The AI Engineer will design, develop, and deploy advanced AI and GenAI solutions across healthcare platforms to improve outcomes and operational efficiency. This role involves end-to-end model development, system integration, and ensuring compliance with healthcare regulatory standards.
The Principal Information Systems Architect designs complex information system frameworks and defines technical components to meet business and client needs. They also oversee cross-functional teams and research technological advancements to ensure systems remain aligned with industry standards.
The Business Analyst - Services Coordinator acts as a liaison between clients and internal teams to gather requirements and manage service requests. They are responsible for coordinating issue resolution, maintaining operational documentation, and supporting project implementation activities.
The Service Representative researches and resolves inquiries from providers, County Waiver Agencies, and the Department of Health Services. They also conduct training sessions and maintain strong business relationships while utilizing internal software systems.
The Senior Manager will lead service delivery and operational execution for Medicaid claims, business policy administration, and reference data maintenance teams. This role drives process improvements, manages client relationships, and ensures delivery outcomes meet quality, compliance, and timeliness standards.
The Customer Care Representative handles complex customer inquiries via telephone and maintains accurate account documentation. They also perform data entry, monitor transaction policies, and assist management with daily operations and staff training.
The analyst will collaborate with stakeholders to define metrics, architect data pipelines, and build dashboards to address business needs. They will also maintain data infrastructure, document processes, and partner with leadership to identify data-driven improvements.
Handle inbound and outbound calls regarding healthcare services, Medicaid, and provider inquiries while documenting interactions accurately. Collaborate with team members to resolve issues and identify recurring customer trends to improve service quality.
The Reporting Analyst will develop and maintain reporting solutions, dashboards, and data pipelines to support business decision-making. They will partner with cross-functional teams to translate complex data into actionable insights while ensuring alignment with contractual requirements.
The agent provides technical support to healthcare providers and trading partners regarding EDI functionality and portal access. They are responsible for investigating transaction issues, analyzing rejection reports, and documenting all troubleshooting steps in the CRM system.
The Client Engagement Manager is responsible for managing client contracts, relationships, and ensuring operational performance meets contractual commitments. They also drive revenue growth through upselling services and monitoring financial goals for assigned clients.
The candidate will lead data analysis efforts, develop program specifications, and create mapping documents to support ETL and reporting processes. They will collaborate with cross-functional teams to ensure business requirements are met through rigorous testing and design validation.
The Senior Business Analyst will bridge the gap between clients, project managers, and technical teams to define and document business requirements for healthcare technology initiatives. They will also support project management activities, including planning, risk tracking, and status reporting, while mentoring junior team members.
The advisor will translate complex Medicaid business requirements and CMS mandates into scalable, FHIR-based technical solutions. They will act as a bridge between state Medicaid stakeholders and engineering teams to ensure interoperability and regulatory compliance.
The Workforce Project Manager will lead small project teams to deliver technological solutions while managing project schedules, scope, and budgets. They are responsible for identifying risks, communicating project metrics, and ensuring high-quality deliverables through effective stakeholder management.
Lead and participate in the full software development lifecycle for NCPDP F6 implementation, including analysis, design, coding, and testing. Collaborate with cross-functional teams to translate functional requirements into scalable technical solutions for pharmacy claim transactions.
Lead and participate in the full software development lifecycle for NCPDP F6 implementations, including analysis, design, coding, and testing. Collaborate with cross-functional teams to translate functional requirements into scalable technical solutions for pharmacy claim transactions.
Lead end-to-end pharmacy testing across various environments to ensure quality delivery of PBM and Medicaid solutions. Manage test strategies, governance, and cross-functional coordination to ensure timely issue resolution and alignment with regulatory requirements.
The Senior Manager will oversee the strategy, design, and execution of complex, multi-account pharmacy programs to meet cost, performance, and quality objectives. They will collaborate with cross-functional teams to drive business development and ensure programs align with organizational goals and regulatory requirements.
The role involves managing complex projects by defining schedules, budgets, and objectives while ensuring stakeholder consensus and quality deliverables. You will oversee project teams, identify risks, implement mitigation strategies, and manage client expectations to ensure project success.
The supervisor will lead, coach, and develop a customer support team to ensure high-quality service delivery and performance standards. They are responsible for managing SLAs, monitoring operational workflows, and implementing quality programs to drive continuous improvement.
The Director of Engineering leads product development, modernization, and cultural shifts while collaborating with product management to drive technology roadmaps. They are responsible for managing global teams, overseeing technical architecture, and ensuring solution delivery remains within budget and on schedule.
Serve as a liaison between clients and technical teams to define business requirements and translate them into functional specifications. Collaborate with development and testing teams to validate requirements, support UAT, and ensure solution readiness.
The Information Security Officer will lead security operational governance, drive remediation efforts, and ensure adherence to SLAs and SLOs. They are responsible for managing security incidents, facilitating audits, and maintaining account security plans to ensure contractual compliance.
Design, develop, and maintain complex SSRS reports while ensuring scalability, performance, and adherence to coding standards. Collaborate with cross-functional teams to translate business requirements into technical specifications and provide ongoing support for system configurations.
You will lead technical teams in the design, development, and testing of complex database applications while overseeing relationships between architects and developers. Additionally, you will provide technical consulting to clients and mentor less experienced application designers.
Provide senior technical leadership for secure, scalable applications supporting Medicaid DDI and modernized Provider Plus delivery. Lead application design and implementation standards while mentoring engineers and communicating technical decisions across teams.
The Manager Service Delivery oversees account service delivery team operations to ensure products and services are delivered according to project schedules. They also manage client relationships, develop demand forecasts, and support proposal teams in integrating new service offerings.
The Senior Internal Auditor will execute risk-based audits of business processes and operational activities to assess control effectiveness and governance. They will also document testing procedures, identify process inefficiencies, and provide actionable recommendations to management to strengthen the control environment.
The Principal Application Architect will own the target-state and transition architecture for modernized Medicaid DDI and Provider Plus capabilities. They will set architecture direction and AI-enabled engineering guardrails across applications, data, integrations, cloud, and security.
The Senior Business Analyst will post payments to medical and pharmacy claims while reconciling accounts receivable to resolve discrepancies. They will also collaborate with client engagement teams to gather business requirements and communicate them to technical personnel.
The Claims Examiner is responsible for reviewing and processing healthcare claims to ensure accuracy and compliance with policies and regulations. They must also document claim statuses, maintain organized records, and collaborate with teams to resolve discrepancies.
The Advisor Test Engineer will lead quality and testing strategies, including the development of standards, methodologies, and automation practices. They will manage testing operations across the full lifecycle while coaching and mentoring a blended team of onshore and offshore professionals.
The associate will assist in establishing quality assurance strategies and documenting standardized quality metrics for assigned projects. They will also conduct assessments to verify compliance with software development standards and analyze defect metrics to report findings.
The Lead Application Architect will design cloud-native and hybrid architectures while driving application migration and modernization to AWS. They will also provide technical leadership, mentor development teams, and ensure the scalability, resiliency, and security of enterprise solutions.
The CX Quality Supervisor leads quality assurance operations, including monitoring interactions and conducting audits to ensure compliance and accuracy. They also drive continuous improvement initiatives and coach high-performing teams to enhance member and provider experiences.
The DRG Quality Advisor Nurse performs ongoing quality assurance audits, complex clinical review validations, and DRG clinical/coding audits of medical records. They also assist management with onboarding, training, and mentoring new reviewers while serving as a subject matter expert for business initiatives.
The Provider Field Representative will review and input enrollment data across multiple systems while maintaining compliance with contract requirements and regulations. The role also involves answering inbound calls and traveling throughout Delaware to facilitate face-to-face interactions.
