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.
The Data Analyst will provide essential data support for reinsurance, large employer RFP, and ASO reporting while collaborating with management on cross-departmental projects. Responsibilities include extracting and cleaning data from the warehouse, developing visualization solutions, and calculating value-based payment terms.
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.
The Care Management Clinician Team Lead is responsible for managing clinical care managers, overseeing team performance, and ensuring the effective delivery of health services. They will lead program development, monitor workflows, and facilitate process improvements using lean methodologies to enhance outcomes.
The Payment Integrity Program Specialist coordinates vendor activities, implementation of initiatives, and project tracking to ensure program effectiveness. They also manage documentation, prepare reports for leadership, and facilitate cross-functional communication across various departments.
The Payment Integrity Analytics Specialist is responsible for developing dashboards, reports, and analytical insights to support payment integrity operations and fraud, waste, and abuse prevention. This role involves analyzing claims and provider data to identify recovery opportunities and monitoring vendor performance to ensure operational efficiency.
