Provider Partners Health Plan

The role involves credentialing practitioners for network participation and maintaining accurate provider data within Salesforce. It also includes auditing delegated entities to ensure compliance with CMS and NQA standards.

The analyst will focus on analyzing pharmacy utilization, claims data, and cost trends to identify savings opportunities and support the development of pharmacy benefit strategies. Key duties include managing reporting tools, optimizing the drug formulary, and ensuring adherence to CMS Medicare Advantage regulations.

The Provider Relations Coordinator acts as a liaison to support the provider network, focusing on onboarding, contract administration, and resolving provider inquiries regarding claims and reimbursements. Key duties include managing provider data accuracy, facilitating internal and external communication, and ensuring compliance with regulatory requirements.

The Chief Clinical Officer is responsible for setting and executing the clinical vision for the organization’s Medicare Advantage I-SNP/IE-SNP, focusing on high-quality, person-centered care, driving risk adjustment accuracy, and managing affordability. This role provides strategic direction over clinical programs, quality initiatives, and care delivery models to improve health outcomes and ensure sustainable financial performance.