The specialist reviews inpatient clinical records to identify documentation gaps and communicates with providers to ensure accurate code assignment. They also provide leadership in clinical documentation improvement and maintain effective relationships with HIM coding professionals.
The Medical Director is responsible for the clinical review and adjudication of appeals and grievances for various health insurance products. They also manage regulatory responses and collaborate with regional medical directors to address network and quality issues.
The Appeals and Grievances Medical Director performs clinical reviews and adjudicates appeals for various health plan products. They also communicate with internal medical directors and regulatory bodies to ensure compliance and quality in healthcare delivery.
The Senior Inpatient Medical Coder is responsible for accurately assigning ICD-10-CM and ICD-10-PCS codes for hospital inpatient services to ensure proper DRG impact. They also provide documentation feedback to providers and maintain high standards of coding quality and productivity.
The Director of AI Transformation will lead large-scale, cross-functional AI initiatives to modernize business processes and operating models. This role involves partnering with executive leadership to develop transformation roadmaps and ensure alignment with enterprise strategic goals.
The Network Contract Manager develops and maintains a competitive provider network by negotiating contracts and managing unit cost performance. They also ensure network adequacy and build strong business relationships with providers and internal stakeholders.
Answer incoming calls from healthcare providers and members to assist with benefits, billing, and treatment authorizations. Document interactions accurately while focusing on resolving issues during the first call to ensure positive member experiences.
The representative manages provider enrollment with contracted payers and ensures accurate billing system integration. They also maintain provider credentials, handle re-validations, and coordinate with clinic leaders to ensure compliance and timely onboarding.
The Associate Software Engineer will build healthcare portal features for claims and insurance processing using Java, Spring Boot, and React. They will also leverage AI-powered tools to optimize application performance and streamline software delivery workflows.
The Senior AI/ML Engineer will design and deploy production-grade LLM agents and RAG pipelines to automate platform issue detection and remediation. They will collaborate with cross-functional teams to build scalable, secure AI solutions integrated into existing software development workflows.
The medical coder will identify and assign appropriate ICD-10, CPT, and modifier codes for emergency department facility services while adhering to official coding guidelines. They are also responsible for maintaining performance standards in coding quality and productivity while participating in departmental meetings and educational events.
Develop and maintain predictive credit models for application scoring, risk detection, and loss estimation while ensuring compliance with fair lending standards. Collaborate with cross-functional teams to integrate model outputs into business strategies and oversee the end-to-end lifecycle of models from prototype to production.
The Billing Representative is responsible for reviewing, validating, and processing medical charge entries through Epic and other billing systems. This role supports revenue cycle operations by managing work queues, verifying insurance benefits, and resolving billing issues to ensure accurate and timely claim submission.
The Discharge Care Manager implements telephonic case management interventions for high-risk members and coordinates discharge plans with clinical teams. They also identify community resources and ensure post-hospital services are arranged to prevent readmissions.
The Clinical Coordinator will assess, plan, and implement individualized care strategies while managing the care plan throughout the continuum. They act as a single point of contact to advocate for patients and ensure quality coordinated care among all stakeholders.
The role involves evaluating and negotiating provider contracts while managing unit cost budgets and financial performance models. You will guide the development of geographically competitive networks and provide recommendations for process improvements.
The Patient Care Coordinator manages patient scheduling, verifies insurance information, and coordinates medical procedures for both inpatients and outpatients. They also handle patient-care related telephone calls and provide education regarding managed care plans and referral processes.
The Hospice RN On-Call provides after-hours clinical support by triaging patient needs and coordinating care to ensure quality outcomes. This role involves assessing patient conditions through both remote phone support and in-person field visits while collaborating with interdisciplinary teams.
The Technical Content Strategist will drive the overall content strategy for an internal IT knowledge platform serving over 52,000 engineers. They are responsible for defining documentation priorities, establishing governance frameworks, and managing information architecture across the organization.
The Coding Quality Auditor is responsible for conducting internal audits of inpatient coding charts to ensure regulatory compliance and identify process gaps. This role also involves collaborating with quality teams and CDI leadership to improve coding accuracy and providing performance feedback to coding staff.
Design, develop, test, and maintain scalable big data and cloud solutions, analytics rules engines, APIs, and AI/ML prototypes. Collaborate across teams on architecture, requirements, estimates, documentation, code reviews, and production support while improving existing analytics and platforms.
Plan and execute deployments of AI-enabled products into local healthcare teams, including readiness, releases, communications, training, and stakeholder coordination. Track adoption and outcomes after launch, manage user feedback and product improvements, and create repeatable deployment and training playbooks for future markets.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease management and social determinants of health.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
Provide Level 3 production support for enterprise applications, APIs, cloud services, and distributed platforms, leading incident response, troubleshooting, root cause analysis, and recovery. Improve reliability through monitoring, automation, operational documentation, cross-functional collaboration, and support for deployments, disaster recovery, and cloud platform operations.
The resident will participate in a pathway program to develop skills in next-generation population health models within a team-based practice environment. This role requires a commitment of a few hours per month to enhance the final year of residency training.
The Clinical Coding Pharmacist serves as a liaison between operations and clinical consultants to provide coding support for formulary and utilization management. This role involves translating client intent into code-able language and managing custom formulary coding within the RxClaim adjudication system.
Review medical necessity for Applied Behavior Analysis treatment requests and manage outpatient cases throughout the treatment plan. Provide education and resources to parents and caregivers while coordinating benefits and transitions between care areas.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatment. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment responses.
The Director of Care Coordination leads multi-state programs across Arizona and New Mexico, overseeing field-based and centralized teams to support high-risk members. This role designs scalable workflows and staffing models while driving improvements in HEDIS, Stars, and value-based care performance.
The Tribal Liaison builds partnerships and facilitates culturally responsive health services for Native American communities in Nebraska. This role serves as a primary interface for tribal providers, managing claims, billing support, and educational outreach to improve health outcomes.
The manager oversees patient safety activities, including quality investigations, tracking quality issues, and managing a clinical team of specialists. They also contribute to the annual quality management plan and assist with the start-up activities for the VA Community Care Network program.
The Manager, Provider Relations supports the Director in executing market operations strategies and enhancing provider network performance. This role involves collaborating with clinical teams, resolving claims issues, and managing provider escalations to ensure operational success.
Design, develop, and deploy scalable, high-performance software applications and AI-powered solutions to address complex business challenges. Collaborate with cross-functional teams to integrate machine learning models and maintain robust CI/CD pipelines.
The Pharmacy Technician provides operational support by processing prescriptions, managing prior authorizations, and maintaining accurate patient records in Epic. They also interact professionally with patients, prescribers, and pharmacies to ensure prompt service and resolve prescription-related issues.
Lead regulatory initiatives and cross-functional projects to interpret, implement, and monitor healthcare requirements, ensuring alignment with federal and state regulations, contractual obligations, and accreditation standards. Coordinate regulatory audits and external inquiries, advise stakeholders, and communicate compliance status, risks, and process improvement opportunities to leadership.
Identify and secure new business, manage the full sales lifecycle, maintain a qualified pipeline, and achieve revenue and sales targets across long-term care and post-acute markets. Build relationships with customer stakeholders, support retention and onboarding with internal teams, monitor market developments, and maintain accurate Salesforce records and forecasts.
Manage complex provider escalations from intake through resolution, investigating claims, payment, authorization, data, access, and operational issues while coordinating accountability across internal teams. Build strategic relationships with Rhode Island healthcare providers, identify systemic causes and risks, and recommend sustainable improvements to provider experience and operational performance.
Drive revenue growth and market share by prospecting for new business, managing the full sales lifecycle, and building relationships with long-term care and post-acute care stakeholders. Maintain sales pipelines and forecasts, negotiate contracts, support customer onboarding and retention, and collaborate with operational, clinical, revenue cycle, and customer success teams.
Drive revenue growth and expand market share by prospecting for new business, managing complex sales cycles, negotiating contracts, and maintaining a qualified sales pipeline. Build relationships with long-term care and post-acute care stakeholders, support customer retention and onboarding with internal teams, and monitor market and regulatory developments.
Lead the strategy, architecture, and delivery of an enterprise context layer and AI-ready data platforms, including semantic models, ontologies, knowledge graphs, metadata capabilities, and reusable contextual data products. Direct multidisciplinary engineering teams and partner with business, data, product, architecture, and governance leaders to establish standards and enable trusted, secure information access for generative AI and agentic workflows.
The supervisor will monitor contact center agent performance, provide coaching, and manage daily staffing and workflow requirements. They are also responsible for hiring, conducting performance evaluations, and resolving customer complaints.
Assess members’ health through inbound and outbound calls, identify treatment barriers, and provide education to support self-management. Coordinate referrals and resources, review medications, and maintain communication to deliver continuous, quality care.
The Advanced Practice Clinician conducts comprehensive health assessments and provides clinical care for high-risk members in nursing homes and community settings. They collaborate with interdisciplinary teams to manage advanced illness planning and provide patient counseling.
Audit provider disputes, member denial letters, pre-lag reports, and claims-related reports to ensure accuracy and compliance with required turnaround times. Process claim-related items, report errors and compliance concerns, and provide backup support to fellow Claims Auditors.
Manage a panel of dual-eligible members with complex health needs by assessing medical, behavioral, functional, cultural, and social needs and developing individualized care plans. Coordinate with care teams, providers, and community resources; support referrals, services, care transitions, member education, and advocacy.
Coordinate safe, timely hospital discharges by identifying barriers, arranging resources, and collaborating with facility staff, patients, families, and internal and external partners. Manage a caseload, lead discharge rounds, document care management activities, assess risks, and support transitions to post-acute care while improving discharge processes and outcomes.
Wellness Coordinators provide care coordination and administrative support to members with behavioral health and substance abuse needs. They act as primary care navigators by screening for gaps in care, addressing social determinants of health, and developing individual care plans.
Improve website visibility, discoverability, user engagement, and conversion performance through SEO, generative search optimization, CRO, analytics, and Sitecore content management. Maintain and enhance websites by building and updating pages, testing functionality, troubleshooting issues, and collaborating with developers, content teams, and stakeholders.
Design, develop, and maintain full-stack web applications while building scalable APIs and backend services. Collaborate with cross-functional teams to integrate AI-enabled features and ensure high-quality software delivery through CI/CD and DevOps practices.
The manager will oversee the development and support of provider networks, including unit cost management and financial modeling. They will also negotiate contracts and lead a team to ensure geographically competitive and stable network performance.
The General Manager is responsible for driving Medicare Advantage business outcomes, including CMS Star Ratings, member experience, and risk adjustment performance across North Carolina and Tennessee. They serve as a cross-functional leader, building strategic relationships with providers and aligning internal teams to execute market priorities.
The Patient Care Coordinator manages the initial patient intake process and coordinates nursing services for infusion pharmacy patients. They maintain communication with care teams, agencies, and families to ensure high-quality patient care and accurate documentation.
