The specialist will monitor and report on Health Services operational activities to ensure compliance with regulatory standards and internal policies. They will also collaborate with leadership to conduct audits, manage delegated functions, and develop employee education programs.
Clinicians facilitate client wellness through assessment, planning, and coordination of healthcare services to ensure cost-effective and safe care. They act as a liaison between clients, providers, and payers while maintaining adherence to regulatory and ethical standards.
This role oversees the Provider Network department's core operational, data, and systems functions, including provider relations, credentialing, and platform interoperability. The director leads strategic planning and execution efforts to ensure high performance across all lines of business while fostering partnerships and optimizing system integration.
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.
