Establish and mature the enterprise AI governance framework and portfolio management to ensure responsible and scalable AI adoption. Partner with cross-functional stakeholders to align AI investments with business outcomes and regulatory requirements.
Enlyte
34 Remote Job Openings at Enlyte
The Telephonic Case Manager creates and implements treatment plans to return injured persons to work while ensuring cost-effective healthcare services. They collaborate with physicians, employers, and legal representatives to monitor recovery and modify case goals.
Design, build, and optimize modern data platforms to power enterprise analytics, machine learning, and AI initiatives. Lead the development of scalable data pipelines and automate infrastructure provisioning using Infrastructure-as-Code tools.
Collaborate with physicians, employers, and injured persons to create and implement cost-effective treatment plans for recovery. Manage a caseload independently to facilitate an optimal return to work and maximum medical recovery.
The role involves conceptualizing, designing, and developing interactive dashboards in Microsoft Power BI. It requires cross-functional collaboration to gather requirements and providing ongoing maintenance, training, and demos.
Perform utilization reviews on workers' compensation treatment referrals to ensure medical necessity and appropriateness. Collaborate with healthcare providers and claims adjusters to gather information and communicate findings through reports.
Collaborate with physicians, employers, and patients to create and implement cost-effective treatment plans for injured individuals. Manage a caseload to facilitate maximum medical recovery and a safe return to work.
Manage a designated book of business to strengthen customer relationships and drive account growth. Serve as a key partner to stakeholders to ensure product adoption and meet sales and renewal objectives.
Design, develop, and implement advanced contact center solutions using the NICE CXone ecosystem with a focus on scripting and automation. Build integrations between NICE CXone and enterprise systems while optimizing agent workflows and AI-driven customer interactions.
Lead claims performance consulting engagements for Tier-1 insurance carriers by transforming complex data into strategic roadmaps. Orchestrate multidisciplinary teams to design success scorecards and provide high-level advisory on program design and operational shifts.
The role involves negotiating and managing contracts with diverse healthcare providers to optimize network profitability and member access. It also requires building strategic relationships with facility leadership and identifying market opportunities for network expansion.
The role involves handling customer service tasks via email, phone, and CRM to resolve complex issues for clients and providers. Responsibilities include analyzing reports to prioritize issues and collaborating with internal and external resources to ensure service level agreements are met.
Act as a trusted advisor for clients and providers to resolve complex inquiries and multifaceted issues. Investigate root causes across various systems to implement comprehensive solutions and maintain service excellence.
Analyze complex business problems to design automated systems and workflows for medical billing software. Lead requirements gathering and technical specifications for data integration and regulatory compliance across Workers' Compensation and Auto lines of business.
Analyzes medical records and bills to determine causality and relatedness for clients. Prepares case summaries and organizes medical evidence while conducting research in medical journals.
Lead the evolution of customer intelligence by developing AI-driven predictive models for retention and churn risk. Unify customer data across platforms to provide actionable insights for customer success, sales, and executive teams.
Collaborate with physicians, employers, and injured persons to create and implement cost-effective treatment plans for recovery and return-to-work. Manage a caseload independently, assessing recovery progress and modifying goals to ensure optimal medical recovery.
Provide proactive and reactive technical support for Mitchell Auto Casualty software, handling high-level escalations and reproducing defects. Develop technical documentation and training materials for internal staff and customers while collaborating with product development to improve serviceability.
Provide inbound telephone triage services to injured workers following state Worker Compensation rules. Use clinical expertise and evidence-based protocols to make safe care decisions for emergent and non-emergent situations.
Collaborate with physicians, employers, and patients to create and implement cost-effective treatment plans for injured individuals. Manage a caseload independently to facilitate maximum medical recovery and a safe return to work.
Independently investigate and resolve complex or litigated Workers' Compensation claims while managing medical treatment and return-to-work processes. Establish claim reserves, handle reinsurance reporting, and collaborate with defense counsel to manage litigation outcomes.
Coordinate with physicians, employers, and injured persons to create and implement cost-effective treatment plans for recovery. Manage a caseload independently to facilitate an optimal return to work and maximum medical recovery.
Lead the vision and execution of a centralized billing and invoicing platform that supports multiple product lines. Translate product usage and business events into scalable billing constructs to ensure accurate revenue realization.
Collaborate with physicians, employers, and injured persons to create and implement cost-effective treatment plans for recovery and return-to-work. Manage a caseload independently, assessing recovery progress and modifying goals to ensure optimal medical recovery.
Independently analyze incoming medical bills for fee schedule and usual and customary application across multiple states and lines of business. Handle provider disputes and provide quality review and training for co-workers.
The role involves researching and reviewing complex medical bills and operative reports to ensure proper provider reimbursement based on state fee schedules. It also includes performing bill re-evaluations and verifying the accuracy of assigned codes against patient charts.
Lead the strategic direction and implementation of technology solutions supporting financial operations and billing. Act as the primary liaison between the finance department and enterprise IT to drive digital transformation and process improvements.
Lead the development and implementation of next-generation software solutions by engaging with customers to define requirements and track project timelines. Collaborate with cross-functional teams and stakeholders to ensure the delivery of customer value within an Agile environment.
Coordinate with physicians, employers, and injured persons to create and implement cost-effective treatment plans for recovery and return-to-work. Manage a caseload independently, assessing recovery progress and modifying goals to ensure optimal medical outcomes.
Provide inbound telephone triage services to injured workers following state Worker Compensation rules. Use evidence-based protocols to make safe care decisions and provide recommendations for emergent and non-emergent situations.
The Field Case Manager will collaborate with physicians, employers, and injured individuals to develop and implement effective treatment plans. They are responsible for managing caseloads, facilitating early return-to-work programs, and ensuring cost-effective healthcare services.
This role is responsible for defining the strategic vision and technical execution of AI, including Generative AI and machine learning, across the Payment Integrity Suite to automate adjudication and enhance fraud detection. Key duties involve developing a multi-year AI product strategy, governing technical architecture, overseeing data pipelines, and leading the transition of AI capabilities into enterprise-scale production.
The role involves designing, analyzing, developing, coding, debugging, testing, and documenting programming solutions to meet business requirements for both small and complex projects. Responsibilities also include providing development estimates, adhering to architecture standards, and assisting with third-level production support.
As a Telephonic Case Manager, you will guide injured workers through their recovery journey and facilitate their return to work by creating and implementing treatment plans. You will collaborate with various stakeholders, including physicians and employers, to ensure effective healthcare services and optimal recovery outcomes.