The Physician Associate is responsible for the clinical review and adjudication of appeals and grievances cases in collaboration with a Medical Director. They will also provide clinical and strategic input while participating in organizational committees and process improvement initiatives.
The RN Case Manager will perform telephonic health assessments, triage patient concerns, and provide health education to support treatment decisions. They will also coordinate services, manage care gaps, and assist members in navigating their benefits and physician selections.
The Secondary Review Nurse evaluates clinical requests for Home and Community-Based Services to ensure medical necessity and cost-effectiveness. They collaborate with care managers and physicians while documenting clinical decisions in compliance with regulatory standards.
The Chief Medical Officer will lead multidisciplinary teams and manage complex clinical programs to improve healthcare delivery. The role involves overseeing clinical quality, utilization management, and regulatory compliance while driving strategic initiatives.
Lead and oversee clinical quality programs for the VA Community Care Network, including medical record reviews, peer review, patient safety, regulatory compliance, and quality improvement. Collaborate with internal and external partners, guide clinical staff, manage provider and independent review participation, and advise leadership on program improvements and clinical initiatives.
Manage behavioral health benefits and conduct utilization reviews for facility-based care, using clinical assessments to determine appropriate levels of care and whether additional services are needed. Coordinate benefits and transitions across levels of care, collaborate with facility staff to improve treatment outcomes, and identify community services to support discharge planning.
Assign accurate diagnostic and procedure codes based on clinical documentation and official guidelines. Monitor work queues to ensure timely coding and generate queries for physician documentation clarification.
The Senior Data Engineer will ensure the reliability and operational excellence of critical data systems by monitoring pipelines and leading incident resolution. They will also implement automated data quality checks and leverage AI tools to streamline operational workflows.
The Provider Relations Advocate maintains relationships with network providers, resolves operational issues, and negotiates cost-effective service fees. They also manage provider compliance, assist with claims resolution, and educate providers on contractual requirements and fee structures.
The role involves overseeing business development and sales strategies within the home health sector to drive growth and service delivery. You will be responsible for managing sales operations, ensuring compliance with healthcare regulations, and fostering relationships to support patient care initiatives.
The Care Coordinator serves as the primary care manager for dual-eligible members, conducting comprehensive needs assessments and developing individualized, person-centered care plans. They collaborate with internal teams and community providers to implement these plans, remove obstacles to care, and support transitions following medical events.
The Production Operations Specialist coordinates end-to-end print production for provider and member notification programs, including data preparation and vendor management. This role ensures the timely, accurate, and compliant execution of regulatory and contractual communications.
Lead a national sales organization to drive commercial growth for Optum's Crimson AI and Value-Based Care portfolios. Build and maintain executive-level relationships with health system leaders to translate analytics insights into measurable clinical, operational, and financial outcomes.
The Clinical Administrative Coordinator manages service requests from members and providers via phone, fax, and portals. They also process referrals and prior authorizations while assisting clinical staff with documentation and case triage.
The role involves overseeing business development activities and ensuring the effective delivery of healthcare services within the Raleigh hub. You will be responsible for managing sales strategies and collaborating with interdisciplinary teams to support patient care goals.
The Senior Investigator identifies, investigates, and prevents healthcare fraud, waste, and abuse by analyzing claims data and conducting interviews. They are responsible for managing complex cases, securing evidence, and reporting findings to appropriate regulatory bodies.
The Discharge Care Manager is responsible for implementing telephonic case management interventions and coordinating discharge plans for high-risk members. They collaborate with clinical teams and providers to ensure post-hospital services are arranged and documented effectively.
The clinician will evaluate and manage patient concerns through virtual encounters, providing clinical recommendations and appropriate dispositions. They are also responsible for documenting interactions in the electronic medical record and participating in evening, overnight, and weekend coverage.
The Sales Director is responsible for overseeing an inside sales department, ensuring the team meets or exceeds sales goals for Medicare Solutions. This role involves leading a remote team, managing performance, and fostering a culture of continuous improvement through coaching and development.
The L&D Program Manager leads the development of scalable role-based and product-based training programs for employees and customers. They collaborate with cross-functional teams to translate business needs into structured learning paths and performance-support content.
The Clinical Administrative Coordinator manages administrative intake, processes referrals and prior authorizations, and maintains documentation within medical management systems. They also provide support to clinical staff and handle inquiries from members and providers to ensure high-quality service.
Conduct initial and concurrent utilization reviews for LTSS, assess medical appropriateness of services using clinical guidelines and benefit determinations, and communicate findings and recommendations to providers, members, and the Health Plan Medical Director. Address complex cases, advocate for appropriate care decisions, identify inconsistencies in clinical information, and provide guidance and feedback to colleagues.
The role involves managing outbound provider calls, inbound call triage, and post-payment audit processing to support healthcare system operations. Responsibilities include documenting provider information, coordinating requests, and ensuring data accuracy within internal systems.
The VP of Business Development is responsible for driving growth and managing sales strategies within the home health sector. This role involves leading business development initiatives to expand service reach and build trusted relationships with healthcare partners.
The Software Engineer will design, code, test, and debug applications while collaborating with stakeholders to refine requirements into technical solutions. They are also responsible for building, deploying, and monitoring production services while mentoring junior team members.
Wellness Coordinators provide care coordination and administrative support to members with behavioral health and substance abuse needs. They act as primary care navigators by screening for gaps in care, addressing social determinants of health, and developing individual care plans.
The Associate Director is responsible for defining and executing strategies to achieve 4+ Star performance across multi-state Medicare contracts. They will analyze data to identify performance improvement opportunities and coordinate with cross-functional teams to drive clinical quality and operational excellence.
Manage the intake of member information and coordinate services by working with hospitals, clinics, and the clinical team. Handle high-volume inquiries from members and providers while processing referrals and prior authorizations.
The Coding Quality Analyst conducts medical record reviews to ensure coding and billing accuracy against regulatory requirements and internal business rules. They also analyze documentation for potential fraud, provide coding expertise to the investigation team, and recommend cost-saving opportunities.
The Vice President of Central Operations and Strategy is responsible for developing and executing the operating strategy for the California IPA business, including technology enablement and network management. This leader will drive cross-functional business outcomes, oversee complex provider transitions, and ensure alignment across regional and national enterprise priorities.
You will design, develop, and maintain scalable software applications and microservices using modern enterprise technology stacks. You will also collaborate with cross-functional teams to translate business requirements into technical solutions and drive automated testing and CI/CD processes.
Conduct independent, risk-based compliance monitoring, testing, and validation to assess regulatory adherence and the effectiveness of first-line controls. Document and report findings, identify risks and control gaps, support examinations and regulatory change assessments, and track remediation through follow-up testing.
Manage charge capture and reconciliation, monitor denials and work queues, and support accurate fee schedules and timely claims submission. Analyze revenue-cycle reports and trends to identify missed revenue and process improvements, recommend solutions, and educate administrative staff on billing requirements.
The Senior Customer Service Representative acts as a key communicator for providers, educating customers on programs and resolving service issues. They are responsible for managing claims, authorizations, and IPA functionality while maintaining accurate records in the tracking database.
The Nurse Practitioner will conduct telemedicine assessments, evaluations, and diagnoses for Medicare Advantage members to manage their health needs. They will also document patient information, coordinate with primary care teams, and educate patients on disease processes and medications.
The Medical Director provides leadership and direction for the claims review program, ensuring the quality and effectiveness of medical services. They participate in claim reviews, provider appeals, and the development of clinical criteria while serving as a liaison between the organization and medical providers.
The Nurse Practitioner provides telephonic and telehealth care, managing acute and chronic conditions for patients across various settings. They coordinate care transitions, document clinical encounters, and collaborate with interdisciplinary teams to ensure high-quality, cost-effective outcomes.
Design, develop, and deploy scalable enterprise software solutions with a focus on Generative AI and engineering productivity. Collaborate with cross-functional teams to integrate AI capabilities into enterprise platforms and cloud services to improve operational efficiency.
The role focuses on reducing provider contact rates by analyzing claim data to identify root cause trends and developing remediation action plans. You will collaborate with internal business partners to implement process improvements and maintain project documentation for assigned initiatives.
The Provider Relations Advocate maintains successful working relationships with network providers by resolving concerns, negotiating fees, and ensuring contract compliance. They also manage provider documentation, assist with claims processing, and provide education on service requirements and fee structures.
The supervisor provides clinical and operational leadership to the behavioral health case management team while maintaining a manageable caseload. Responsibilities include staff coaching, documentation audits, care plan development, and ensuring compliance with regulatory and contractual standards.
The Care Coordinator serves as the primary manager for a panel of members with chronic health needs, conducting comprehensive assessments and implementing person-centered care plans. They collaborate with internal teams and community providers to remove obstacles to care and support members' medical, behavioral, and social needs.
The coordinator develops and oversees programs to ensure members receive comprehensive maternal and child health and EPSDT services. They also collaborate with internal teams and community stakeholders to optimize care delivery and ensure regulatory compliance.
The Senior DevOps Engineer will lead the end-to-end release lifecycle and design robust CI/CD pipelines using Azure and Terraform. They will also develop and operationalize AI-driven automation to enhance release engineering, deployment support, and operational workflows.
The registered nurse will assess patients using triage guidelines and software protocols to offer appropriate care options and facilitate referrals. They are responsible for documenting health history, managing inbound calls, and maintaining professional communication with patients and healthcare providers.
The Senior Customer Service Representative will research and resolve healthcare claim calls from providers while navigating multiple computer systems. They will also assist members with benefit, billing, and authorization inquiries to ensure an exceptional service experience.
The role involves performing unit cost and contract valuation analysis to ensure healthcare contracts are priced accurately and fairly. Additionally, the consultant will provide strategic leadership, mentor colleagues, and develop innovative analytical approaches to improve pricing accuracy.
The manager oversees the Clinical Documentation Improvement (CDI) program, including staff training, workflow management, and conducting chart audits to ensure documentation accuracy. They also facilitate physician education and collaborate with healthcare teams to improve clinical documentation quality and compliance.
The role involves developing and maintaining financial models to support Individual and Family Plan (IFP) initiatives and network pricing strategies. The manager will collaborate with cross-functional teams to provide actionable insights and ensure the long-term sustainability of the business.
The Sales Account Manager will interface with the New York Health Plan to drive membership growth for the Essential Plan through strategic business relationships and community outreach. Responsibilities include prospecting new B2B opportunities, conducting product presentations, and managing the enrollment process for eligible members.
The Telephonic Care Navigator conducts outreach to members to educate them on gaps in care, schedule provider appointments, and link them to community resources. They are responsible for maintaining high-quality service standards, meeting performance metrics, and ensuring compliance with HIPAA regulations.
The Clinical Coordinator RN acts as a clinical liaison to manage patient intake, assess referrals, and coordinate infusion therapy services. They ensure continuity of care by communicating with physicians, nursing agencies, and families while maintaining accurate clinical documentation in the EMR.
