagnosing complex medical conditions and establishing collaborative care plans. They will work closely with the member's care team, including PCPs and specialists, to coordinate care and provide feedback on electronic health systems.
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 patient care, identify complex needs, and document all interactions in the electronic health record.
The Cardiovascular Clinical Guide will manage hypertension care by conducting assessments, delivering lifestyle counseling, and coordinating multidisciplinary support for members. They serve as the primary point of contact to help members monitor their health, adhere to medication, and achieve sustainable behavioral changes.
The licensing contractor will manage initial and renewal license applications for medical providers across multiple states. They are responsible for maintaining credentialing files and ensuring all documentation complies with state, federal, and accreditation standards.
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.
Provide telephonic clinical advice and triage to members while coordinating their care across various healthcare settings. Monitor patient portal messages and deliver telehealth support to ensure members receive the appropriate level of care.
The Advanced Practice Provider will perform virtual acute care visits to diagnose complex medical conditions and establish collaborative care plans. They will work closely with the member's care team, including PCPs and specialists, to coordinate care and provide feedback on electronic health information systems.
The Clinical Guide will conduct prospective, concurrent, and retrospective utilization reviews to evaluate medical necessity and appropriate levels of care for inpatient, behavioral health, and post-acute services. They will collaborate with Medical Directors on complex cases and ensure all documentation complies with CMS and Medicare Advantage regulatory standards.
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 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.
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 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 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.
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 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 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.
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.
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 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 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.
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.
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.
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.
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.
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 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.