Provide senior technical leadership for secure, scalable applications while guiding design and implementation standards across the full stack. Mentor engineering teams and oversee complex technical specifications, including integrations, data modeling, and automated delivery pipelines.
Design, build, test, and operate secure, scalable software for Medicaid DDI programs and modernized Provider Plus capabilities. Develop micro-frontends and microservices while utilizing cloud-native engineering and AI coding tools to improve delivery speed.
The Lead Application Architect will define target-state and transition architectures for modernized Medicaid DDI and Provider Plus capabilities. They will set AI-enabled engineering guardrails and lead architecture reviews, threat modeling, and technical-risk decisions across the organization.
The supervisor will lead a remote team of pharmacy technician support representatives to ensure high-quality customer service and operational efficiency. They are responsible for monitoring performance metrics, resolving escalated inquiries, and implementing process improvements to meet service level agreements.
The specialist will perform quality-control assignments, data validation, and trend analysis to ensure adherence to business rules and contractual requirements. They will also develop operational dashboards and provide analytical recommendations to stakeholders to support continuous improvement.
The Nurse Reviewer is responsible for performing clinical reviews to determine medical necessity and appropriateness of care based on established criteria and policies. They also document findings, process authorizations, and provide support for review determinations while maintaining quality and productivity standards.
The Senior Finance Manager will oversee the financial health of the Customer Experience organization by managing budgeting, forecasting, and financial modeling. They will also partner with operational leaders to provide variance analysis and strategic recommendations to improve profitability.
Manage inbound and outbound calls regarding prior authorization requests and provider inquiries. Accurately process and document authorization requests while ensuring compliance with HIPAA and confidentiality protocols.
The Business Analyst will collaborate with teams to translate client business needs into technical requirements and document system processes. They will also participate in technical reviews and execute test case scenarios to ensure final products meet client expectations.
The CX Quality Supervisor leads quality assurance operations by monitoring voice and non-voice interactions to ensure compliance and service excellence. They also drive continuous improvement initiatives by analyzing performance data and coaching high-performing teams to meet organizational goals.
The role involves acting as a bridge between stakeholders and project teams to document requirements, manage project timelines, and ensure client objectives are met. You will also perform financial variance analysis, manage project risks, and support the development of operational reports and RFP processes.
The Client Engagement Manager is responsible for managing client contracts, relationships, and ensuring operational performance meets contractual commitments. They also drive revenue growth through upselling services and monitoring client budgets and strategic goals.
The Senior Project Manager will lead medium-sized project management teams to deliver innovative healthcare technology solutions while overseeing staffing, budgets, and project timelines. They are responsible for interfacing with clients and leadership to communicate metrics, mitigate risks, and ensure the quality of project deliverables.
The developer will code, test, debug, and document healthcare administration programs while assisting in the modification of systems to meet client needs. They will also participate in production support activities and conduct quality assurance through peer reviews.
The Business Analyst will analyze, plan, and document business processes to support client technological goals while acting as a bridge between clients and technical teams. They are responsible for defining business requirements, creating test scenarios, and ensuring the intent of change is maintained throughout project phases.
You will design, develop, and maintain scalable database systems to support critical healthcare operations. Additionally, you will monitor performance, automate data processes, and provide technical guidance to junior team members.
The role involves acting as a bridge between stakeholders and clients to document requirements and manage project impacts, risks, and timelines. You will also analyze business processes to support CX goals and motivate teams to deliver on client contact center launch objectives.
Provide senior technical leadership for secure, scalable applications supporting Medicaid and provider delivery systems. Oversee application design, code reviews, and the implementation of automated quality gates and CI/CD pipelines.
Define target-state and transition architecture for modernized Medicaid DDI and Provider Plus capabilities. Lead architecture reviews, threat modeling, and align product, engineering, security, and data roadmaps.
Design, build, test, and operate secure, scalable software for Medicaid DDI programs and modernized Provider Plus capabilities. Develop React/TypeScript micro-frontends and .NET/C# microservices while implementing automated tests, CI/CD pipelines, and cloud-native integrations.
The Vice President provides executive leadership and strategic direction for the Medicaid Pharmacy Administration and Technology portfolio. They are responsible for driving product modernization, financial performance, and building strategic relationships with state Medicaid agencies and industry partners.
The role involves monitoring and evaluating voice and non-voice interactions to ensure compliance with federal and state policies regarding provider enrollment. You will also identify quality issues, facilitate calibration sessions, and recommend process improvements using data-driven insights.
The Capacity Planner will develop and maintain multi-channel forecasting models to translate workload demand into staffing requirements across voice and non-voice operations. They will partner with cross-functional teams to identify capacity risks, optimize resource allocation, and provide data-driven insights to support business goals.
The Business Analyst will analyze, design, and document business processes to support technological solutions for healthcare clients. They will act as a bridge between clients and technical teams to define requirements and verify system designs through testing.
Develop and deliver comprehensive training programs for clinical reviewers, coders, and auditors regarding DRG validation and coding guidelines. Serve as a subject matter expert to mentor teams, analyze quality trends, and ensure compliance with industry standards and clinical policies.
The Account Program Manager oversees large, complex, multi-account programs to ensure they meet cost, performance, and quality objectives. They act as the primary point of contact for clients while managing project planning, risk mitigation, and resource allocation.
The role involves enforcing IAM strategy, architecture, and roadmaps while managing identity lifecycles, access controls, and privileged access management. You will also lead IAM projects, ensure compliance with regulatory frameworks, and mentor team members on identity standards.
The Quality Improvement Specialist will apply methodologies like Lean and Six Sigma to support population health initiatives and ensure compliance with EQRO requirements. They will also collaborate across departments to facilitate quality improvement projects and maintain essential program documentation.
Help design, develop, install, test, and document application software across server, client, and web components. Support technical architecture, requirements and solution design, documentation, test planning, integration, and deployment in collaboration with architects, developers, and clients.
The Associate Manager oversees daily operations for a multidisciplinary team of coders and nurse reviewers, ensuring productivity and quality metrics are met. They are responsible for staff management, process improvement, and serving as a subject matter expert for clinical review services.
The analyst will monitor and evaluate voice and non-voice interactions to ensure compliance with regulatory standards and quality policies. They will also facilitate calibration sessions and provide data-driven recommendations for process and policy enhancements.
Oversee pharmacy product implementations from intake and requirements through delivery and go-live, including claims-system configuration, environment readiness, and continuity across projects. Partner with business, customer, clinical, operations, and technical stakeholders to prioritize work, shape product roadmaps, and ensure solutions meet business needs.
Post payments to medical and pharmacy claims from paper and electronic EOBs, reconcile accounts receivable, and investigate and resolve posting errors. Gather and document client requirements and business processes, analyze potential solutions, and communicate requirements to technical personnel.
Respond to client inquiries, resolve issues, update account histories, and escalate complex cases to appropriate staff while meeting service-level agreements and production targets. Collaborate with colleagues, management, and clients, train new team members, and recommend improvements to procedures and workflows.
Analyze customer interactions, feedback, surveys, and operational data to identify trends, pain points, contact drivers, risks, and root causes across the customer journey. Develop reports and actionable recommendations, and collaborate with business partners to improve customer experience, operational performance, and business outcomes.
Partner with business and operational stakeholders to gather reporting requirements, then develop, automate, maintain, validate, and distribute reports, dashboards, scorecards, and analytics solutions. Analyze performance data to identify trends, risks, root causes, and improvement opportunities, and present actionable recommendations while leading reporting workstreams through implementation and ongoing support.