The therapist will screen, assess, and provide evidence-based treatment for patients with various mental health and substance abuse conditions. They are also responsible for maintaining accurate clinical documentation and monitoring patient treatment responses.
The Financial Counselor ensures reliable cash flow and maximizes revenue collections by screening patients for financial assistance and coverage opportunities. They act as a liaison between departments to manage financial options for procedures and maintain accurate records for outreach programs.
The Telephonic Care Navigator conducts outreach to members to educate them on care gaps, schedule appointments, and connect them with community resources. They are responsible for maintaining accurate health records while meeting quality and performance metrics in a telephonic environment.
Design and develop log collection systems and pipelines for on-premise and cloud environments using tools like LogStash, Kafka, and LogBeats. Monitor and troubleshoot platform alerts while collaborating with security teams to ensure reliable data flow for SIEM and storage.
The Senior Clinical Practice Performance Consultant provides enterprise-level clinical consultation to ensure regulatory alignment, quality, and operational readiness across various health programs. The role leads complex clinical analyses and cross-functional workstreams to develop scalable, audit-ready clinical solutions and governance frameworks.
The Software Engineer will design, develop, and maintain robust ETL pipelines and software applications to drive data standardization across healthcare systems. This role involves optimizing complex SQL queries in Oracle and collaborating with cross-functional teams to translate business requirements into technical deliverables.
The Telephonic Care Navigator conducts outreach to members to educate them on care gaps, schedule appointments, and connect them with community resources. They are responsible for maintaining high-quality service standards while ensuring compliance with HIPAA and internal performance metrics.
Perform complex clinical coding reviews to identify inaccuracies, documentation gaps, and opportunities to improve claim accuracy. Collaborate with internal and external partners to ensure compliance with reimbursement policies and regulatory requirements.
The Telephonic Care Navigator conducts telephonic outreach to members to educate them on care gaps, schedule appointments, and connect them with community resources. They are responsible for maintaining high-quality performance metrics while ensuring compliance with HIPAA and other health regulations.
The Telephonic Care Navigator conducts outreach to members to educate them on care gaps, schedule appointments, and connect them with community resources. They are responsible for maintaining accurate health information records while meeting quality and performance metrics.
Design, develop, and deploy scalable AI/ML models and GenAI applications using Python and Kubernetes infrastructure. You will also evaluate emerging technology trends and maintain rigorous coding standards across all AI/ML pipelines.
The Telephonic Care Navigator conducts outreach to members to educate them on gaps in care and assist with scheduling provider appointments. They also help members address social determinants of health by linking them to community resources while maintaining accurate health records.
Review patient medical records, extract relevant case details, and prepare accurate, well-supported appeal letters using templates, medical literature, and national criteria. Meet quality and productivity expectations while following company policies, HIPAA requirements, and applicable laws, and collaborate with colleagues and clients.
Triage security alerts and DLP events, support users with security issues, investigate suspicious activity, and escalate confirmed or high-risk incidents with clear documentation. Collaborate with IT, compliance, and security teams to identify recurring issues and improve detections, workflows, and automation.
Conduct concurrent and retrospective inpatient chart reviews to improve the accuracy, specificity, and completeness of clinical documentation, and communicate with providers to clarify diagnoses and documentation requirements. Use Optum CDI 3D and approved clarification processes, track follow-through, and collaborate with coding professionals and physician advisors to support compliance and revenue integrity.
Support and develop an end-to-end understanding of the Revenue Manager financial application, including healthcare data integrations, financial processing, validation, reconciliations, controls, and journal-entry output. Analyze complex data issues, deliver SQL-based analytics and scalable reporting solutions, strengthen data quality and operational controls, and partner with business and technology teams to implement reliable improvements.
Lead CDI operations and performance across six hospitals in Arizona and Nevada, overseeing staffing, workflows, quality, budgets, reporting, and compliance. Partner with hospital executives and clinical teams, resolve documentation issues, deliver education, and drive strategic and continuous-improvement initiatives.
Design, build, and deploy secure, scalable AI-powered applications that integrate LLMs, RAG pipelines, and agentic AI architectures. Collaborate with cross-functional teams to modernize legacy systems and automate complex underwriting workflows.
The Senior Software Engineer will design, develop, and support enterprise applications using MuleSoft, Java, and microservices architecture. They will also implement AI-powered solutions and automation tools to streamline claims and provider operations while ensuring system stability.
The Provider Relations Advocate maintains relationships with network providers, resolves operational issues, and negotiates cost-effective service fees. They also manage provider compliance, assist with claims resolution, and educate providers on contractual requirements and fee structures.
The Director of Software Engineering will lead geographically distributed teams to deliver scalable, secure, and innovative technology solutions for healthcare operations. This role involves driving AI-enabled engineering practices, managing operational excellence, and partnering with stakeholders to align technical initiatives with business objectives.
Evaluate and manage patient concerns through telephone and virtual encounters while providing clinical recommendations based on evidence-based guidelines. Facilitate appropriate patient disposition and maintain accurate documentation within the electronic medical record.
The Senior Information Security Risk Auditor will lead internal and external audits while maintaining PCI compliance for the Optum Public Cloud platform. They will partner with engineering and operations teams to automate remediation, evidence collection, and drive continuous security improvements.
The Clinical Appeals RN is responsible for analyzing, reviewing, and evaluating clinical appeals and grievances while acting as a liaison between facilities and providers. They must interpret plan language, coordinate with medical directors, and ensure accurate documentation of clinical determinations.
Design, develop, and deploy scalable AI/ML models and GenAI applications using Python, Kubernetes, and agentic frameworks. Integrate semantic search capabilities and maintain robust inference APIs to address complex healthcare business challenges.
The Utilization Management Nurse reviews patient medical records to extract case details and crafts defensible appeal letters using national criteria guidelines. They must maintain high quality and productivity standards while collaborating with internal teams and clients to support health optimization goals.
The Clinical Administrative Coordinator is responsible for scheduling patient appointments, verifying insurance information, and managing patient charts within the Epic EMR system. They also facilitate care by coordinating referrals, responding to patient inquiries, and connecting patients with necessary community resources.
The Senior Technical Product Manager will oversee team-level execution, product backlogs, and sprint delivery while leveraging AI tools to expedite development. They will also manage project budgets, lead stakeholder intake discussions, and ensure high-quality software delivery aligned with business strategy.
Lead complex payer technology consulting engagements, including solution architecture, delivery execution, stakeholder alignment, and client communications. Develop high-quality client deliverables, coach consulting teams, manage project economics and quality, and contribute to business development and reusable practice capabilities.
Support providers with claims and issue resolution, improve call quality and physician portal usability, and help develop programs that strengthen relationships between the health plan, providers, and practice managers. Support provider network development, deliver provider education, and identify gaps in network composition and services.
Provide telephonic and virtual care to members, caregivers, and facility staff, including assessment and management of acute, chronic, and behavioral health needs. Coordinate transitions and care plans, document encounters and quality measures, and collaborate with patients, families, providers, and care teams.
Lead and coordinate the claims review program, reviewing surgical and other professional claims for coding accuracy and supporting initial reviewers. Discuss cases with treating providers, participate in appeals and performance reviews, prepare clinical rationales when needed, and support compliance with applicable regulatory standards.
Conduct clinical coverage reviews and make benefit determinations based on member plan benefits, coverage policies, and medical necessity. Document review outcomes, communicate with providers and internal partners, participate in clinical rounds, and support quality and cost-effective care.
Lead end-to-end production and formatting of complex Medicaid proposals, ensuring printed and digital submissions meet RFP requirements, quality standards, and deadlines. Coordinate internal teams and external vendors, delegate production tasks, and improve processes, tools, and resources, including through the use of AI.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
Lead a high-volume pharmacy prior authorization operation, managing leaders and a workforce of more than 100 pharmacists and technicians while owning operational, quality, compliance, and financial performance. Improve end-to-end processes and technology adoption, manage escalations and regulatory readiness, and partner with clinical, client, compliance, and technology teams.
Provide customer service to patients by resolving billing questions, outstanding balances, complaints, and payment plans accurately and in accordance with department policies. Collaborate with peers and management, meet quality and productivity standards, and support team and financial performance goals.
The role involves designing and maintaining cloud-native microservices while driving scalability and interoperability across the healthcare ecosystem. You will also lead technical collaboration across teams and leverage AI-assisted tools to enhance engineering productivity and code quality.
Develop and implement solutions to automate and streamline workflows for the Security Operations Center. Coordinate development across multiple projects and maintain in-house security products.
The Senior Software Engineer will design, develop, and modernize scalable enterprise applications and cloud-native microservices within an Agile environment. They will also leverage AI-powered tools to enhance engineering productivity and ensure the high availability of mission-critical healthcare transaction systems.
The resident will participate in a primary care pathways program involving 1-3 hours of commitment per month to learn value-based care models. They will receive mentorship from experienced physicians to facilitate a smooth transition from residency into a post-residency career at Atrius Health.
The medical coder will identify and assign appropriate ICD-10, CPT, and modifier codes for emergency department facility services. They are responsible for maintaining high levels of coding quality and productivity while adhering to official coding guidelines and ethical standards.
The consultant will serve as a clinical domain expert for Radiology, providing comprehensive clinical support, product demonstrations, and strategic sales assistance. They will also collaborate with product management and R&D to document workflows and provide insights based on customer interactions.
The Manager, 340B Solutions serves as a consultant to ensure client compliance with 340B program requirements and oversees 340B Referral Capture services. They are responsible for analyzing data, conducting self-audits, and providing training to client staff regarding 340B oversight processes.
Drive growth and manage relationships with strategic pharmaceutical clients in the mid-market segment. Collaborate with internal teams to deliver solutions including real-world data, clinical trial research, and epidemiology analytics.
The representative is responsible for processing behavioral health provider applications and re-applications, including data entry and tracking. They also conduct audits to ensure accuracy and act as a technical resource to resolve complex problems within the team.
The Patient Access Center Supervisor provides leadership, coaching, and development to a team of Health Service Representatives while monitoring performance metrics. They also partner with Workforce Management to optimize resource planning and serve as an escalation point for clinic staff and providers.
Drive growth and manage strategic relationships with top pharmaceutical clients by selling real-world data and clinical research solutions. Partner with internal consulting and delivery teams to ensure successful execution of client initiatives and strategic objectives.
The Specialty Operations & Strategy Lead is responsible for overseeing specialty pharmacy operations, pricing, and financial performance for HealthTrust. This role drives cross-functional initiatives and provides strategic guidance to ensure clinical value and competitive service delivery.
The Principal Quality Engineer will lead the integration and end-to-end quality strategy for complex Enterprise Imaging solutions. This role involves defining automation standards, mentoring engineers, and managing quality engagements with external partners to ensure clinical outcomes.
The clinician will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatments like CBT and DBT. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment progress.
The clinician will evaluate and manage patient concerns through telephone and virtual encounters while facilitating appropriate care dispositions. They are also responsible for documenting interactions in the electronic medical record and collaborating with the clinical team to support departmental workflow.
