The specialist will monitor and report on Health Services operational activities to ensure compliance with Federal, State, and industry regulations. They will also collaborate with leadership to conduct internal audits, manage delegation oversight, and develop employee education programs.
Clinicians facilitate client wellness through assessment, planning, and coordination of healthcare services while ensuring safe and cost-effective care. They act as a liaison between clients, providers, and payers to manage resources and interpret medical contracts.
This position oversees the Provider Network department's core operational, data, and systems functions, including Provider Relations, Credentialing, and data management. The role leads strategic planning and execution across multiple lines of business to ensure high performance and compliance with organizational and regulatory standards.
Direct all actuarial pricing activities, including the development of premium rates for Commercial and Medicare Advantage lines of business. Provide leadership to a team of analysts while ensuring sound risk analysis and alignment with the organization's financial and enrollment goals.