Design, develop, and deploy advanced AI and Generative AI solutions for healthcare technology platforms. Collaborate with software engineers to integrate models while ensuring compliance with regulatory standards like HIPAA.
Design, develop, and maintain complex batch processing applications within Linux and Unix environments for Medicaid business operations. Provide technical leadership by mentoring developers, guiding solution design, and collaborating with cross-functional teams to deliver scalable technical solutions.
The Provider Enrollment Supervisor leads and develops a team of individual contributors to ensure operational success and high-quality service delivery. They are responsible for monitoring performance metrics, managing client service level agreements, and providing ongoing coaching to team members.
The role involves coordinating IT project workstreams to align solutions with client business priorities and acting as a liaison between technical and non-technical teams. You will also oversee the documentation of system requirements and validate test results to ensure project quality and compliance.
The Vice President of Payment Integrity is responsible for developing business strategies and operational plans to drive revenue growth and margin expansion within the payment integrity portfolio. They lead cross-functional teams to ensure high-quality delivery, manage budgets, and oversee the development of AI-driven solutions to improve operational efficiency.
The Senior Business Analyst leads business process design and requirements validation to align IT solutions with strategic healthcare objectives. They also manage training material development and provide mentorship to junior team members across multiple complex accounts.
The Business Analyst will drive strategic initiatives and operational excellence by developing data-driven insights and KPI measurements. They are responsible for managing business requests, supporting workflow optimization, and coordinating leadership communications and planning sessions.
The Senior Business Analyst will lead a team of analysts to provide functional and technical expertise for Medicaid claims configuration within a maintenance and operations environment. They will translate complex client requirements and Medicaid policies into scalable QNXT configuration solutions while ensuring quality and accuracy.
The Senior Business Analyst develops and maintains business process models, workflows, and training materials to support enterprise solution implementations. They facilitate workshops with stakeholders to gather requirements, analyze process gaps, and ensure operational readiness through cross-functional collaboration.
The developer will code, test, debug, and document programs while assisting in the modification of systems to meet client needs. They will also conduct quality assurance activities and provide production support to resolve technical issues.
Review and analyze complex medical, psychological, and developmental records to support disability determinations for the Katie Beckett Medicaid program. Independently manage a caseload while collaborating with clinical consultants and partners to ensure timely and accurate decisions.
The Provider Field Representative will serve as a primary point of contact for healthcare providers, conducting virtual and onsite visits to provide education and operational support. They will also research billing and claims issues while acting as a liaison between providers and internal teams to ensure program compliance.
The Provider Field Representative serves as a primary point of contact for healthcare providers, conducting virtual and onsite visits to deliver training and resolve billing or policy issues. They act as a liaison between providers and internal teams to identify trends and improve the overall provider experience within the Medi-Cal program.
The Provider Field Representative serves as a primary point of contact for healthcare providers, conducting virtual and onsite visits to provide training and operational support. They are responsible for researching claims and billing issues while ensuring providers understand Medi-Cal policies and program requirements.
The Advisor will provide strategic oversight to optimize system operations, performance, and service delivery across healthcare technology platforms. They will partner with cross-functional teams to drive continuous improvement, resolve complex system issues, and implement operational best practices.
The representative serves as the primary liaison between Gainwell, state Medicaid programs, and healthcare providers to manage enrollment and revalidation initiatives. They conduct proactive outreach, resolve provider inquiries, and deliver education to ensure regulatory compliance and prevent reimbursement disruptions.
The Principal Application Architect designs complex information system architectures and defines technical standards to meet business and client needs. They oversee cross-functional teams and ensure that delivered solutions align with performance expectations and industry standards.
Lead market, policy, federal, and competitor analysis to shape product strategy and innovation roadmaps across the Provider Solutions portfolio. Oversee product and technology advancements from concept through delivery, aligning cross-functional teams and reporting on strategy, progress, and finances to executives.
Lead security governance and operational compliance, including remediation, incident management, audit preparation and follow-up, risk and exception management, and adherence to security standards. Maintain account security plans, coordinate security metrics and reporting, and work with suppliers, clients, and delivery teams to resolve security issues and meet contractual commitments.
Lead technical teams in designing, developing, testing, and installing complex database applications, and coordinate architects and developers to deliver flexible, reusable system components. Produce technical design, coding, and testing documentation, advise clients on complex projects, serve as a subject matter expert, and mentor less experienced designers.
Code, test, debug, implement, and document programs, and modify systems to meet client and end-user needs. Analyze existing systems and requirements, design program enhancements, support production issue resolution, develop test plans, and conduct quality assurance reviews.
Own end-to-end delivery outcomes, financial performance, contractual commitments, and operational transition across multiple concurrent Medicaid Provider implementations. Lead governance, client and cross-functional alignment, risk resolution, recovery planning, and development of a scalable delivery organization.
Design, develop, maintain, and support complex batch applications for Medicaid pharmacy and healthcare systems, while providing technical leadership, mentoring, and guidance throughout the software development lifecycle. Collaborate with business and technical teams to resolve application and database issues, support releases and deployments, maintain documentation, and advance automation, cloud adoption, and DevOps practices.
Lead quality activities by monitoring incidents, service-level performance, corrective actions, audits, and contractual deliverables, while analyzing trends and investigating root causes. Coordinate reporting and compliance work, advise and mentor team members, and collaborate with operational leaders and stakeholders to resolve risks and drive continuous improvement.
The Vice President of Provider Solutions DDI Delivery is accountable for end-to-end performance and delivery outcomes across multiple concurrent Medicaid Provider system implementations. This role establishes governance, financial controls, and cross-functional accountability to ensure projects are delivered with quality and predictability.
The developer will design, develop, and maintain complex batch processing applications within Linux and Unix environments for Medicaid healthcare systems. They will also provide technical leadership by mentoring teams and collaborating with stakeholders to deliver scalable, high-quality technical solutions.
The Vice President of Provider Solutions Business Architecture owns the end-to-end business architecture, application design, and configuration standards for Provider DDI initiatives. This executive governs design decisions, ensures regulatory compliance, and leads a team of 50+ professionals to drive transformation through standardization and automation.
The Functional Test Engineer will support the full testing life cycle by developing test plans, scripts, and cases based on functional specifications. They will execute manual tests, log defects, and collaborate with cross-functional teams to ensure software quality and alignment with project goals.
The Senior Manager owns the strategic direction and delivery of Medicaid Drug Rebate solutions while managing a team of 5+ members. They oversee client relationships, system implementations, and the development of testing plans to ensure operational efficiency and regulatory compliance.
Deliver engaging virtual training sessions to call center agents and various departments while designing interactive learning materials. Assess training effectiveness through feedback and performance metrics to ensure continuous improvement.
The associate will assist in establishing and documenting quality strategy plans while conducting assessments to verify compliance with software development standards. They will also analyze defect metrics, report findings, and participate in process improvement initiatives.
The role involves creating and implementing complex project definitions, schedules, and budgets for high-complexity projects while managing stakeholder expectations. You will also oversee project teams, identify risks, and implement mitigation strategies to ensure project deliverables meet quality and performance standards.
The associate is responsible for monitoring and evaluating voice and non-voice interactions to ensure accuracy, compliance, and quality standards. They will also communicate quality insights to stakeholders and recommend data-driven process improvements.
Lead database architecture and management system design, implementation, and integration across complex technical environments. Guide project teams and clients, mentor personnel, support business development, and ensure delivery objectives and client satisfaction.
Design, build, deploy, and optimize AI and generative AI solutions for healthcare platforms, including machine learning, multimodal LLMs, predictive analytics, natural language processing, and image processing. Integrate solutions with existing systems, manage model evaluation and monitoring, apply security and regulatory safeguards, and identify opportunities to automate workflows.