Provide telephonic and telehealth clinical care, direction, and coordination for patients across various settings. Manage acute and chronic conditions while collaborating with an interdisciplinary team to ensure high-quality, cost-effective care.
The National Provider Relations Advocate manages provider relations, including claims resolution, portal support, and provider education programs. They are responsible for network retention, identifying operational shortfalls, and ensuring provider compliance through regular outreach and data analysis.
The analyst determines the accuracy of provider claims by comparing them against medical records and state/government compliance guidelines. They are responsible for identifying aberrant billing patterns, managing daily case reviews, and providing clinical expertise for pre-payment claims.
Assign accurate diagnostic and procedure codes for Primary Care and Family Medicine services while ensuring timely processing of work queues. Generate coding queries for physician documentation clarification and maintain compliance with evolving coding conventions.
Design, develop, and maintain scalable, secure, and high-performance cloud-based enterprise applications using .NET, Angular, and Azure technologies. Collaborate with cross-functional teams to translate business requirements into technical solutions while contributing to AI integration and engineering best practices.
The Senior Software Engineer will lead end-to-end SDLC activities for mission-critical healthcare applications using Java, Spring Boot, and cloud architectures. They will collaborate with cross-functional teams to modernize applications, implement technical solutions, and mentor junior engineers.
The Registered Nurse provides comprehensive, person-centered diabetes education and self-management support via telehealth to improve patient outcomes. They collaborate with an interprofessional team to develop individualized care plans and document all patient interactions in the Electronic Health Record.
The Patient Service Representative screens incoming patient inquiries and resolves issues related to patient satisfaction, flow, and compliance. They also manage administrative tasks such as medication renewals, referrals, and updating patient records.
Manage and grow assigned client relationships within the national employer segment to drive revenue and product expansion. Lead the full sales life cycle, including RFP processes and renewal negotiations, while collaborating across a matrixed organization.
Conduct telehealth-based psychiatric evaluations and provide evidence-based pharmacologic and non-pharmacologic interventions for patients with complex behavioral health needs. Act as a behavioral health consultant within an interdisciplinary care team to support care planning, triage, and continuity of care.
The Field Care Coordinator manages a panel of members by conducting comprehensive needs assessments and developing person-centered care plans. They collaborate with internal teams and community providers to support member health, facilitate care transitions, and promote self-management.
Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of hospital billing and identify potential overpayments. Compose clear, accurate rationales for audit findings while maintaining compliance with ICD-10 guidelines and reimbursement trends.
Conduct telehealth-based psychiatric evaluations and provide evidence-based pharmacologic and non-pharmacologic interventions for patients with complex behavioral health needs. Collaborate with an interdisciplinary care team to ensure effective care coordination, treatment planning, and connection to community resources.
Manage high-volume inbound and outbound calls to process prior authorization requests for formulary and non-formulary medications. Research benefit information, verify clinical data, and document all interactions while adhering to regulatory and service level standards.
The Lead Technical Product Manager will drive AI-enabled solutions and digital transformation initiatives across the Indiana Health Plan. This role involves partnering with leadership to align technology roadmaps with Medicaid and Medicare market needs while ensuring operational excellence and regulatory compliance.
The Practitioner Recruitment Coordinator is responsible for recruiting, screening, and onboarding healthcare practitioners to maintain a quality provider network. They will manage job advertisements, communicate with subcontracted professionals, and ensure compliance with network needs.
The Registered Nurse will manage patient care within the Gastroenterology department by utilizing the nursing process and coordinating with the clinical team. Responsibilities include assessing patient symptoms, providing clinical guidance, and maintaining accurate electronic medical record workflows.
The Care Coordinator applies clinical knowledge to manage the care needs of medically complex members, ensuring appropriate access to services and providers. They conduct assessments, develop individualized care plans, and collaborate with the care team to improve health outcomes and service delivery.
The Clinical Practice Consultant will strategically develop partnerships and education plans to improve quality scores based on HEDIS, NCQA, and state measures. This role involves ongoing management of provider practices, clinical documentation review, and reporting on key metrics to ensure compliance and performance standards.
The role involves leading complex, cross-functional cybersecurity due diligence programs for mergers and acquisitions. You will translate technical security insights into executive-level risk recommendations and establish governance frameworks to support strategic decision-making.
The Community Health Worker serves as a link between the health plan, providers, and members to improve health outcomes and close gaps in care. They conduct proactive outreach, facilitate access to community resources, and support members in navigating the healthcare system.
Coordinate clinical and psychosocial care for medically complex members through assessments, individualized care plans, education, referrals, and advocacy across care settings. Monitor service delivery and hospital encounters, document care in health plan systems, collaborate with interdisciplinary teams, and support quality improvement and smooth transitions of care.
Assess members’ needs, develop individualized care plans, coordinate services across the continuum of care, and connect members with social, financial, and community resources. Serve as a single point of contact, communicate health-related information to stakeholders, and advocate for members and families through frequent field visits.
Coordinate individualized care for medically complex Medicare and Medicaid members through assessments, care planning, education, referrals, and advocacy. Monitor service utilization and hospital encounters, document care activities, collaborate with care teams and providers, and support quality improvement and smooth care transitions.
The Strategic Account Executive is responsible for developing and executing commercial plans to drive growth and manage relationships with key provider clients. They lead matrixed teams to deliver Optum solutions, ensure service commitments are met, and negotiate renewals while driving client satisfaction.
The Senior Account Executive serves as the primary point of contact for strategic provider clients, developing and executing commercial plans to drive profitable growth. They lead matrixed teams to deliver Optum solutions, manage contract renewals, and ensure high levels of client satisfaction and revenue growth.
The Senior Manager will lead revenue cycle performance improvement initiatives, including denial management, financial analysis, and operational standardization across health system partnerships. They will act as a subject matter expert to drive efficiency, resolve reimbursement barriers, and implement technology-driven solutions to optimize net revenue.
Serve as an L1.5 subject matter expert for enterprise security, gateway infrastructure, and data privacy issues within a 24/7 call center environment. Troubleshoot complex technical escalations, manage ticket queues, and triage privacy incidents while maintaining strict compliance with standard operating procedures.
Design, deploy, and operate secure, scalable, highly available Azure infrastructure, including infrastructure supporting Epic EHR workloads, using Terraform and CI/CD automation. Improve monitoring, security, reliability, performance, and cost efficiency while resolving complex issues and collaborating with engineering teams and mentoring junior engineers.
The Care Coordinator serves as the primary care manager for members with chronic and complex health needs, conducting assessments and developing individualized care plans. They collaborate with internal teams and community providers to implement these plans, remove barriers to care, and support transitions between care settings.
The Medical Coding Auditor determines the accuracy of claims by comparing them to medical records and identifying potential waste, error, or fraud. They are responsible for managing a caseload, providing clinical narratives, and ensuring compliance with state and federal regulations.
The Licensed Psychologist evaluates requests for initial and continued coverage of ABA treatment and assessment services. They conduct peer-to-peer consultations and issue clinical determinations based on medical necessity and benefit-plan requirements.
The Strategic Account Executive manages ongoing client relationships, service delivery, and contract renewals for an assigned book of business. They act as a client-centric advocate, coordinating with internal functional areas to implement benefits and address service needs.
Physicians are responsible for examining adult patients, diagnosing medical conditions, and providing treatment plans. They also manage patient in-baskets, coordinate follow-up care, and have the option to provide virtual medical services.
The role involves reviewing medical records and clinical documents to identify medication discrepancies and coordinate care under the supervision of a pharmacist. Responsibilities also include conducting outbound calls to members and providers to update medication lists and follow up on clinical recommendations.
The Lead Data Scientist will design and implement ML models, RAG pipelines, and agentic workflows using Databricks and Generative AI. They will partner with cross-functional teams to integrate AI-driven intelligence into enterprise applications while optimizing pipelines for performance and scalability.
The Medical Director conducts clinical coverage reviews and medical necessity determinations to ensure cost-effective, quality care for members. They collaborate with multidisciplinary teams and providers to manage medical benefits and facilitate clinical operational processes.
Design, develop, and maintain enterprise-grade applications using C#, .NET Core, and Azure cloud services. Collaborate with cross-functional teams to build scalable microservices and implement CI/CD pipelines while utilizing AI-assisted development tools.
The Strategic Account Executive is responsible for developing and executing strategic plans to drive profitable growth and manage key provider client relationships. They lead matrixed teams to deliver Optum solutions, negotiate contracts, and ensure client satisfaction through consultative engagement.
The Field Case Manager will assess, plan, and implement person-centered strategies while connecting members with essential community and financial resources. They will also coordinate care across the continuum and collaborate with providers and families to improve health outcomes.
The specialist will manage relationships with ABA providers to monitor clinical effectiveness, efficiency, and contractual compliance. They will also analyze clinical and utilization data to implement performance improvement plans and optimize treatment outcomes.
The Business Analyst Consultant will lead the migration of legacy BusinessObjects and Crystal Reports assets to modern platforms like Power BI and SSRS. They will collaborate with stakeholders to document requirements, define data mappings, and ensure the quality and performance of reporting solutions.
The Field Case Manager will assess, plan, and implement person-centered strategies while coordinating care across the continuum. They will serve as a key point of contact and advocate for members and families to ensure their needs are supported.
The Senior Clinical Quality Auditor will conduct treatment record audits and implement corrective action plans for behavioral health providers. They will also collaborate on quality improvement projects and present data-driven recommendations to management.
The Executive Director defines and leads local initiatives to achieve CMS Star ratings, growth, and affordability goals while managing provider and broker relationships. They are responsible for driving cross-organizational alignment and executing new business strategies to meet member needs across the Medicare & Retirement market.
The Plan Pharmacy Director is responsible for setting the strategic direction, operational execution, and financial oversight of pharmacy programs for the UnitedHealthcare Community Plan of Washington. This role serves as the primary subject matter expert and point of contact for internal and external stakeholders regarding pharmacy benefits, compliance, and affordability initiatives.
Lead a large engineering organization to design, deploy, and scale responsible AI-powered solutions that drive digital transformation. Manage team performance, talent development, and cross-functional collaboration to ensure high-impact, reliable technology delivery.
The Senior Principal AI/ML Engineer will drive the architectural vision and hands-on delivery of scalable AI/ML solutions and cloud-native software. They will own complex technical initiatives from experimentation through production while mentoring engineers and influencing technical roadmaps across the organization.
The specialist performs concurrent and retrospective chart reviews to ensure the completeness and accuracy of clinical documentation. They also collaborate with providers and interfacing departments to clarify documentation requirements and resolve coding issues.
The Chief Medical Officer is responsible for clinical vision, quality oversight, and population health management across federal and commercial programs. This role involves leading clinical innovation, driving growth strategies, and collaborating with executive leadership to ensure high-quality healthcare delivery.
