The Enterprise BI Analyst designs, develops, and maintains business intelligence solutions including dashboards and reports to support data-driven decision-making. They partner with stakeholders to define KPIs, automate reporting processes, and ensure data quality across the organization.
The Data Quality Engineer ensures the accuracy, reliability, and integrity of data across health plan and delivery systems by validating inputs, outputs, and transformations. This role develops test plans, executes SQL-based validation, and collaborates with cross-functional teams to resolve data anomalies.
The SIU Investigator manages a caseload of suspected fraud, waste, and abuse from intake through resolution, including data analysis and medical record reviews. They are responsible for developing investigative plans, conducting interviews, and preparing referrals to federal oversight entities and law enforcement.
Lead data engineering, integration, database administration, and architecture teams while maintaining and optimizing the production SQL Server environment. Direct the migration of data platforms and pipelines to Azure and Databricks, ensuring secure, scalable systems that meet business, clinical, and regulatory needs.
The Vice President of Pharmacy Services provides strategic leadership and oversight for all pharmacy operations, including PBM management, formulary strategy, and financial performance. They ensure regulatory compliance, optimize clinical and fiscal outcomes, and collaborate across the organization to support patient-centered care.
The Utilization Review Nurse ensures high-quality, cost-efficient medical outcomes for enrollees needing inpatient/outpatient authorizations. Responsibilities include reviewing prior authorization requests, coordinating transitions of care, and managing health care within compliance regulations.