Analyze, document, and recommend improvements to business processes, translating client needs into requirements and basic data and process models. Develop or analyze test scenarios and participate in technical reviews to ensure intended changes are implemented throughout project phases.
Design, develop, deploy, and optimize AI solutions—including generative AI, NLP, and predictive models—for healthcare platforms, integrating them into existing systems and processing large healthcare datasets. Monitor model performance, apply MLOps practices, ensure regulatory and ethical compliance, and identify opportunities to automate workflows and improve operational efficiency.
Analyze client business needs and processes, document system requirements, and translate technical requirements into clear, non-technical language. Develop basic data and process models, test system requirements against existing plans, and participate in technical reviews to ensure solutions meet client expectations.
Analyze client business needs and processes, document system requirements, and translate technical requirements into clear, non-technical language. Model potential system changes, execute test scenarios, and participate in technical reviews to help ensure solutions meet client expectations.
Coordinate client and project team meetings, communications, onboarding and offboarding, and maintain accurate project documentation and calendars. Support PMO governance through action-item tracking, project logs, reports, templates, and process improvements, escalating issues when needed.
The Senior Manager will lead a team of over 30 System Operations Managers to ensure the stability, performance, and continuous improvement of Medicaid Management Information Systems. This role oversees operational governance, incident management, vendor performance, and regulatory compliance across integrated healthcare platforms.
The Provider Communications Lead is responsible for planning, developing, and managing provider-facing publications and communications to support Medicaid program operations. This role involves collaborating with subject matter experts and stakeholders to ensure all materials are accurate, timely, and aligned with regulatory requirements.
The analyst will lead the development and maintenance of rate-setting models for complex Medicaid long-term care programs. They will also evaluate cost trends and policy impacts to ensure reimbursement strategies align with organizational and program goals.
The Business Analyst supports requirements management activities by gathering, documenting, and maintaining functional and technical requirements throughout the project life cycle. They collaborate with stakeholders and cross-functional teams to ensure requirements are clear, traceable, and aligned with business objectives.
The Project Manager leads end-to-end delivery of complex projects by coordinating cross-functional teams and managing scope, milestones, and dependencies. They are responsible for driving execution discipline, managing project risks, and ensuring alignment across business and technology stakeholders.
The consultant will lead complex process improvement and operational readiness initiatives by partnering across business, technology, and operations teams. They are responsible for analyzing performance metrics, facilitating improvement workshops, and establishing governance models to drive measurable business outcomes.
Lead process improvement initiatives to enhance operational performance, quality, and customer experience using Lean and Six Sigma methodologies. Facilitate cross-functional problem-solving sessions and develop process designs that align with strategic business objectives.
The PMO Lead will establish and oversee project management governance, controls, and delivery processes for a large-scale DDI program. They will drive performance against KPIs and SLAs while managing cross-functional workstreams and executive reporting.
Lead end-to-end customer experience launch initiatives across contact center, mailroom, and back-office operations. Drive cross-functional alignment and operational readiness to ensure successful service delivery and performance outcomes.
Lead end-to-end CX client launch initiatives for contact centers and back-office operations from scope definition through go-live. Drive cross-functional execution by managing integrated project schedules and holding teams accountable to deliverables and risk controls.
Lead end-to-end customer experience launch initiatives across contact centers, mailrooms, and back-office operations. Drive cross-functional alignment and operational readiness to ensure successful service delivery and performance outcomes.
The manager will lead the design and standardization of provider-facing processes and technical solutions across Medicaid accounts. They are responsible for defining business requirements, developing reporting frameworks, and driving operational performance improvements.
The developer will design, build, and maintain complex business programming applications throughout the entire system lifecycle. They will also collaborate with team members to analyze system requirements and ensure compliance with technical standards.
The Lead Associate performs quality audits of itemized medical bills, healthcare claims, and medical records to ensure billing accuracy, regulatory compliance, and proper documentation. This role also provides subject matter expertise, staff mentoring, and identifies opportunities for quality improvement within the billing and reimbursement process.
The Technical Analyst provides hands-on technical analysis, SQL development, and system troubleshooting for Medicaid Management Information Systems. They collaborate with cross-functional teams to ensure solutions are technically sound, scalable, and aligned with system architecture throughout the SDLC.
The Provider/Domain Lead is responsible for the end-to-end delivery of the Provider+ domain, ensuring business requirements are translated into effective solution designs. This role coordinates across cross-functional teams to manage requirements, oversee configuration, and ensure operational readiness for go-live.
The Project Manager will lead large project teams to deliver technological solutions for health and human services clients. Responsibilities include managing project schedules, budgets, and objectives while ensuring effective communication and risk mitigation across stakeholders.
The role involves researching, writing, and editing technical documentation such as manuals, procedures, and system specifications. Additionally, the writer will compile online help files and documentation packages to support end users and project teams.
Design, develop, test, and maintain applications using PowerBuilder while managing both UI and backend logic. Collaborate with architects to translate business requirements into technical solutions and ensure compliance with coding standards.
The supervisor will lead a team of Provider Field Representatives to conduct outreach, education, and training for the California Medi-Cal program. They are responsible for monitoring team performance, resolving complex provider issues, and collaborating with stakeholders to improve the provider experience.
The Financial Cash Control Supervisor leads a team responsible for accounts receivable, EFT enrollment, and financial transaction processing for the Medi-Cal program. This role involves managing daily operations, coaching staff, and collaborating with internal teams to improve financial processes and ensure compliance.
The Financial Cash Control Team Lead coordinates weekly Accounts Receivable operations and ensures the accuracy of financial transactions for the Medi-Cal program. They also research complex financial issues, provide procedural guidance to the team, and collaborate with stakeholders like the DHCS and State Controller’s Office.
The Team Lead monitors suspended Medi-Cal claims inventories to ensure timely resolution and adherence to service standards. They also provide daily guidance, training, and operational support to Claims Examiners while tracking team performance metrics.
The business analyst will collaborate with teams to translate client business needs into technical requirements and document system processes. They will also execute test case scenarios to ensure system designs meet client expectations and project outcomes.
Respond to high-volume phone and email inquiries while documenting interactions and resolutions accurately within company systems. Navigate multiple applications to resolve customer issues efficiently while maintaining confidentiality and adhering to established policies.
The Senior Business Analyst is responsible for developing business process models, role-based training content, and process documentation to support enterprise solution implementations. They facilitate stakeholder workshops, analyze process gaps, and ensure alignment between business requirements and operational readiness.
The Quality Improvement Specialist supports Population Health and Quality Improvement initiatives by applying methodologies like PDSA, Lean, and Six Sigma to drive measurable outcomes. They collaborate across departments to monitor quality initiatives, maintain documentation, and ensure compliance with EQRO requirements.
The Business Analyst leads the analysis, design, and optimization of business processes to align technical solutions with strategic Medicaid pharmacy and care management goals. They facilitate stakeholder workshops, develop process models, and oversee the creation of training materials to ensure operational readiness.
The Business Analyst will drive strategic initiatives and operational excellence by developing data-driven insights and KPI reporting. They will also manage leadership communications, coordinate strategic planning sessions, and support workflow optimization across the organization.
The role involves analyzing, cleaning, and modeling data to support business decisions while developing Power BI dashboards and reports. You will also use coding and automation to improve data processes and collaborate with teams to translate requirements into technical solutions.
The developer will design, develop, and maintain complex batch processing applications within Linux and Unix environments while providing technical leadership to development teams. They will collaborate with stakeholders to translate business requirements into scalable technical solutions and support the full software development lifecycle.