The Field Care Coordinator facilitates patient care by conducting in-depth assessments and developing person-centered care plans in collaboration with an interdisciplinary team. They act as a liaison between the health plan, enrollees, and their families while managing care transitions and promoting member self-sufficiency.
The role involves developing and validating AI methodologies, designing testing protocols, and ensuring responsible AI practices within healthcare applications. You will collaborate with cross-functional teams to document findings, automate testing processes, and provide mentorship to colleagues.
The Sr. Clinical Product Lead will partner with product and engineering teams to design, build, and deploy AI-enabled clinical products that are safe and clinically useful. This role involves leading clinical engagement, defining safety criteria, and ensuring products meet quality outcomes across local market teams.
The professional will identify appropriate CPT-4 codes and modifiers for inpatient hospitalist and intensivist services. They will also abstract data during chart reviews and provide documentation feedback to providers.
The Care Coordinator serves as the primary care manager for members with chronic and complex health needs, conducting assessments and developing person-centered care plans. They collaborate with internal teams and community providers to implement interventions, remove obstacles to care, and support transitions between health settings.
The Vice President will lead strategic client relationships with health plans, driving growth, retention, and financial performance while serving as a trusted advisor to C-suite executives. They will oversee contract execution, manage P&L performance, and lead a high-performing team to deliver innovative pharmacy benefit solutions.
The radiologist will perform general radiology duties including radiography, fluoroscopy, and procedures while interpreting ultrasound and body CT scans. The role involves working within a 30+ radiologist group with potential rotations to satellite clinics.
The Executive Director is accountable for all P&L aspects within the Texas market, focusing on Medicare Advantage growth, provider network development, and achieving CMS Star rating goals. They act as the primary market strategist, collaborating with cross-functional teams to drive clinical quality, affordability, and member retention.
The Senior Technical Project Manager will lead high-priority security and technology initiatives within the Enterprise Security & Resilience Office. This role involves managing complex technical projects end-to-end, ensuring disciplined execution, and coordinating across cross-functional teams.
The Client Executive is responsible for new business development and managing a book of strategic accounts within the Public Sector and Labor & Trust segments. They will drive growth, retention, and profitability by executing client-specific business plans and fostering strong stakeholder relationships.
The Charge Capture Coding Analyst supports accurate coding, billing compliance, and revenue integrity for Cardiac Catheterization and Interventional Radiology services. The role involves analyzing clinical documentation, performing audits, and partnering with cross-functional teams to implement solutions that enhance billing accuracy and revenue performance.
The Senior Care Advocate manages psychiatric and chemical dependency treatment authorizations and supports the Utilization Management team with clinical documentation and data entry. This role also involves coordinating benefits, consulting with providers, and assisting leadership with team training and project support.
The Clinical Coordinator will assess, plan, and implement person-centered strategies while connecting members with essential community and financial resources. They will also coordinate care across the continuum and serve as a primary advocate for members and their families.
The medical coder will assign accurate diagnostic and procedure codes for cardiology and electrophysiology services based on clinical documentation. They are also responsible for monitoring work queues, generating coding queries for physician clarification, and staying updated on coding conventions.
The Senior Credentialing Representative is responsible for enrolling behavioral health providers with payers and managing the full credentialing lifecycle. They also conduct quality audits, provide team coaching, and ensure compliance with NCQA and CMS standards.
The Support Coordinator manages a panel of members with intellectual or developmental disabilities by conducting comprehensive needs assessments and developing person-centered care plans. They collaborate with internal teams and community providers to implement these plans and ensure members receive appropriate medical, behavioral, and socioeconomic support.
The Licensed Clinical Social Worker will assess and treat patients for mental health and substance abuse disorders using evidence-based methods like CBT and DBT. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment progress.
The Licensed Clinical Social Worker will screen and assess patients for mental health and substance abuse disorders while providing evidence-based psychotherapy. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment responses.
The Systems Analyst IV leads major incident response, defines system stability practices, and architects complex configuration solutions. They also drive modernization initiatives, implement advanced monitoring, and mentor team members to ensure operational excellence.
The Full Stack Engineer will design, develop, and maintain full-stack applications using ReactJS, Java-based microservices, and GraphQL. They will also architect solutions leveraging Azure cloud services and Kubernetes while collaborating with cross-functional teams in an agile environment.
Design and deliver robust, scalable technology architecture solutions that align business objectives with enterprise technology standards. Lead architectural planning, mentor engineering teams, and deploy AI-powered solutions to drive automation and process improvements.
Conduct comprehensive in-home health assessments for Medicare Advantage and other plan members to identify diagnoses and address care gaps. Educate patients on disease processes and medications while collaborating with primary care providers to improve health outcomes.
Conduct thorough mental health compensation and pension evaluations for veterans and active duty military members. Collaborate with multidisciplinary teams and provide medical opinions in accordance with VA guidelines.
The Behavioral Health Program Manager facilitates and coaches clinical practices to implement quality improvement strategies and redesign efforts to enhance patient outcomes and office efficiency. They are responsible for the development and administration of behavioral health clinical quality programs while collaborating with internal and external stakeholders.
The Director of Network Programs will lead the strategy, design, and rollout of an enterprise-wide Provider Data Management Platform. This role involves managing cross-functional teams, driving product vision, and ensuring seamless integration with downstream applications.
The Care Coordinator serves as the primary manager for members with chronic and complex health needs, conducting comprehensive assessments and developing individualized care plans. They collaborate with internal teams and community providers to implement these plans, facilitate referrals, and support transitions of care.
The Supervisor coordinates and oversees the daily activities of ambulatory coding staff to ensure productivity, quality, and turnaround expectations are met. They also set team priorities, resolve operational issues, and ensure work aligns with established policies and revenue cycle performance goals.
The Care Coordinator serves as the primary manager for a panel of members with chronic health needs, conducting comprehensive assessments and implementing person-centered care plans. They collaborate with internal teams and community providers to remove barriers to care and support members in achieving improved health outcomes.
The radiologist will perform general radiology duties including radiography, fluoroscopy, and the interpretation of ultrasound and body CT scans. The role involves working within a multi-specialty group with potential rotations between the main campus and satellite clinics.
The Coder II is responsible for assigning accurate diagnostic and procedural codes to patient health records to support data retrieval and claims processing. They also provide documentation feedback to providers and ensure coding meets established quality and performance standards.
The consultant supports and validates provider network contracting and unit cost management activities through financial modeling and analysis. They also conduct contract valuation analysis to support negotiations and develop pricing strategies.
The Network Pricing Consultant will support and validate provider network contracting and unit cost management through financial modeling, analysis, and reporting. They will collaborate with local network leaders to develop pricing strategies and evaluate the financial impact of provider contracts and corporate initiatives.
This role provides oversight to Optum360 coding services, managing facility-based and HIM operations leadership within an assigned region. The analyst drives quality initiatives, monitors performance metrics, and collaborates with CDI and quality teams to ensure coding accuracy and compliance.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatment. They are also responsible for maintaining accurate electronic medical records and collaborating with the team to ensure high-quality patient care.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatment. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment progress.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatment. They are also responsible for maintaining accurate electronic medical records and monitoring patient clinical progress.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatments like CBT and DBT. They are also responsible for maintaining accurate electronic medical records and monitoring patient clinical progress.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatments like CBT and DBT. They are also responsible for maintaining accurate electronic medical records and monitoring patient clinical progress.
The Account Manager will drive membership growth by building strategic relationships with key sales influencers and community institutions in New York. They are responsible for prospecting, enrolling eligible members in the Essential Plan, and conducting product presentations in various settings.
The Account Manager will build strategic business relationships and drive membership growth for the Essential Plan by prospecting new B2B opportunities. They are responsible for conducting product presentations, managing sales pipelines, and providing excellent enrollment services to potential members.
The Account Manager will drive membership growth for the Essential Plan by building strategic relationships with key market influencers and community institutions. They are responsible for conducting sales presentations, managing pipelines, and enrolling eligible members within their assigned territory.
Conduct telephonic or face-to-face holistic evaluations to identify and manage member needs across physical, behavioral, and social services. Develop and implement individualized care plans while collaborating with families and healthcare providers to ensure quality, cost-effective care.
The clinician will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatments like CBT and DBT. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment responses.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatments like CBT and DBT. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment progress.
Design, develop, and maintain Amazon Connect and supporting AWS services while partnering with cross-functional leaders to align platform capabilities. You will also drive innovation through the implementation of GenAI and AI/ML capabilities while managing network and voice system operations.
The role involves conducting physician chart audits and translating medical diagnoses and procedures into designated numerical codes. Additionally, the coder will assist with billing policy implementation and provide formal training to clinical staff.
The role involves performing medical coding and auditing services by translating clinical diagnoses and procedures into numerical codes. Additionally, the coder will conduct physician chart audits and assist in training clinical staff on billing policies and coding guidelines.
The Associate Director leads the evaluation, governance, and optimization of clinical supplemental data sources to ensure compliance with HEDIS and regulatory requirements. This role manages a team to drive process improvements, audit readiness, and strategic data integrations across the enterprise.
The Clinical Coordinator will assess, plan, and implement person-centered strategies while connecting members with essential community and state resources. They will also serve as a key point of contact, advocating for members and collaborating with providers to improve health outcomes.
The role involves assessing and implementing person-centered care strategies while connecting members with essential community and financial resources. You will also collaborate with providers and caregivers to advocate for member needs and improve overall health outcomes.
The Clinical Coordinator will assess, plan, and implement person-centered strategies while connecting members with essential community and state resources. They will also coordinate care across the continuum and advocate for members to ensure their health needs and preferences are met.
The Clinical Coordinator will assess, plan, and implement person-centered strategies while connecting members with essential community and state resources. They will also serve as a key point of contact to advocate for members and collaborate with providers to improve health outcomes.
The Clinical Coordinator will assess, plan, and implement person-centered strategies while connecting members with essential community and financial resources. They will also coordinate care across the continuum and advocate for members to ensure their health needs and preferences are met.
The Associate Patient Care Coordinator is responsible for pre-registering patients by accurately updating demographic and insurance information. They also facilitate financial clearance by verifying benefits and collecting patient liabilities prior to the date of service.
The radiologist will perform general radiology duties including radiography, fluoroscopy, and interpretation of ultrasound and body CT scans. The role involves working within a 30+ radiologist group with potential rotations to satellite clinics.
The consultant is responsible for developing clinical partnerships to improve HEDIS quality scores and state-specific quality measures. They will conduct medical record audits, provide provider education on documentation and coding, and monitor performance metrics to ensure compliance with NCQA standards.
The Clinical Program Manager facilitates and coaches clinical practices in quality improvement strategies to enhance patient outcomes and operational efficiency. They are responsible for the development and administration of clinical quality programs while collaborating with internal and external stakeholders to meet organizational goals.
Design, build, and maintain scalable backend services and AI-powered solutions using Java, Python, and microservices architecture. Collaborate cross-functionally to ensure production readiness, performance, and the responsible use of AI in health-focused applications.
