The Senior Staff Dentist provides clinical leadership for utilization management and review programs to ensure appropriate dental care adjudication. They also engage in quality improvement initiatives, provider counseling, and clinical mentorship to support organizational compliance and performance goals.
The Compliance Program Manager will oversee regulatory and contractual compliance across multiple lines of business, including Medicaid and Medicare. They are responsible for managing audits, conducting risk assessments, and ensuring adherence to HIPAA privacy standards.
The Clinical Operations Analyst will analyze clinical and operational data to drive strategic decision-making and improve organizational performance. They will also coordinate cross-functional initiatives, evaluate clinical workflows, and facilitate communication between clinical teams and leadership.
The Staff Dentist will review dental claims and prior authorization requests to ensure clinical necessity and adherence to benefit policies. They will also participate in peer-to-peer consultations and collaborate with internal teams to maintain clinical quality and consistency.
The Implementation Manager will lead client onboarding initiatives and oversee a high-performing team to ensure operational readiness and project success. They are responsible for establishing best practices, managing complex project portfolios, and driving process improvements across the organization.
The IT Applications Engineer is responsible for maintaining, supporting, and enhancing business applications across production and non-production environments. This role involves collaborating with vendors and internal teams to troubleshoot issues, manage deployments, and ensure overall application stability.
The IT Applications Analyst will support and maintain enterprise applications while coordinating issue resolution between business stakeholders, vendors, and IT teams. They are responsible for performing data analysis, managing application enhancements, and ensuring operational stability through effective system integration and testing.
The Case Manager provides confidential assistance to Medicaid enrollees with special health care needs and manages dental service inquiries. They are responsible for documenting cases in the database, educating enrollees on benefits, and collaborating with multidisciplinary teams to ensure quality care.
The IT Operational Analyst serves as a liaison between business units and IT teams to translate business needs into technical requirements. They are responsible for analyzing system performance, identifying process improvements, and supporting the implementation of technology solutions.
The Quality Program Administrator manages Medicaid and Medicare quality programs by ensuring regulatory compliance and operational excellence. They facilitate cross-functional projects, analyze performance data, and prepare reports to drive continuous quality improvement.
The Manager of Grievance & Appeals oversees the grievance system, ensuring all member and provider disputes are resolved in compliance with state and federal regulations. This role also drives quality improvement initiatives, manages audit preparedness, and collaborates across departments to implement process improvements.
Lead and mentor a team of systems engineers while driving operational excellence and infrastructure reliability. Oversee requirements management, system architecture, and verification processes to ensure compliance and performance.
The Claims Referral Specialist II is responsible for accurately processing dental claims, pre-authorizations, and referrals in accordance with regulatory guidelines and service level agreements. They will collaborate with internal teams to resolve claim-related issues while maintaining high standards of quality and productivity.
The Population Health Integration Lead will develop and execute enterprise-wide strategies to improve health outcomes and reduce disparities across diverse populations. This role involves collaborating with clinical and operational teams to implement care integration programs and community outreach initiatives while ensuring regulatory compliance.
The State Fair Hearing Analyst manages Medicaid Fair Hearing cases by preparing detailed legal documentation, evidence, and case analyses. They represent the organization during hearings and collaborate with internal teams and state regulators to ensure compliance.
The System Configuration Analyst will coordinate and execute claims and utilization management system configurations while ensuring alignment with benefit designs and regulatory standards. This role involves collaborating with cross-functional teams to test system logic, audit rules, and support new business implementations.
The Quality Improvement Analyst will lead and support quality improvement projects while analyzing healthcare data to identify performance trends and gaps. They will facilitate cross-functional collaboration and present actionable findings to leadership to drive clinical and non-clinical outcomes.
Perform clinical reviews of dental claims, prior authorizations, and treatment requests to ensure evidence-based care and regulatory compliance. Collaborate with providers and leadership to maintain consistency in coverage determinations and support quality improvement initiatives.
Perform clinical reviews of dental claims, prior authorizations, and treatment requests to ensure evidence-based care. Collaborate with providers and leadership to maintain quality outcomes and regulatory compliance across various member populations.
Review dental claims and prior authorization requests to ensure medical necessity and adherence to coverage guidelines. Collaborate with clinical leaders and providers to maintain consistency in clinical determinations and support quality initiatives.
