The Manager oversees and directs utilization management operations for inpatient, post-acute, and DSNP services to ensure regulatory compliance and cost-effective care. They lead interdisciplinary teams, manage departmental budgets, and implement process improvements to optimize member outcomes.
The Director of Provider Network Operations oversees core operational, data, and system functions, including provider relations, credentialing, and platform interoperability. This role leads strategic planning and execution across multiple lines of business to ensure high performance and compliance with organizational and regulatory standards.
The Senior FWA Specialist serves as a subject matter expert responsible for developing and maintaining the organization's Payment Integrity and FWA program framework. This role leads investigations, manages regulatory reporting, and partners with internal and external stakeholders to detect and prevent fraud, waste, and abuse.
The Senior Fraud, Waste and Abuse Investigator manages complex healthcare audits and investigations to ensure compliance with state and federal regulations. They collaborate with cross-functional teams to identify patterns of fraud and present findings to management and regulatory agencies.
The Senior FWA Specialist serves as a subject matter expert responsible for developing and maintaining the organization's Payment Integrity and Fraud, Waste, and Abuse (FWA) programs. This role involves leading investigations, coordinating audits, ensuring regulatory compliance, and collaborating with internal and external stakeholders to prevent and recover improper payments.
The Senior Fraud, Waste and Abuse Investigator manages complex healthcare audits and investigations to ensure compliance with state and federal regulations. They collaborate with cross-functional teams to identify patterns of fraud, conduct fact-finding interviews, and develop comprehensive case files.
The Senior FWA Specialist serves as a subject matter expert responsible for developing and maintaining payment integrity and fraud, waste, and abuse programs. This role involves leading investigations, coordinating audits, and collaborating with regulatory agencies to ensure compliance and financial recovery.
The Senior FWA Specialist serves as a subject matter expert responsible for supporting and advancing the organization's Payment Integrity and Fraud, Waste, and Abuse programs. This role involves developing program policies, coordinating audits, managing regulatory reporting, and collaborating with internal and external stakeholders to detect and prevent payment vulnerabilities.
Develop and administer compensation programs and guidelines that align with the company's philosophy and organizational culture. Partner with business leaders to manage job evaluations, salary benchmarking, and the administration of direct compensation within the Workday HRIS.
The Senior Risk Adjustment Analyst ensures accurate data submission to regulatory entities like CMS and optimizes risk models for HCCs and HEDIS performance. They lead cross-functional projects, manage vendor partners, and provide mentorship to junior analysts to improve risk adjustment processes.
The Senior Risk Adjustment Analyst ensures accurate data submission to regulatory entities like CMS and optimizes risk models for HCCs and HEDIS performance. The role involves collaborating with internal and external partners to improve processes, maintain documentation, and provide mentorship to junior analysts.
