Manage and grow relationships with skilled nursing facilities, provider groups, and community partners, including conducting engagement meetings and supporting onboarding and ongoing participation in the ACO program. Coordinate with internal teams to advance regional growth and provider alignment, support CMS compliance, and represent the organization at industry and community events.
The Pharmacy Business Analyst will analyze pharmacy utilization and cost trends to support the development of pharmacy benefit strategies for a Medicare Advantage plan. They will also manage formulary optimization, ensure CMS regulatory compliance, and lead cross-functional projects to improve operational efficiency.
The Chief Clinical Officer is responsible for setting and executing the clinical vision for Medicare Advantage Institutional Special Needs Plans to ensure high-quality, person-centered care. This role oversees clinical operations, risk adjustment accuracy, and affordability initiatives while driving strategic leadership across the organization.
The Credentialing Coordinator is responsible for performing primary source verification of practitioner credentials and maintaining accurate provider data within Salesforce. They also conduct annual audits of delegated entities to ensure compliance with CMS and NQA regulatory standards.
The Data Analyst will develop and maintain reports, dashboards, and data solutions while analyzing business requirements. They are responsible for integrating healthcare data, identifying trends, and troubleshooting complex data and application issues.
The Data Integration Specialist will monitor and optimize enterprise data pipelines while resolving data quality and integration issues. They will also provide operational support for Power BI reporting and collaborate with cross-functional teams to ensure accurate data governance.
The Credentialing Assistant provides administrative support by managing credentialing communications, facility recredentialing outreach, and application intake. They are also responsible for maintaining provider records in Salesforce and monitoring expired licenses to ensure departmental compliance.