The Senior Manager provides executive-level leadership for Pharmacy Benefit Management quality assurance and testing across large-scale Medicaid implementations. They are responsible for defining enterprise testing strategies, managing multi-vendor teams, and ensuring compliance with regulatory and contractual requirements.
The Healthcare Call Center Agent handles inbound and outbound calls to assist members and providers with inquiries, claims, and insurance verification. The role requires accurate documentation of interactions while maintaining strict compliance with HIPAA and healthcare regulations.
Lead and develop multiple reporting and analytics teams to support operational service delivery and business insights. Partner with stakeholders to drive performance improvements, SLA attainment, and modernization initiatives across client accounts.
The role involves acting as a product owner and delivery lead to design and implement advanced data mining and AI-driven analytics solutions for healthcare payment integrity. You will translate complex reimbursement policies into scalable audit algorithms while collaborating with cross-functional teams to safeguard healthcare resources.
The Advisor Data Sciences will design, build, and deploy advanced AI and Generative AI solutions across healthcare technology platforms. This role involves integrating models into existing systems while ensuring compliance with healthcare regulations and optimizing performance for operational efficiency.
The Batch Developer will code, test, debug, and implement programs while assisting in the modification of systems to meet client objectives. They will also research existing systems, design enhancements, and resolve production support problems.
The DevOps Engineer is responsible for designing and building flexible infrastructure and automation solutions to improve team productivity. They will collaborate with developers and IT staff to manage deployment processes and maintain configuration management standards.
The DevOps Engineer is responsible for designing and building flexible infrastructure and automation solutions to improve team productivity. They will collaborate with developers and IT staff to manage deployment processes and maintain account standards for configuration management.
The Process Writer will document existing processes, create standardized SOPs and DLPs, and conduct gap analyses to improve operational efficiency. They will collaborate with cross-functional teams and Lean Six Sigma experts to ensure documentation is accurate, consistent, and aligned with industry best practices.
The Project Manager will lead large project management teams to deliver technological solutions for health and human services clients. Responsibilities include project planning, budget oversight, risk mitigation, and clear communication of project metrics to stakeholders.
The Project Manager will lead small teams to manage technological program components and oversee functional contributors to ensure high-quality deliverables. They are responsible for managing project schedules, budgets, and scope while mitigating risks and communicating progress to stakeholders.
The SME will architect data pipelines, design dashboards, and collaborate with stakeholders to define key business metrics. They are also responsible for maintaining data infrastructure and providing clear documentation to support data-driven decision-making.
The Senior Project Manager will lead medium-sized project management teams to deliver innovative healthcare technology solutions while overseeing project metrics, budgets, and schedules. They are responsible for interfacing with clients and leadership to mitigate risks and ensure the timely, high-quality completion of project deliverables.
The Business Process Analysis SME will translate Medicaid policy requirements into BPA rule specifications and configure benefit, assignment, and provider contract plans. They will collaborate with cross-functional teams to design, validate, and maintain rule solutions to ensure accurate claims adjudication.
The candidate will manage the configuration and maintenance of Medicaid benefit plans, provider contracts, and reference tables. They will also be responsible for troubleshooting and providing production support for claims adjudication components.
The AI Engineer will design, build, and deploy advanced AI and Generative AI solutions across healthcare platforms to improve outcomes and operational efficiency. This role involves managing end-to-end AI model development, data processing, and system integration while ensuring compliance with healthcare regulations.
The Advisor Business Analyst will provide senior functional and technical expertise for Medicaid claims configuration while leading a team of analysts. They are responsible for translating complex client requirements into scalable QNXT solutions and performing root cause analysis on claims processing issues.
The Certified Pharmacy Technician supports pharmacy operations by managing prior authorizations, pharmacy claims, and benefit inquiries for members and providers. They are responsible for researching and resolving pharmacy-related issues while maintaining accurate documentation and compliance with regulatory guidelines.
The SME will review and evaluate CPT, HCPCS, and ICD-10 coding updates to ensure compliance and accuracy within Wisconsin Medicaid Long-Term Care programs. They will also lead cross-functional projects, facilitate stakeholder discussions, and provide expert guidance on complex medical coding and policy inquiries.
The Lead Coding Auditor performs itemized bill reviews, chart reviews, and coding validation to ensure services are accurately documented and reimbursed. They also manage the appeals process, participate in hearings, and provide training and mentorship to other coding auditors.
The analyst will perform complex processing, quality reviews, and audits to support outsourced healthcare services while maintaining standard operating procedures. They are also responsible for identifying operational issues, recommending workflow improvements, and providing leadership and training to team members.
Lead the validation of business requirements and coordinate IT project workstreams to align technical solutions with client priorities. Act as a subject matter expert and liaison between technical and non-technical stakeholders to streamline workflows and approve test results.
The Senior Manager leads the design, development, and operational support of enterprise integration solutions for healthcare programs like Medicaid and MMIS. They oversee a team of integration engineers and analysts while ensuring successful project delivery and compliance with regulatory standards.
Design, develop, and deploy advanced AI and Generative AI solutions for healthcare platforms while ensuring system integration and performance optimization. Collaborate with cross-functional teams to automate workflows and maintain compliance with healthcare industry regulations.
Monitor and evaluate customer interactions in English and Spanish to ensure adherence to quality standards and compliance. Analyze performance trends and collaborate with teams to drive process improvements and service delivery excellence.
The Provider Enrollment Advisor serves as a subject matter expert for Nevada Medicaid, ensuring compliance with regulatory standards and business requirements. They analyze operational data to recommend process improvements and collaborate with technical teams to implement system enhancements.
The Lead Associate performs quality audits of itemized medical bills and institutional claims to ensure accuracy, compliance, and proper billing practices. They also provide subject matter expertise, staff education, and mentoring to support departmental performance goals.
The role involves providing knowledgeable responses to client inquiries and resolving issues while adhering to production targets and service level agreements. You will also collaborate with team members to improve workflows and assist in training new resources on customer service processes.
Serve as the primary point of contact for healthcare providers to resolve EDI and provider-related inquiries via phone and written communication. Research, troubleshoot, and process provider requests while maintaining documentation standards and meeting productivity goals.
The Senior Certified Pharmacy Technician serves as a subject matter expert to resolve complex pharmacy benefit inquiries and medication access issues for members and providers. They also support team members with escalated issues, training, and process improvement initiatives across multiple communication channels.
The Clinical Pharmacist will participate in all aspects of the Connecticut Medicaid pharmacy program, including prior authorization criteria development and preferred drug list management. They will also provide clinical leadership and mentorship to account-based pharmacy staff to ensure consistent clinical decision-making and program alignment.
Assist members by phone with inquiries regarding healthcare benefits, eligibility, and available services. Accurately document all customer interactions and resolutions within the company systems.
Review and adjudicate Medicaid prior authorization requests for behavioral treatment services to ensure medical necessity and eligibility. Provide clinical guidance to providers and maintain accurate documentation within the Medicaid Management Information System.
The physician will provide clinical oversight and medical expertise for utilization management and prior authorization activities within a Medicaid-focused environment. Responsibilities include conducting medical necessity reviews, participating in peer-to-peer discussions, and ensuring care decisions align with program guidelines.
The RN Consultant reviews Medicaid prior authorization requests to determine medical necessity based on state policy guidelines. They also serve as a clinical subject matter expert to support providers and internal stakeholders in ensuring program integrity and quality outcomes.
The Internal Medicine Physician serves as a clinical subject matter expert responsible for medical oversight, utilization management, and evidence-based medical necessity determinations. They collaborate with multidisciplinary teams to ensure program compliance, improve healthcare outcomes, and support quality improvement initiatives.
