The Social Worker coordinates psychosocial services and assists members with medical resource utilization, case management, and discharge planning. They partner with interdisciplinary teams to assess needs, connect members to community resources, and develop effective care plans.
This role provides strategic leadership and oversight for all actuarial and pricing functions supporting Medicare Advantage plan operations. The VP will manage CMS bid submissions, financial valuation, risk adjustment forecasting, and cross-functional collaboration to ensure long-term financial sustainability.
The Principal RAS Partner & Educator is responsible for implementing initiatives to improve coding and documentation accuracy for clients. They act as a subject matter expert to develop and facilitate risk adjustment strategies and provider training programs.
Build and lead an enterprise-wide member journey management practice, coordinating cross-functional teams to design, deliver, measure, and continuously improve member experiences. Guide digital portal and mobile app roadmaps, sponsor the Member 360 data strategy, and align experience initiatives with healthcare quality outcomes and regulatory requirements.
The Strategic Provider Partnerships Director is responsible for identifying, prospecting, and cultivating high-value partnerships with health systems and physician groups. This role involves developing strategic business cases, managing complex negotiations, and coordinating across internal departments to support market growth.
The Chief Medical Officer provides strategic clinical direction and oversees medical management, pharmacy management, and quality initiatives for Essence Healthcare. They are responsible for fostering physician relationships, managing medical costs, and ensuring clinical programs align with evidence-based guidelines and regulatory standards.
