Supports the Medical Services division by coordinating care for members in Behavioral Health, Quality Management, and Member Care Management programs. Responsibilities include assessing member needs, linking them to community resources, and ensuring adherence to regulatory requirements and care gaps.
Excellus BCBS
26 Remote Job Openings at Excellus BCBS
Design and maintain distributed public and private cloud platforms to support business requirements and infrastructure deployment lifecycles. Lead the implementation of PaaS, SaaS, and on-premises solutions while ensuring security, resiliency, and cost optimization.
Provides high-level administrative and strategic support to key corporate officers, managing complex calendars and executive communications. Acts as a liaison to the Board of Directors and oversees operational workflows to align daily activities with business objectives.
Account Executive Pharmacy Solutions (Rochester Region)
Excellus BCBS
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Full Time
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4 days ago
Excellus BCBS
Responsible for sales, prospecting, and retention of medical and Rx groups while acting as a strategic advisor on benefit design and financial impacts. Provides subject matter expertise on pharmacy trends and clinical developments to clients, brokers, and internal sales teams.
Case Manager, RN or Licensed Behavioral Health (Multiple Openings!)
Excellus BCBS
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Full Time
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5 days ago
Excellus BCBS
Conducts comprehensive case management activities to identify member needs, develop care plans, and coordinate health services. Collaborates with interdisciplinary teams and community resources to ensure cost-effective and optimal health outcomes for members.
The IT Platform Administrator ensures the availability and operation of enterprise applications through monitoring, troubleshooting, and maintenance. They act as a liaison between business and technical teams to optimize system functionality and maintain compliance.
Provides administrative and operational support for the Long-Term Support and Services (LTSS) and Duals Special Needs (DSNP) departments. Responsibilities include managing member benefits, coordinating care management referrals, and ensuring regulatory compliance across various levels of seniority.
The Customer Care Advocate resolves member and provider inquiries regarding contract benefits, claim payments, and enrollment across various communication channels. They are responsible for documenting interactions and ensuring compliance with legislative requirements to enhance customer satisfaction.
Case Manager, RN or Licensed Behavioral Health (SN LTSS)
Excellus BCBS
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Full Time
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8 days ago
Excellus BCBS
Conducts comprehensive case management activities to identify, assess, and coordinate care for members to ensure optimal health outcomes. Collaborates with interdisciplinary teams to develop care plans and mitigate healthcare cost drivers while adhering to regulatory standards.
Enterprise Regulatory Compliance Audit & Monitoring Program Admin I/II/III
Excellus BCBS
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Full Time
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10 days ago
Excellus BCBS
Perform audits and monitoring to ensure organizational compliance with federal, state, and association regulatory requirements. Provide oversight, conduct root-cause analysis, and make recommendations for process improvements to mitigate risk.
This role serves as the primary representative for physician, ancillary, and facility reimbursement analysis, focusing on contracting strategies and rate testing. The analyst monitors provider billing trends and develops common payment approaches to ensure cost and quality management goals are met.
Lead the strategy and delivery of customer-facing digital platforms using an AI-first approach to improve member experiences and operational efficiency. Oversee cross-functional teams in product, engineering, and architecture while ensuring regulatory compliance within a healthcare environment.
Manage strategic and national accounts by acting as a strategic advisor on benefit design and financial impacts. Focus on account retention, prospecting new business, and maintaining strong relationships with clients and brokers.
The Purchasing Specialist manages automated and stand-alone procurement systems, processes purchase orders, and coordinates with suppliers to ensure timely delivery of products. The role also involves supporting strategic sourcing efforts, managing supplier contracts, and providing reporting and analytics for stakeholders.
The Business Systems Analyst acts as the primary interface between business stakeholders and IT teams to elicit and document functional and non-functional requirements. They are responsible for defining project scope, conducting systems analysis, and ensuring IT solutions align with business objectives.
The Actuarial Analyst performs services to support Health Plan operations, focusing on financial solvency, rate establishing, and reserve maintenance. Responsibilities range from basic data analysis and pricing for Level I to strategic planning and advanced statistical risk prediction for Level IV.
The Business Systems Analyst collaborates with stakeholders to elicit and document functional and non-functional IT system requirements. They serve as the primary interface between business units and IT teams to ensure solutions align with organizational objectives.
The Software Engineer IV is responsible for designing, developing, and maintaining complex ETL processes and software system architectures. This role involves directing programming initiatives, mitigating technical risks, and serving as a subject matter expert for cross-functional teams.
Community Connections Representative I/II (Central New York Region)
Excellus BCBS
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Full Time
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a month ago
Excellus BCBS
This role bridges the gap between health plan members and clinical operations through home visits and community outreach. Responsibilities include educating members on benefits, assisting with health insurance enrollment, and connecting individuals to community social services.
The role involves designing and creating correspondence and transactional statements using variable data composition systems. Responsibilities include developing code, resolving system issues, and maintaining document workflows and functional specifications.
Customer Care Advocate (Customer Care Representative)
Excellus BCBS
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Full Time
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a month ago
Excellus BCBS
The Customer Care Advocate resolves customer inquiries regarding contract benefits, claim payments, and enrollment across multiple communication channels. They are responsible for enhancing member and provider satisfaction while adhering to legislative and corporate requirements.
Provides administrative and customer service support for Utilization Management workflows, including handling inbound and outbound calls and creating authorizations. Acts as a primary contact for providers and members while ensuring compliance with regulatory requirements and internal policies.
Medical Director, Children's Behavioral Health
Excellus BCBS
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Full Time
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a month ago
Excellus BCBS
Directs medical management, quality improvement, and credentialing functions for the children's behavioral health business unit. Provides medical leadership for utilization review, cost containment, and the implementation of performance improvement initiatives.
Payment Integrity DRG Coding & Clinical Validation Analyst I/II/III (RHIA, RHIT, CCS, or CIC Certification Required)
Excellus BCBS
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Full Time
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a month ago
Excellus BCBS
Review medical records to validate coding and DRG assignment accuracy, ensuring physician documentation supports hospital coded data. Perform audits of acute inpatient claims and provide guidance or leadership depending on the analyst level.
The Medical Director oversees utilization and case management activities, including clinical reviews and the development of medical policies. They serve as a liaison between the organization and the regional medical community while ensuring compliance with state and federal mandates.
Responsible for the accounting and financial reporting of company investments, including GAAP and statutory reporting and monthly close processes. Collaborates with internal finance teams and external custodians to ensure accuracy of financial data and regulatory compliance.