The physician serves as a senior clinical subject matter expert providing medical oversight and review for behavioral health services, specifically focusing on Autism Spectrum Disorder and ABA therapy. They collaborate with clinical and operational teams to ensure medical necessity determinations are evidence-based and compliant with Medicaid regulations.
The PM&R Physician provides senior-level clinical expertise and oversight for rehabilitation programs, including medical necessity determinations and policy development. They serve as a subject matter expert to support utilization management, peer-to-peer consultations, and quality improvement initiatives.
Assist members via phone with inquiries regarding healthcare benefits, eligibility, and services. Accurately document all customer interactions and resolutions within company systems.
The Team Lead will manage daily enrollment operations, including queues, applications, and inbox activities while resolving complex issues. They are responsible for leading, training, and mentoring team members to ensure operational efficiency and high-quality client service.
The Genetic Testing Physician provides senior-level clinical expertise and oversight for genetics programs, including reviewing complex authorization requests and medical necessity determinations. They serve as a clinical advisor to internal teams and providers to ensure high-quality, evidence-based, and cost-effective healthcare outcomes.
Design and govern data architectures for large-scale Medicaid system implementations and modernizations. Collaborate with cross-functional teams to ensure data integrity, scalability, and alignment with CMS requirements.
The RN Consultant reviews Medicaid prior authorization requests to determine medical necessity based on state policy guidelines. They also serve as a clinical subject matter expert to support providers and internal stakeholders in delivering cost-effective healthcare services.
The Client Engagement Manager is responsible for managing client contracts, relationships, and ensuring operational performance meets contractual commitments. They also drive revenue growth through upselling services and monitoring strategic business goals.
The Lead Coding Auditor performs itemized bill reviews, chart reviews, and coding validations to ensure accurate documentation and reimbursement. They also manage the appeals process, participate in hearings, and provide training and mentorship to other coding auditors.
The Senior Coding Auditor performs itemized bill reviews, chart reviews, and coding validation to ensure billed services are accurate and documented. They also assist management with training, mentoring, and monitoring new auditors while maintaining current knowledge of coding guidelines.
The Business Analyst acts as a domain subject matter expert to translate Medicaid policy into system requirements and design artifacts. They lead requirements sessions, support configuration activities, and ensure operational readiness through testing and collaboration with cross-functional teams.
The Technical Writer will create, edit, and maintain technical documentation such as manuals, system guides, and release notes for healthcare products. They will collaborate with cross-functional teams including product managers and developers to ensure documentation accuracy and consistency.
The Technical Writer will create, edit, and maintain technical documentation such as manuals, release notes, and online help systems for healthcare products. They will also collaborate with cross-functional teams and manage documentation projects using MadCap Flare while ensuring version control and quality standards.
The Business Analyst will support enterprise content and document management initiatives by gathering requirements and mapping end-to-end solutions. They will collaborate with stakeholders and technical teams to ensure quality, compliance, and operational readiness through data analysis and testing.
The specialist will lead the development, negotiation, and administration of complex commercial and government contracts while managing contractual risks. They will collaborate with cross-functional teams to ensure regulatory compliance and provide guidance on contract governance across the enterprise.
The Healthcare Data Entry Specialist is responsible for accurately entering, reviewing, and validating claims-related information and healthcare records. They must maintain data integrity and confidentiality while meeting productivity and quality standards within a remote environment.
The representative will handle call center operations to support healthcare clients and their members. They are responsible for providing innovative solutions while maintaining professional communication and focus.
The Advisor Information Systems Architect is responsible for designing, implementing, and governing enterprise-wide ServiceNow solutions. This role focuses on architectural integrity, platform scalability, and managing complex integrations across the corporate environment.
The Senior Client Services Analyst provides comprehensive support to FraudCapture clients, acting as the primary point of contact for issues and escalations. Responsibilities include conducting user training, maintaining documentation, and collaborating with product teams to gather requirements.
The Contract Management Lead will draft, review, and negotiate a wide variety of complex commercial and government healthcare contracts. They will also analyze contractual risks, ensure regulatory compliance, and collaborate with cross-functional teams to manage the full contract lifecycle.
The specialist will lead the development, negotiation, and administration of complex contracts while ensuring regulatory compliance across the enterprise. They will collaborate with legal, procurement, and business stakeholders to manage contractual risks and support organizational objectives.
The Senior Software Engineer will design, develop, and support enterprise integration solutions, including secure APIs, microservices, and cloud-native services. They will collaborate with cross-functional teams to implement system integrations and support Medicaid modernization initiatives.
The representative will handle inbound and outbound member interactions to support the Customer Engagement Verification program. Responsibilities include documenting customer activity, updating account information, and resolving routine inquiries while adhering to program requirements.
The representative will answer customer inquiries regarding insurance and healthcare programs while maintaining service level agreements. They are also responsible for documenting account history, processing appeals, and collaborating with stakeholders to resolve complex issues.
Assist members by phone with inquiries regarding healthcare benefits, eligibility, and available services. Maintain accurate documentation of interactions and resolve member concerns within a high-volume environment.
The agent is responsible for responding to member inquiries regarding eligibility and benefits via telephone and documenting interactions in a CRM system. They also conduct outbound calls and interface with team personnel to resolve customer service issues.
The Reporting Analyst will develop and maintain reporting and analytics solutions to help leadership make data-driven decisions. They will partner with cross-functional teams to define performance metrics and translate complex data into actionable insights.
Assist members via phone with inquiries regarding healthcare benefits, eligibility, and available services. Accurately document all customer interactions and resolutions while maintaining a professional and friendly demeanor.
Handle a high volume of inbound provider calls to assist with billing, policy, and Medicaid-related inquiries. Accurately document all interactions in the system while maintaining performance standards and data integrity.
The AI Engineer will design, develop, and deploy advanced AI solutions, including Generative AI, across healthcare technology platforms. This role involves building machine learning models, integrating them into existing systems, and ensuring compliance with healthcare regulatory standards.
The Project Manager will lead end-to-end customer experience launch initiatives across various operational workstreams including contact centers and back-office functions. They are responsible for defining project scope, managing integrated plans, and ensuring operational readiness through cross-functional alignment.
The Data Engineer will design, develop, and maintain complex database applications and data pipelines using Cloudera and AWS technologies. They will also provide technical consulting, mentor junior staff, and ensure alignment between application architects and developers.
You will design, develop, and integrate scalable Amazon Connect solutions to enhance customer contact experiences across voice and digital channels. Additionally, you will collaborate with cross-functional teams to troubleshoot production issues and ensure seamless integration with CRM and enterprise applications.
The representative will handle customer calls regarding healthcare services and Medicaid benefits while accurately documenting interactions. They are responsible for researching inquiries using internal systems to provide timely resolutions while maintaining HIPAA compliance.
The analyst will monitor and evaluate customer interactions to ensure compliance with quality standards and client requirements. They will also analyze performance trends and collaborate with teams to drive process improvements and service delivery.
Monitor and evaluate customer interactions to ensure adherence to quality standards, compliance, and performance expectations. Analyze quality results and trends to provide recommendations for process improvements and coaching.
The Healthcare Application Support Analyst codes, tests, debugs, and documents programs to meet client needs while resolving production support issues. They also conduct quality assurance activities and research industry technical trends to maintain system standards.
The Senior Business Analyst is responsible for posting medical and pharmacy claims, reconciling accounts receivable, and resolving payment discrepancies. They also collaborate with client engagement teams to gather business requirements and communicate them to technical personnel.
