The manager will lead the coordination of analytics and process functions within the Enterprise Risk Adjustment department to achieve organizational objectives. They are responsible for managing staff, facilitating alignment across business units, and providing actionable insights to leadership through reporting and presentations.
The clinician assesses behavioral health needs against clinical guidelines to ensure appropriate levels of care and monitors patient outcomes throughout the continuum of care. They coordinate with multidisciplinary teams, patients, and families to facilitate cost-effective, high-quality care and manage resource utilization.
The Director of Enterprise Applications is responsible for creating technology and digital strategy for a portfolio of up to 150 applications while leading a team of approximately 350 staff. They oversee the software development lifecycle, manage vendor relationships, and ensure high-quality service levels across all business applications.
This role involves conducting on-site and desk audits of hospital billing and coding practices, including DRG validation and utilization review. The auditor will identify billing discrepancies, track error trends, and provide technical guidance to stakeholders regarding coding and payment regulations.
The RN I assesses patient clinical needs against established guidelines to ensure appropriate level of care and length of stay. They coordinate care across the continuum, monitor medical services, and advocate for members while maintaining accurate documentation.
The RN I assesses patient clinical needs against established guidelines to ensure appropriate level of care and length of stay. They coordinate care across the continuum, monitor medical services, and advocate for members while maintaining accurate documentation.
The Appeals Resolution Analyst II-RN manages medical appeal cases by assessing clinical needs against established guidelines and ensuring compliance with regulatory standards. They also provide clinical liaison support, resolve high-priority inquiries, and coordinate with internal and external stakeholders to facilitate the appeals process.
The RN I assesses patient clinical needs against established guidelines to ensure appropriate level of care and length of stay. They coordinate care across the continuum, monitor medical services, and advocate for members while maintaining accurate documentation.
The RN performs clinical assessments against established guidelines to ensure medically appropriate levels of care and length of stay. They coordinate care transitions, monitor services across the continuum, and advocate for members while maintaining fiscal accountability.
The Care Manager assesses member clinical needs against established guidelines to ensure appropriate care and develops individualized plans to improve health outcomes. They also facilitate transitions of care, monitor medical activities, and serve as a mentor to new nursing staff.
The RN I assesses patient clinical needs against established guidelines to ensure appropriate level of care and length of stay. They coordinate care plans with multidisciplinary teams and advocate for members across the continuum of care.
The Actuarial Analyst II will support the No Surprises Act (NSA) team by managing data, developing forecasts, and performing financial impact assessments. They will also collaborate with cross-functional teams to improve data collection processes and communicate key financial results to senior leadership.
The Provider Strategy Coordinator implements cross-departmental initiatives to support strategic goals and ensures compliance with regulatory and accreditation standards. They also manage special projects, develop physician communications, and drive action plans to improve quality scores like CAHPS and HEDIS.
The resident will perform pharmacy case management, develop clinical policies, and conduct drug utilization reviews within a managed care environment. They will also assist with Pharm.D. student oversight and contribute to outcomes research and formulary development.
The Medical Director provides clinical leadership and oversight for utilization, care, and quality management programs within an assigned region. They collaborate with cross-functional teams to support provider relations, medical policy development, and operational effectiveness.
The Medical Director designs and implements provider education and performance management initiatives to improve population health and value-based care outcomes. They lead clinical transformation teams and collaborate with internal and external stakeholders to drive quality, affordability, and provider engagement.
The Primary Nurse performs clinical assessments, develops member-centric care plans, and facilitates transitions across the continuum of care. They also monitor medical care activities, advocate for members, and serve as a mentor to new staff.
The role involves conducting data collection and analysis to support process improvement initiatives aimed at reducing cost and complexity across the enterprise. The incumbent will lead projects, supervise business process analysts, and develop business cases using ROI models to improve productivity and efficiency.
The specialist provides subject matter expertise to account management teams regarding underwriting, billing operations, and benefit design. They are responsible for maintaining strategic stakeholder relationships and supporting the growth and retention of the SHBP book of business.
The Care Manager assesses clinical needs and implements cost-effective care plans for specialty populations to ensure optimal health outcomes. They partner with members, families, and healthcare teams to coordinate resource utilization and facilitate transitions across the continuum of care.
The RN will perform clinical assessments for PCA and MDC services to ensure medically appropriate care and coordinate services across the continuum of care. They will also monitor patient outcomes, advocate for members, and assist with MLTSS case management as needed.
The RN performs clinical assessments to ensure medically appropriate care and develops individualized care plans for high-risk members. They also coordinate care across the continuum, facilitate transitions, and serve as a mentor to new staff members.
The Actuarial Analyst II is responsible for pricing, underwriting support, reserving, and forecasting for Stop Loss and Level Funded groups. They will also design trend analyses and lead meetings with business partners to provide transparency regarding actuarial results.
The RN II coordinates and monitors patient care across the continuum, ensuring high-quality and cost-effective outcomes through clinical practice guidelines. They also serve as a mentor to staff, act as a subject matter expert for projects, and advocate for members throughout their healthcare journey.
The analyst is responsible for performing internal and external vulnerability assessments, managing scanning programs, and evaluating security exceptions. They will also partner with technology teams to prioritize remediation efforts and support threat hunting initiatives to reduce organizational risk.
The role focuses on the conservation of existing public market accounts and selling additional product lines to maximize retention. Responsibilities include negotiating contract terms, conducting client workshops, and ensuring stakeholders are informed of regulatory issues.
Lead a growth operations team focused on pipeline management, BANT qualification, and CRM hygiene to scale the enterprise growth engine. Coordinate executive-level meeting generation and orchestrate complex enterprise deals across cross-functional teams.
Supports the Quality Management department through project planning, implementation, and the establishment of policies for Government and Commercial programs. Analyzes complex data to improve health plan quality ratings and member experience through CAHPS coaching and provider action plans.
The RN Case Manager is responsible for assessing patients' clinical needs and coordinating care to ensure appropriate levels of care. This role includes monitoring services, advocating for members, and collaborating with multidisciplinary teams.
