The UM Nurse Supervisor provides direct leadership and oversight to the nursing team, ensuring productivity, compliance, and professional development. They manage daily operations, including case assignments, authorization workflows, and performance evaluations while serving as a mentor to frontline staff.
The Utilization Management Coordinator supports the clinical team by processing prior authorizations and appeals using ICD-10 and HCPCS codes. They are responsible for verifying eligibility, maintaining documentation, and communicating with providers to ensure regulatory deadlines are met.
The Compliance Manager will administer the corporate compliance program, oversee audits, and manage fraud, waste, and abuse investigations. They will also collaborate with internal teams and external payers to ensure adherence to regulatory requirements and security standards.
The analyst is responsible for monitoring and documenting production quality through claims auditing and evaluating interactions within the Revenue Cycle Management function. They will identify trends, report findings to leadership, and facilitate training to drive continuous operational improvement.
The UM Nurse performs pre-service and post-service utilization reviews to determine medical necessity for DMEPOS requests. They collaborate with the Medical Director and non-clinical teams to manage appeals and ensure compliance with accrediting agency standards.
The Implementation Manager leads complex, post-sale health plan implementations from initiation through operational handoff. They are responsible for managing project plans, client relationships, cross-functional coordination, and ensuring readiness activities are completed on time and within scope.
The Lead Full Stack Software Engineer will drive the design, architecture, and development of scalable, cloud-native healthcare applications. This role involves providing technical leadership, mentoring engineers, and ensuring high-quality delivery through code reviews and production support.
The EDI Lead Engineer will spearhead the modernization of the healthcare interoperability platform by designing and implementing scalable EDI and FHIR integration solutions. This role involves providing technical leadership, mentoring engineering staff, and collaborating with cross-functional teams to ensure high-availability data exchange.
The Medical Director conducts clinical reviews of DMEPOS authorization requests to ensure determinations align with Medicare, Medicaid, and health plan criteria. They also provide clinical guidance to the UM team, participate in peer-to-peer discussions, and maintain documentation standards for regulatory compliance.
The EDI Engineer will manage data transformation processes for healthcare-specific formats and ensure reliable data exchange between applications and external partners. They will also collaborate with the SRE team to automate build and deployment processes while monitoring application performance and health.
The Director of Utilization Management oversees clinical and non-clinical teams to ensure efficient prior authorization and appeals processes while maintaining regulatory and NCQA standards. They collaborate with executive leadership and account managers to align UM programs with corporate initiatives and client contractual requirements.
The Sales Director will be responsible for creating a robust pipeline of new business opportunities and managing all sales activities to convert revenue opportunities. This includes prospecting, generating qualified leads, and developing relationships with key decision makers in the healthcare sector.