You will build advanced UI features using React and develop robust integrations using AWS services like Lambda and API Gateway. Additionally, you will design SQL data models and mentor developers to ensure high engineering standards across the contact center platform.
The Senior Associate performs audits of inpatient medical records to ensure the accuracy of diagnosis and procedure coding according to regulatory guidelines. They also provide mentorship and training to other auditors while maintaining productivity and quality standards.
The Long-Term Care Auditor I is responsible for identifying and recovering improper Medicaid payments by auditing provider records and financial data. They serve as a primary liaison for providers, managing a caseload and delivering status reports to management.
The SME will review and evaluate CPT, HCPCS, and ICD-10 coding updates to ensure compliance with Wisconsin Medicaid Long-Term Care programs. They will also lead cross-functional projects, facilitate stakeholder discussions, and maintain centralized documentation for coding and reimbursement policies.
The Batch Developer will code, test, debug, and document low to moderately complex programs while designing systems to meet business needs. They will also collaborate with management to validate requirements, develop test plans, and conduct quality assurance activities.
The Data Engineer will design, develop, and maintain complex database applications and large-scale data pipelines using Cloudera and AWS technologies. They will also provide technical consulting, mentor junior designers, and oversee relationships between architects and developers.
The Medical Reviewer will evaluate laboratory-related claims, Treatment Authorization Requests, and supporting documentation to ensure compliance with medical policies and coverage requirements. They will collaborate with clinical and operational teams to resolve review questions and document findings accurately.
The Medical Reviewer will evaluate durable medical equipment claims, Treatment Authorization Requests, and supporting medical documentation to ensure compliance with program requirements. They will collaborate with clinical and operational teams to document findings and support timely claim adjudication.
The Medical Reviewer will evaluate laboratory-related claims, treatment authorization requests, and supporting documentation to ensure compliance with medical policies and program requirements. They will collaborate with clinical and operational teams to resolve review questions and document findings accurately.
The Medical Reviewer will evaluate speech, language, and audiology-related claims, treatment plans, and clinical documentation to ensure compliance with medical necessity and program requirements. They will also collaborate with clinical and operational teams to resolve review questions and document findings accurately.
The Medical Reviewer will evaluate radiology-related claims, treatment authorization requests, and medical records to ensure compliance with clinical standards and medical necessity. They will document findings and collaborate with clinical and operations teams to support healthcare program requirements.
The Medical Reviewer will evaluate podiatry-related medical records, claims, and treatment authorization requests to ensure compliance with clinical and program requirements. They will collaborate with multidisciplinary teams to resolve review questions and document clinical findings accurately.
The Medical Reviewer evaluates prosthetic and orthotic device requests, claims, and treatment authorizations to ensure they meet medical necessity and coverage requirements. They also collaborate with clinical and operational teams to document findings and support accurate, timely claim determinations.
The Medical Reviewer will evaluate optometry-related medical records, claims, and treatment authorization requests against clinical standards and policies. They will collaborate with clinical and operational partners to ensure accurate documentation and timely coverage determinations.
The Medical Reviewer will evaluate physical therapy-related medical records, claims, and treatment plans to ensure compliance with clinical and coverage requirements. They will collaborate with healthcare professionals to resolve review questions and document findings accurately.
Perform physician-level medical reviews of claims, treatment authorization requests, and appeals to ensure clinical accuracy. Collaborate with multidisciplinary teams to support medical policy development and maintain compliance with regulatory requirements.
The Medical Reviewer will perform clinical pharmacy reviews, claim adjudication, and drug utilization reviews to support California healthcare programs. They will collaborate with multidisciplinary teams to ensure compliance with pharmacy policies and regulatory requirements.
The Process Writer is responsible for documenting, maintaining, and standardizing Standard Operating Procedures (SOPs) and Desk Level Procedures (DLPs) for the Customer Experience team. They will collaborate with cross-functional teams and Lean Six Sigma experts to map workflows, identify process gaps, and ensure documentation remains accurate and compliant.
The Outpatient Coding Auditor performs audits of medical records to ensure the accuracy of diagnosis and procedure codes according to regulatory guidelines. They also assist management with training, mentoring, and providing feedback to new coding auditors.
The PMO Lead creates and implements complex project schedules, budgets, and objectives while ensuring alignment with architectural dependencies and release milestones. They also manage a team of project managers and act as the primary point of contact for client project management.
The specialist will collaborate with providers and insurance carriers to resolve denied or unpaid claims and ensure proper reimbursement. They are responsible for managing aging reports, pursuing appeals, and maintaining accurate documentation within the case management system.
The role involves responding to inbound calls from Medicaid providers and members to verify insurance coverage and coordinate benefits. Additionally, the assistant will process correspondence, maintain accurate records, and perform administrative data entry tasks while adhering to HIPAA regulations.
The Integrated Delivery Program Manager leads complex product solution implementations by coordinating across multiple internal development teams. This role oversees planning, execution, risk management, and stakeholder alignment to ensure projects are delivered on time and within scope.
Translates state and federal Medicaid policy into product features, system configurations, and design artifacts. Acts as a domain subject matter expert to ensure successful implementation and operational readiness across healthcare systems.
The Project Manager will lead large technological programs, overseeing project planning, staffing, and budget management to ensure timely delivery. They will also communicate project status to stakeholders, manage risks, and support business development through proposal efforts.
The ORR Lead oversees the readiness assessment, demonstrations, and cutover of legacy systems into new Gainwell solutions. They are responsible for maintaining project schedules, managing vendor relationships, and communicating progress to leadership.
The DRG Nurse Reviewer coordinates and performs appeal-related duties, including analyzing provider appeals and preparing case files for hearings. They also participate in hearings alongside the Medical Director and assist in training new reviewers.
The Client Services Analyst II supports client success by ensuring the accurate delivery of data files, reports, and letters while managing operational workflows. They collaborate with cross-functional teams to analyze performance metrics, resolve issues, and drive improvements in service delivery and client satisfaction.
The PMO Lead will establish and oversee project management governance, controls, and delivery processes for a large-scale DDI program. They will drive performance against KPIs and SLAs while facilitating executive reporting and stakeholder communications.
The PMO Lead will establish and oversee project management governance, controls, and delivery processes for a large-scale DDI program. They will drive performance against program KPIs and SLAs while supporting executive leadership through strategic reporting and stakeholder engagement.
The Business System Architect is responsible for eliciting, analyzing, and documenting business requirements while acting as a bridge between stakeholders and technical teams. They support the software development lifecycle, manage project impacts, and provide guidance to junior analysts.
The role involves coding, testing, debugging, and documenting programs to meet client needs while assisting in production support. You will also design program enhancements, develop test plans, and conduct quality assurance activities like peer reviews.
The Contract Management Lead will independently manage the full lifecycle of complex commercial, technology, and government contracts. They will collaborate with cross-functional teams to negotiate terms, mitigate contractual risks, and ensure compliance with healthcare regulations and corporate policies.
The specialist will lead the development, negotiation, and administration of complex commercial and government contracts while ensuring regulatory compliance. They will partner with legal, procurement, and business stakeholders to manage contractual risks and drive standardized contract practices.
The Senior Manager oversees the strategy, design, and execution of complex, multi-account pharmacy programs to meet cost, performance, and quality objectives. They collaborate with cross-functional teams to drive business development and ensure programs align with client needs and regulatory requirements.
The Advisor Application Developer will lead the design, development, and deployment of healthcare transaction solutions, specifically focusing on NCPDP F6 processing. They will also collaborate with cross-functional teams to maintain APIs, perform code reviews, and ensure system scalability and compliance.