Manage and maintain assigned client relationships to ensure the delivery of OptumHealth solutions and drive revenue growth. Lead the entire sales life cycle, including RFP processes and proactive renewals, while collaborating with internal stakeholders to improve client satisfaction.
The Field Case Manager will assess, plan, and implement person-centered strategies while coordinating care across the continuum. They will serve as a key point of contact and advocate for members and families to ensure their needs and preferences are met.
The Clinical Coordinator will assess, plan, and implement individualized care strategies while serving as a single point of contact for patients. They are responsible for managing care plans across the continuum and advocating for patient needs within the community.
The role involves applying clinical knowledge to coordinate member transitions between residential and community settings while providing intensive medical and psychosocial support. You will collaborate with care teams to develop individualized care plans, monitor health risks, and ensure appropriate utilization of health benefits.
The Medical Director conducts clinical coverage reviews and renders medical necessity determinations based on benefit plans and national policies. They collaborate with multidisciplinary teams and providers to ensure the delivery of cost-effective, high-quality care while managing utilization activities.
The Clinical Coordinator will assess, plan, and implement person-centered strategies while connecting members with essential community and financial resources. They will also coordinate care across the continuum and collaborate with providers and caregivers to improve health outcomes.
The software engineer will design, code, test, and debug applications while collaborating with stakeholders to refine requirements into technical solutions. They are also responsible for operational excellence, including building, deploying, and monitoring production services while mentoring junior team members.
The Account Manager will drive membership growth for the Essential Plan by building strategic relationships with community influencers and potential customers. They are responsible for conducting sales presentations, managing the sales pipeline, and providing excellent service to members throughout the enrollment process.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
The Clinical Coordinator assesses, plans, and implements individualized care strategies while serving as a single point of contact for patients. They also manage care plans across the continuum and advocate for patient needs to ensure quality coordinated services.
The Clinical Claim Review Nurse performs clinical reviews of professional or facility claims against medical records to verify correct coding and charges. They are responsible for documenting findings, ensuring adherence to state and federal compliance policies, and providing clinical logic for claims and appeals.
The Clinical Coordinator will assess, plan, and implement person-centered strategies while connecting members with essential community and financial resources. They will also coordinate care across the continuum and collaborate with providers and caregivers to improve health outcomes.
The Clinical Coordinator will assess, plan, and implement person-centered strategies while connecting members with essential community and financial resources. They will also coordinate care across the continuum and advocate for members to ensure their health needs and preferences are met.
The resident physician will participate in a mentorship program to transition from training into a value-based care model. They will contribute to population health initiatives while providing clinical care to patients.
The Senior Provider Engagement Specialist analyzes provider group performance and develops strategic action plans to improve revenue, quality outcomes, and operational efficiency. They serve as a liaison between the health plan and providers, fostering relationships and implementing business solutions to meet organizational goals.
This role provides strategic leadership for culture, health optimization, and social responsibility initiatives across Missouri and Iowa health plans. The director identifies health disparities and develops innovative solutions to improve access, affordability, and outcomes for Medicaid and DSNP populations.
The Case Manager will visit members in hospitals prior to discharge to facilitate safe transitions and coordinate care resources. They act as an intermediary between providers and members to provide education, medication reviews, and service coordination.
The Behavioral Health Care Advocate conducts telephonic clinical reviews with providers to ensure members receive effective and efficient outpatient care. They assess treatment plans against coverage guidelines to promote best practices in behavioral health services.
The Associate Director will develop and manage programs to optimize behavioral health quality and reduce costs through partnerships with payer accounts and enterprise stakeholders. They are responsible for creating project plans, operational workflows, and analyzing data to drive program performance and clinical outcomes.
The Account Manager will drive membership growth for the Essential Plan by building strategic relationships with key market influencers and community institutions. They are responsible for conducting sales presentations, managing the sales pipeline, and enrolling eligible members within their assigned territory.
The Patient Liaison coordinates services between OptumRx and patients by managing recruitment, retention, and educational activities. They are responsible for developing consumer relationships, conducting workshops, and identifying new business opportunities within the bleeding disorder community.
The role involves supporting sales enablement through tasks such as agent onboarding, training delivery, and workforce management. Responsibilities also include tracking dependency issues, generating schedules, and maintaining business relationships.
The Sales Account Manager is responsible for prospecting and enrolling new members in the Essential Plan through strategic business-to-business relationships and community outreach. They will manage a sales pipeline, conduct product presentations, and track performance metrics within their assigned New York territory.
The Account Manager will drive membership growth for the Essential Plan by building strategic relationships with community influencers and providers. They are responsible for prospecting, conducting product presentations, and enrolling eligible members within their assigned territory.
The provider is responsible for delivering virtual medical care, including patient triage, assessments, and referrals within Optum Serve operations. They must maintain accurate medical records, ensure HIPAA compliance, and provide support in emergent situations while working collaboratively with the healthcare team.
The Account Manager will drive membership growth for the Essential Plan by building strategic relationships with community influencers and business partners. They are responsible for prospecting, enrolling eligible members, and conducting product presentations within their assigned territory.
The Field Care Coordinator facilitates patient independence by conducting comprehensive needs assessments and developing person-centered care plans. They collaborate with interdisciplinary teams and community partners to manage care transitions and ensure the delivery of efficient, cost-effective health services.
The Marketing Specialist supports the development and execution of external marketing communications and patient-facing content across multiple digital and physical channels. They coordinate with cross-functional teams and stakeholders to ensure consistent messaging and effective project management for Optum Massachusetts practices.
Manage inbound and outbound call center communications to support patient case management and coordinate care with pharmacists, sales, and nursing teams. Process prescriptions, verify benefits, and ensure accurate documentation of patient inquiries to achieve resolution.
The Vice President of Pharmacy Services provides strategic, operational, and financial leadership for all pharmacy operations across the clinic enterprise. This role oversees multi-site pharmacy services, drives growth and quality outcomes, and collaborates with executive leadership to develop innovative pharmacy solutions.
The role involves assigning accurate diagnostic and procedure codes for palliative care services while monitoring work queues to ensure timely processing. Additionally, the coder will generate documentation queries and stay updated on evolving coding conventions and regulations.
The specialist coordinates and facilitates internal and external authorizations for medical procedures while ensuring clinical documentation meets insurance carrier requirements. They also manage the denial and appeal process, communicating effectively with physicians, clinical staff, and insurance companies.
The Associate Director leads enterprise pharmacy informatics strategy and delivers technology-enabled solutions to improve medication safety and clinical effectiveness. They oversee the design, configuration, and implementation of EHR tools while partnering with cross-functional stakeholders to drive clinical and business value.
The Plan Pharmacy Director is responsible for setting the strategic direction, operational execution, and financial oversight of the pharmacy program for the UnitedHealthcare Community Plan of Hawaii. This role serves as the primary subject matter expert and point of contact for internal and external stakeholders regarding pharmacy benefits, compliance, and affordability initiatives.
The Senior AI/ML Engineer will lead the design, development, and enterprise deployment of machine learning models and generative AI architectures to improve patient health outcomes. They will collaborate with cross-functional teams to translate complex clinical data into actionable intelligence and streamline healthcare workflows.
The specialist is responsible for improving the quality and accuracy of medical record documentation through collaboration with physicians and coding staff. They conduct concurrent reviews of inpatient admissions to ensure documentation reflects the appropriate level of service, severity of illness, and risk of mortality.
The ERP Systems Analyst is responsible for designing, implementing, and maintaining PeopleSoft HR technology solutions. They also coordinate with technical teams to develop integrations, manage project documentation, and provide training on new HR processes.
The analyst provides qualitative analysis of departmental functions and procedures to improve institutional efficiency and cost-effectiveness. They also coordinate user requirements for automated systems and act as a liaison with data processing personnel.
This role involves the design, configuration, and maintenance of clinical applications, including managing the Epic Master Training Environment. The analyst will also collaborate with technical teams on system upgrades and provide support for clinical documentation and security-related issues.
The position is responsible for analyzing business problems and providing technical solutions through the administration and maintenance of enterprise systems like OnBase, Archibus, and RightFax. The analyst will also lead project meetings, automate business processes, and support system integrations to ensure optimal performance.
The Patient Service Representative screens incoming patient inquiries and resolves issues related to patient satisfaction, flow, and administrative needs. They also facilitate updates to patient records and maintain effective communication with the interdisciplinary team and providers.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including medication reconciliation and physical exams. Collaborate with primary care providers to address care gaps and educate patients on disease processes and social determinants of health.
The Technical Product Owner manages the product backlog for enterprise GRC platforms, translating risk and compliance requirements into actionable user stories. They partner with engineering and vendors to ensure platform stability, scalability, and operational excellence.
The Appeals and Grievances Medical Director is responsible for the clinical review and adjudication of appeals and grievances related to various health plan products. They also communicate with medical directors and network management staff regarding clinical rationales, quality issues, and regulatory responses.
The Data Architect will define and evolve target-state data architecture, standards, and roadmaps while leading the design and implementation of scalable data pipelines. This role also involves mentoring engineering teams and ensuring data quality, security, and performance across cloud-based data platforms.
The Medical Behavioral RN Case Manager acts as a clinical liaison to assess, plan, and coordinate care for high-risk members across various settings. They develop individualized care plans, monitor utilization, and collaborate with interdisciplinary teams to ensure quality and cost-effective health outcomes.
The Peer Support Specialist collaborates with clinical teams to implement care coordination and provide direct support to consumers to stabilize their conditions. They also advocate for consumers, facilitate access to community services, and assist in the development of recovery and crisis plans.
The Sales Executive is responsible for driving business development and selling complex revenue cycle solutions to healthcare providers within a defined territory. This role involves managing the full sales lifecycle, from pipeline development to deal closure, while leveraging AI tools to enhance productivity and client engagement.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatments. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment responses.
The Medical Behavioral RN Case Manager acts as a clinical liaison to assess, plan, and coordinate care for high-risk members across various settings. They are responsible for developing individualized care plans, monitoring utilization, and collaborating with interdisciplinary teams to ensure quality, cost-effective outcomes.
The Sales Implementation Manager leads the opening of new skilled nursing facility accounts and manages the transition process for partners. They act as a bridge between strategy and execution, ensuring project timelines are met while fostering strong, trust-based relationships.
The Network Contract Manager develops and maintains a competitive provider network by negotiating contracts and managing provider relationships. They are responsible for unit cost budgets, financial modeling, and ensuring network compliance with company standards.
The Care Coordinator applies clinical knowledge to manage the care needs of medically complex members, ensuring access to services and providers. They conduct assessments, develop individualized care plans, and collaborate with the care team to improve health outcomes and service efficiency.
Assign accurate diagnostic and procedure codes for Primary Care and Family Medicine services based on clinical documentation. Monitor work queues to ensure timely coding and generate queries for physician documentation clarification.