The Principal Data & Analytics Delivery Leader will oversee the delivery of MMIS data and analytics solutions for state and local government clients. This role involves managing a team of analysts and developers while collaborating with cross-functional leaders to drive integrated reporting initiatives and ensure compliance.
The Senior Batch Developer will design, develop, and test complex application software while guiding connections between architects and developers. They will also serve as a technical consultant to senior management for complex projects and application modules.
The Cloud Data Solutions Architect designs and supports strategic technology solutions to drive operational efficiency and business growth. This role collaborates with cross-functional teams and stakeholders to identify business requirements and ensure successful implementation of data-driven solutions.
Design, develop, and maintain Databricks ETL/ELT pipelines to process complex Medicaid datasets including claims, eligibility, and provider files. Create Power BI semantic models and dashboards to support operational performance monitoring, regulatory reporting, and program integrity.
The developer will design, develop, and test healthcare administration products while managing batch job automation and system integration. They will also be responsible for resolving technical issues, documenting programs, and conducting quality assurance activities.
The Information Security Officer will lead security operational governance, drive remediation efforts, and ensure adherence to SLAs and SLOs. They are responsible for managing security incidents, facilitating audits, and maintaining account security plans while ensuring compliance with regulatory and contractual standards.
The SQL Developer Analyst will analyze, design, and program SQL-based solutions while collaborating with cross-functional teams to meet business requirements. They are also responsible for monitoring system performance, mentoring team members, and providing actionable insights through data mining and modeling.
The Systems Manager is responsible for the performance, availability, and modernization of systems supporting the Medicaid Management Information System. This role leads technical operations, enforces ITSM processes, and acts as a primary liaison for client stakeholders.
The Advisor, Program Management oversees the planning and delivery of application development initiatives while ensuring alignment across product, engineering, and business stakeholders. This role drives the end-to-end program lifecycle, including road mapping, execution, risk management, and continuous improvement.
The Business Analyst serves as a liaison between clients, project managers, and technical teams to gather and document business requirements and process flows. They also act as a subject matter expert in Medicaid financial processing while coordinating project milestones and supporting testing activities.
The Engagement Lead is responsible for overseeing complex client implementation initiatives, ensuring they meet scope, schedule, budget, and quality expectations. This role serves as the primary point of accountability, managing cross-functional teams and maintaining senior-level client relationships throughout the program lifecycle.
The ISO is accountable for security-related compliance and delivery for assigned customers, acting as a trusted advisor for healthcare industry regulated security requirements. Key duties include managing security risks, reporting on threat and vulnerability management, and coordinating security metrics and incident responses.
Provide application and operations support for cloud-based infrastructure on Azure and AWS, including environment setup and deployment. Collaborate with development teams and end users to troubleshoot issues and apply ITIL principles for service management.
The specialist is responsible for reviewing and processing provider enrollment and revalidation applications for the Nevada Medicaid Program. This includes performing outreach to providers and coordinating with clients to obtain necessary approvals.
The specialist is responsible for accurately entering, reviewing, and validating claims-related information and healthcare records. They must ensure data compliance and maintain the security of sensitive member information while meeting productivity standards.
Acts as the enrollment liaison between Gainwell Technologies, the Idaho Department of Health & Welfare, and the provider community. Responsible for processing initial and maintenance enrollment applications while ensuring adherence to state requirements and SLAs.
Acts as the primary liaison between healthcare providers and Missouri Medicaid by conducting site visits to ensure compliance with state and federal requirements. Delivers education and training on billing practices and policies while resolving complex operational issues for providers.
The Technical Analyst bridges business needs with technical execution by translating requirements into technical specifications and data models for pharmacy claims. They leverage SQL to validate data and collaborate with cross-functional teams to ensure scalable system architecture.
Lead the design, implementation, and governance of enterprise-wide ServiceNow solutions with a focus on platform scalability and architectural integrity. Manage integrations between ServiceNow and external systems while optimizing CMDB health and data integrity.
Acts as a technical liaison between customers and partners to ensure end-to-end solution delivery for client projects. Responsible for creating technical artifacts, managing security documentation, and overseeing SFTP/MFT implementations.
Research, resolve, and process medical claims while ensuring compliance with established guidelines. Coordinate with internal departments and prepare necessary documentation such as Return to Provider forms.
Respond to member telephone calls regarding eligibility and benefit information using an automated system. Research inquiries, document interactions in a CRM ticketing solution, and conduct outbound calls as needed.
Lead end-to-end data and analytics delivery for the Provider+ solution, overseeing integrations, reporting, and data conversions. Act as the primary technical advisor to Engagement Leaders to ensure technical design integrity and alignment with client commitments.
Provide comprehensive support and troubleshooting for FraudCapture client users to ensure retention and system efficacy. Develop training materials and act as the primary point of contact for technical issues and escalations.
Design, develop, and deploy advanced AI and Generative AI solutions to improve healthcare outcomes and operational efficiency. This includes managing end-to-end deployment, data engineering, and ensuring compliance with HIPAA and industry standards.
The Clinical DRG Auditor performs clinical and coding validation reviews of medical records to ensure the accuracy of DRG assignments and documentation. They also assist management by mentoring new staff and maintaining current knowledge of coding guidelines and regulatory mandates.
The representative will answer telephones, respond to basic customer questions regarding insurance and healthcare, and provide consultancy utilizing expertise. This role also involves developing and implementing policies, investigating claim characteristics, and responding to provider appeals.
The representative will handle a high volume of inbound calls from healthcare professionals regarding billing, policy questions, and Medicaid inquiries, aiming to resolve 92% of calls within 3–5 minutes. Key duties include accurately documenting all interactions, maintaining policy knowledge, and ensuring full HIPAA compliance while supporting team goals.
The Medical Claims Auditor reviews and analyzes medical claims and supporting documentation to ensure accuracy, compliance with company policies, and adherence to industry standards, including validating coding accuracy using ICD-10, CPT, and HCPCS guidelines. This role involves identifying discrepancies like upcoding or duplicate claims and communicating findings to recommend corrective actions to the claims processing team or management.
Assist the project team with gathering requirements and designing new methods to improve information processing. Help create or update data/process models based on client requests.
The Healthcare Project Manager creates and implements complex project definitions, schedules, budgets, and objectives for large or multiple high-complexity projects. They manage costs, schedules, and quality by overseeing project deliverables and ensuring that project metrics are met.
The Senior Business Analyst - SAS Coder will perform analysis, development, and evaluation of complex reports related to Medicaid and FoodShare programs. This role involves determining report specifications, meeting with stakeholders, and ensuring compliance with federal and state regulations.
As a GUI Developer, you will design, develop, and maintain responsive and interactive GUIs while integrating them with AI solutions. You will also analyze and modernize legacy GUI components to ensure compatibility with modern frameworks.
The engineer is responsible for designing, building, and maintaining Azure and AWS infrastructure for product demo environments. They will collaborate with cross-functional teams to ensure seamless integration and operational excellence.
Oversee daily operations of the development team for a Medicaid Management Information Systems (MMIS) Contract, ensuring end-to-end delivery of technical solutions. Facilitate operational meetings, monitor processes, and drive improvements to enhance service delivery.
The Claims Manager oversees routine claims processing operations and manages a team responsible for data entry, claims resolution, and reporting. This role involves ensuring compliance with laws and regulations while developing policies for efficient operations.
The Lease Accountant will manage end-to-end lease accounting processes, ensuring compliance with relevant accounting standards. Responsibilities include maintaining lease agreements, performing modifications, and supporting financial reporting and audits.
As a Call Center Project Manager, you will lead project management teams to ensure quality and timely completion of tasks. You will communicate project metrics and status to clients and stakeholders while managing risks and implementing solutions.