Design and prioritize end-to-end AI solutions for healthcare provider clients, redesigning clinical, revenue cycle, and administrative workflows with appropriate human oversight. Advise client stakeholders, translate designs into implementation plans and success measures, support deployment and training, and ensure solutions align with responsible AI and governance standards.
The Strategic Client Executive manages a book of National Accounts, focusing on maintenance, growth, and profitability. They develop client-specific business plans and coordinate superior service delivery through strong intercompany relationships.
This role is responsible for securing IBMi servers and applications to prevent unauthorized access and ensuring system integrity. The position also involves managing security reporting, investigating potential breaches, and providing evidence for various regulatory audits.
Design, develop, and deploy AI-powered agentic solutions to address complex business challenges within an enterprise platform. Manage the end-to-end lifecycle of agents, including orchestration, evaluation, and production monitoring.
The RN Assessor performs in-person UAS-NY assessments in members' homes to develop and manage person-centered service plans. They coordinate care strategies, initiate social service referrals, and advocate for members to ensure quality health outcomes.
The consultant will provide oversight and performance evaluation for CMARC/CMHRP programs while building strategic relationships with OB providers and local health departments. They will also analyze data to identify trends and facilitate quality improvement initiatives to ensure contractual and clinical requirements are met.
The therapist will screen and assess patients for mental health and substance use disorders while providing evidence-based psychotherapeutic interventions. They are also responsible for maintaining accurate clinical documentation and tracking patient treatment progress within an integrated care setting.
The Director of Growth & Distribution will lead the development and activation of sales and marketing campaigns for Optum Financial Provider Products. They will identify new growth sources, build strategic partnerships, and collaborate across internal teams to improve provider engagement and product adoption.
The Senior Rebate Audit Analyst facilitates end-to-end management of external client audits focused on rebate administration and billing. They act as a liaison between internal teams and external audit firms to ensure accurate financial reconciliation and timely resolution of audit findings.
The RN Field Clinical Care Coordinator conducts comprehensive needs assessments and implements individualized care strategies for members. They act as a single point of contact to manage care plans and coordinate with internal teams and community resources.
The role involves supporting and validating the lifecycle management of capitation agreements with providers while conducting performance analysis and reporting. You will also interface with senior leadership to manage revenue recovery efforts and create SQL queries to support business needs.
The Integrated Care Coordinator serves as the primary care manager for older adults with complex medical and behavioral health needs. They conduct comprehensive needs assessments, develop person-centered care plans, and collaborate with internal teams and community resources to improve health outcomes.
The Sales Account Manager is responsible for enrolling Medicare beneficiaries into the UnitedHealthcare Institutional Special Needs Plan by managing account strategies and engaging facility personnel. They must document all sales activities to ensure compliance with Medicare Marketing Guidelines while meeting established enrollment targets.
The Care Coordinator applies clinical knowledge to manage the care needs of medically complex members, ensuring access to services and providers. They conduct assessments, develop individualized care plans, and collaborate with multidisciplinary teams to improve health outcomes and service efficiency.
The Sr. Software Engineer will design, develop, and deploy end-to-end data integration solutions for clinical reporting platforms while driving the adoption of AI tools. They are also responsible for providing production support, resolving complex technical issues, and maintaining system availability.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and social determinants of health.
The Care Coordinator applies clinical knowledge to manage the care needs of medically complex members, ensuring access to services and providers. They conduct assessments, develop individualized care plans, and collaborate with the care team to improve health outcomes and reduce hospital encounters.
The Patient Liaison coordinates services between OptumRx and patients by managing recruitment, retention, and educational activities. They are responsible for developing consumer relationships, facilitating patient workshops, and identifying new business opportunities within the bleeding disorders community.
Wellness Coordinators provide care coordination and administrative support to members with behavioral health and substance abuse needs. They act as primary care navigators by identifying gaps in care, addressing social determinants of health, and developing individual care plans.
The Associate Director leads clinical operations for itemized bill reviews, managing staff to achieve productivity and financial objectives. They serve as the primary clinical subject matter expert, influencing product strategy and ensuring compliance with CMS guidelines.
The Senior Clinical Transformation Consultant leads multi-disciplinary practice improvement initiatives to enhance quality, efficiency, and utilization within ACO and value-based programs. They act as the primary clinical point of contact, facilitating meetings and implementing action plans to achieve performance milestones.
Support core accounting activities, including general ledger review, account reconciliations, financial analysis, journal entries, and financial close, while ensuring compliance with GAAP. Assist with projects and business integrations, advise business partners on accounting impacts, prepare audit documentation, and improve operational efficiency.
Lead AI engineering teams in developing AI and large language model applications for clinical platforms, while providing software engineering leadership and mentoring development teams. Partner with stakeholders to deliver projects end to end, and oversee production support, troubleshooting, and deployment activities.
Wellness Coordinators provide care coordination and administrative support to members with behavioral health and substance abuse needs. They act as primary care navigators by screening for gaps in care, developing individual care plans, and connecting members with community resources.
The role involves identifying and extracting relevant clinical data to assign accurate medical codes while ensuring compliance with federal and professional guidelines. Additionally, the position requires performing medical coding audits, mentoring team members, and managing multiple work demands to meet productivity standards.
The Outreach Care Coordinator organizes, collects, and reports health and social information through member home visits and community outreach. They serve as a consultant to care teams, conduct member assessments, and facilitate access to preventive and disease management services.
The Care Coordinator serves as the primary manager for a panel of members with chronic and complex health needs, conducting comprehensive assessments and implementing person-centered care plans. They collaborate with internal teams and community providers to remove obstacles to care and support members in achieving improved health outcomes.
The Care Coordinator serves as the primary manager for members with chronic health needs, conducting assessments and developing person-centered care plans. They collaborate with internal teams and community providers to remove barriers to care and support successful transitions between health settings.
The Home Infusion Nurse provides clinical care and education to patients receiving parenteral medications in home and ambulatory settings. They collaborate with a multi-disciplinary team to manage vascular access, administer medications, and maintain thorough clinical documentation.
The Care Coordinator serves as the primary manager for a panel of members with chronic health needs, conducting comprehensive assessments and developing person-centered care plans. They collaborate with internal teams and community providers to remove barriers to care and support successful transitions for members.
The Territory Leader is responsible for managing and growing a provider market client territory to achieve above-market growth and profitability. They will lead account management teams, drive strategic initiatives, and foster executive-level relationships with C-Suite stakeholders.
The Strategic Account Executive manages ongoing client relationships, service delivery, and contract renewals for an assigned book of business. They act as a client-facing advocate, coordinating with internal functional areas to implement benefits and address service needs.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatments. They are also responsible for maintaining accurate electronic medical records and tracking patient treatment responses.
The Senior Investigator gathers and analyzes data to identify and document fraud, waste, and abuse (FWA) schemes within healthcare claims. They collaborate with clinical consultants, law enforcement, and legal partners to articulate findings and ensure compliance with regulatory standards.
The Senior Investigator gathers and analyzes data to identify and document fraud, waste, and abuse within healthcare claims. They collaborate with clinical consultants, legal teams, and law enforcement to conduct interviews and ensure compliance with regulatory standards.
The RN Clinical Care Coordinator manages a panel of members with complex medical and behavioral needs by conducting comprehensive assessments and developing person-centered care plans. They collaborate with internal teams and community providers to facilitate care transitions, provide health coaching, and advocate for member needs.
Provide accurate inpatient coding services by identifying appropriate ICD-10-CM and PCS codes while adhering to official guidelines. Maintain high standards for documentation, perform chart reviews, and provide feedback to providers to ensure optimal health system outcomes.
The RN Clinical Care Coordinator manages a panel of members with complex medical and behavioral needs by conducting assessments and developing person-centered care plans. They collaborate with internal teams and community resources to provide education, support care transitions, and advocate for member needs.
The Chair provides clinical leadership for the Behavioral Health Division, focusing on aligning clinical activities with access, service, and quality standards. They are responsible for executing organizational goals, managing departmental budgets, and supervising clinical staff to ensure high-quality, patient-centric care.
The role involves accurately determining CPT and ICD-10 edits for professional coding services while ensuring compliance with coding policies. Additionally, the coder will provide documentation feedback to physicians and manage medical necessity and denial accounts.
The Regional Account Manager will develop and execute territory sales plans to achieve targets while coordinating with strategic manufacturing partners. They are responsible for managing medical practice accounts, solving client issues, and maintaining business through consultative sales processes.
You will lead the design, development, and deployment of enterprise-scale data engineering solutions and AI-powered data pipelines. You will also collaborate with cross-functional teams to optimize ETL/ELT architectures and drive data governance across healthcare data sources.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams, medication reconciliation, and point-of-care testing. Collaborate with primary care providers to address care gaps and educate patients on disease processes and social determinants of health.
The ECSA serves as the enterprise technical authority for Epic infrastructure, managing client deployment, interoperability services, and API management. This role focuses on ensuring secure, highly available access to Epic applications while driving technical strategy and system optimization.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatment. They are also responsible for maintaining accurate electronic medical records and monitoring patient progress throughout the treatment journey.
Review provider documentation and medical records to assign accurate diagnosis and procedure codes for cardiology services. Manage coding edits, claim denials, and audit findings while maintaining productivity and quality standards.
The Patient Service Representative screens incoming patient inquiries and resolves issues related to patient satisfaction, flow, and administrative needs. They also facilitate updates to patient records and maintain effective communication across the interdisciplinary team.
The Field Care Coordinator manages a panel of members by conducting comprehensive needs assessments and developing person-centered care plans. They collaborate with internal teams and community resources to support member health, facilitate care transitions, and provide ongoing education and coaching.
The Technical Product Manager will design, deliver, and optimize business applications using the Microsoft Power Platform and Dynamics 365. They will facilitate stakeholder sessions to translate business needs into scalable technical solutions while managing backlogs and production support.
The Care Coordinator applies clinical knowledge to manage care for medically complex members, ensuring access to services and coordinating across the continuum of care. They perform assessments, develop individualized care plans, and collaborate with multidisciplinary teams to improve health outcomes and service efficiency.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
The RN Field Clinical Care Coordinator conducts comprehensive needs assessments and develops individualized care strategies for members. They act as a single point of contact to manage care plans and coordinate with internal teams and community resources.
The Senior Investigator gathers and analyzes data to identify fraud, waste, and abuse (FWA) schemes while maintaining compliance and auditability in case tracking systems. They collaborate with clinical consultants, legal teams, and law enforcement to conduct interviews and articulate investigation findings.
The Sales Account Manager will drive membership growth for the Essential Plan by building strategic relationships with key market influencers and community institutions. Responsibilities include conducting product presentations, managing sales pipelines, and enrolling eligible members within the assigned territory.
The Account Liaison is responsible for creating and tracking patient escalation reports, monitoring prior authorization expirations, and managing clinical tasks. They work closely with sales and operational partners to ensure timely communication and support for the Account Managers in the field.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address gaps in care and educate members on disease processes and health management.
The Senior Associate General Counsel will act as internal antitrust counsel, providing legal guidance on M&A, litigation, and complex business transactions. They will also develop legal strategies, conduct antitrust training, and advise on competition issues across the enterprise.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatment. They are also responsible for maintaining accurate electronic medical records and participating in regular team consultations.
The lead investigator is responsible for triaging, investigating, and resolving potential instances of healthcare fraud and abusive conduct by medical providers. They also perform root-cause analysis, mentor junior investigators, and present case findings to leadership and legal entities.
The clinical reviewer analyzes hospital facility bills and conducts forensic reviews to identify payment adjustments. They also research clinical standards and maintain documentation in compliance with departmental and HIPAA guidelines.
The Associate Director will guide the development of competitive provider networks and manage unit cost performance through financial modeling and pricing analysis. They are responsible for developing market-level strategies and resolving complex operational or technical problems within the network contracting function.
The Community Health Worker will conduct field-based outreach to engage members, provide education on health benefits, and coordinate clinical services. They are responsible for documenting engagement in electronic medical records and identifying community resources to help members overcome barriers to care.
Provide telephonic and telehealth clinical direction to patients, caregivers, and facility staff while managing acute and chronic conditions. Coordinate care transitions and document comprehensive assessments in compliance with CMS regulations.
The role involves managing, optimizing, and maintaining Azure cloud infrastructure while automating deployments using Infrastructure as Code methodologies. Additionally, the engineer will collaborate with security teams to remediate vulnerabilities and develop AI-powered solutions to address complex business challenges.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
The Account Executive serves as the primary relationship owner for State Government clients, managing portfolios and driving growth across Optum's healthcare and technology solutions. They lead multi-year account planning and act as a trusted advisor to senior state officials to ensure client satisfaction and retention.
The Care Manager assesses, plans, and implements individualized care management interventions while serving as a single point of contact for members. They also identify community-based service referrals and advocate for members to ensure their needs are met within the integrated care model.
The analyst determines the accuracy of provider claims by comparing them against medical records and state/government compliance guidelines. They are responsible for identifying aberrant billing patterns, managing caseloads, and providing clinical expertise for pre-payment claim reviews.
The role involves developing scalable data pipelines, microservices, and ETL/ELT solutions within the Azure cloud environment. You will also mentor other engineers and collaborate with stakeholders to implement AI-based solutions and optimize data reliability.
The Pharmacy Audit Analyst conducts onsite and desktop audits to identify discrepant pharmacy claims and ensure compliance with regulatory requirements. They are responsible for gathering documentation, reporting findings to providers, and performing quality control on completed audits.
The Technical Product Manager will own and execute product work for API platform capabilities, including requirements gathering, prioritization, and delivery support. They will lead cross-functional planning with engineering, architecture, and security teams to ensure platform reliability and operational readiness.
The Nurse Practitioner provides telephonic and telehealth care, managing acute and chronic conditions for patients in various settings. They coordinate care across the interdisciplinary team and ensure all clinical encounters are documented in compliance with CMS regulations.
Perform concurrent and retrospective chart reviews to improve clinical documentation completeness and accuracy. Actively communicate with providers to clarify documentation requirements and ensure appropriate diagnosis coding based on severity of illness.
The Medical Director is responsible for the clinical review and adjudication of appeals and grievances for various health plan products. They also communicate with internal medical directors and regulatory bodies to ensure compliance and quality in medical service determinations.
The Community Health Worker assesses, plans, and implements individualized care strategies while managing referrals for social services. They act as a liaison for Medicaid/Medicare members to ensure access to care and address social determinants of health.
The Senior CICS System Programmer will configure, maintain, and optimize CICS environments on IBM z/OS systems across multi-LPAR and Parallel Sysplex architectures. They will also manage CICS regions, troubleshoot stability issues, and contribute to disaster recovery planning and operational automation.
The Senior Medical Coder performs concurrent reviews of coding rules to ensure accurate CPT and E/M coding for maximum reimbursement. They also manage coding edits, resolve denials, and mentor team members to maintain high coding quality standards.
The Patient Service Representative screens incoming patient inquiries and resolves issues related to patient satisfaction, flow, and administrative needs. They also maintain accurate patient records and facilitate effective communication between patients, providers, and the interdisciplinary team.
The medical coder will be responsible for coding ancillary facility encounters such as lab, therapy, and radiology while ensuring documentation supports code selection. They must also resolve facility edits and maintain established quality and productivity standards in a production environment.
The auditor performs outpatient facility coding audits to ensure compliance with ICD-10-CM, CPT, and billing standards while identifying trends and root causes of non-compliance. They also provide quality assurance oversight, conduct independent reviews, and develop educational materials based on audit findings.
The Oracle AI Agent Studio Engineer is responsible for designing, building, and supporting AI-powered solutions within Oracle Fusion Cloud. This role involves partnering with business and technical teams to translate requirements into scalable, secure, and maintainable AI-enabled workflow automations.
The Support Coordinator manages a panel of members with intellectual or developmental disabilities by conducting comprehensive needs assessments and developing person-centered care plans. They collaborate with internal teams and community providers to implement these plans and ensure members receive appropriate medical, behavioral, and socioeconomic support.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and social determinants of health.
Conduct comprehensive in-home health assessments for Medicare Advantage and other plan members to identify and document diagnoses. Educate members on disease processes and medications while collaborating with primary care providers to address gaps in care.
You will design, build, and optimize next-generation cloud contact center solutions while migrating from legacy systems to AWS Connect. This involves architecting complex call routing strategies and maintaining backend integrations using AWS Lambda and various programming languages.
The Senior Investigator is responsible for identifying, investigating, and preventing healthcare fraud, waste, and abuse by analyzing claims data and conducting interviews. They must manage complex cases, maintain accurate documentation, and collaborate with regulatory partners to ensure compliance.
The analyst will maintain and optimize medication records, formularies, and workflows within the Epic Willow system. They will also collaborate with clinical teams to resolve system issues and ensure compliance with regulatory and safety standards.
The Technical Writer will produce tutorials, how-to guides, and release documentation for internal engineering platforms. They will collaborate with engineering teams to ensure technical accuracy and maintain documentation through product updates and user feedback.
Lead the design, development, and deployment of AI-powered solutions and intelligent automation to drive business outcomes. Partner with cross-functional teams to prototype and scale emerging AI technologies while establishing engineering best practices.
Design, develop, and deploy AI-powered solutions and intelligent automation to drive business outcomes and operational efficiency. Collaborate with cross-functional teams to prototype and scale emerging AI technologies while establishing governance and best practices.
The Outpatient Therapist will screen, assess, and provide evidence-based treatment for patients with various mental health and substance abuse conditions. They are also responsible for maintaining accurate clinical documentation and tracking patient treatment progress within an electronic health record system.
The Senior Software Engineer will design, build, and deploy enterprise-scale AI-powered data solutions and automated ETL workflows. They will collaborate with cross-functional teams to optimize cloud database performance and maintain big data infrastructure.
The clinician will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatments like CBT and DBT. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment progress.
Design, develop, and maintain advanced Power BI dashboards while integrating data from Azure and Databricks. Collaborate with stakeholders to translate business requirements into technical solutions and optimize data models for performance.
Provide evidence-based behavioral health treatment for primary care patients with co-occurring medical or substance use conditions. Collaborate with primary care teams and specialists to create and implement comprehensive treatment plans.
Provide behavioral health treatment for primary care patients with co-occurring medical conditions and mild substance use disorders. Collaborate with the behavioral medicine team and primary care providers to create and implement effective treatment plans.
The clinician will screen and assess patients for mental health and substance abuse disorders while providing evidence-based psychotherapy treatments. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment progress.
Develop and maintain complex Quadient Workflow Designer solutions including automation, business rules, and metadata-driven processing. Integrate Quadient solutions with enterprise systems, cloud platforms, and high-volume document production environments.
The Senior Manager will lead the design, implementation, and management of Identity & Access Management (IAM) systems while ensuring compliance with security and privacy regulations. They will also provide technical leadership, mentorship, and guidance to engineering teams to drive organizational efficiency and best practices.
The Medical Director provides leadership and oversight for the claims review program, ensuring the quality and effectiveness of medical services. They act as a liaison between the organization and providers, conducting clinical reviews and participating in appeals and policy development.
The M&R Coding Clinical Investigator determines the accuracy of provider claims by comparing them against medical records and established coding guidelines. They are responsible for identifying aberrant billing patterns, ensuring compliance with state and federal mandates, and providing clinical expertise for pre-payment claim reviews.
The Community Health Worker acts as a liaison for Medicaid members, providing home assessments, social support, and health education. They spend 50-75% of their time in the field engaging with members to ensure access to appropriate care and community resources.
The radiologist will perform general radiology duties including radiography, fluoroscopy, and procedures. They will also be responsible for the interpretation of ultrasound and general body CT scans within a multi-specialty clinic environment.
The role involves accurately determining CPT and ICD-10 codes for various outpatient procedures and ensuring coding assignments meet quality and productivity standards. Additionally, the coder will provide documentation feedback to physicians and analyze medical necessity accounts.
The radiologist will perform general radiology duties including radiography, fluoroscopy, and procedures. They are expected to provide high-quality interpretations of ultrasound and body CT scans within a multi-specialty clinic environment.
The radiologist will perform general radiology duties including radiography, fluoroscopy, and procedures. They are also expected to provide expert interpretation of ultrasound and general body CT scans.
The role involves designing, coding, and maintaining scalable Big Data and cloud solutions while developing analytics rules engines. You will also collaborate with cross-functional teams to build AI/ML models and provide production support for analytic applications.
The Psychiatric Nurse Practitioner will formulate comprehensive treatment plans using evidence-based tools and deliver individual or group psychotherapy. They are also responsible for prescribing and managing psychotropic medications while maintaining accurate electronic medical records.
The role involves configuring, maintaining, and optimizing CICS environments on IBM z/OS systems within a multi-LPAR, Parallel Sysplex infrastructure. You will also diagnose system incidents, support application teams, and contribute to disaster recovery planning and operational resilience.
The pharmacist will review prescription prior authorization requests and oversee the activities of pharmacy technicians and support staff. They will also ensure all pharmacy operations comply with state and federal regulations while providing clinical consultation in a call center environment.
The ED RN Case Manager monitors real-time ADT notifications to provide proactive patient outreach and discharge coordination. They collaborate with hospital teams and outpatient resources to ensure optimal transitions of care and continuity for members.
The role involves identifying and assigning accurate ICD-10 and CPT codes for inpatient and outpatient services while ensuring compliance with coding policies. Additionally, the coder will provide documentation feedback to physicians and maintain high standards of coding quality and productivity.
The Sales Account Manager is responsible for enrolling Medicare beneficiaries into the UnitedHealthcare Institutional Special Needs Plan by generating leads and managing account strategies. They must educate facility personnel and document all sales activities to ensure compliance with Medicare Marketing Guidelines.
Design, develop, and deploy AI-powered healthcare solutions using Java microservices and interoperability standards. Manage event-driven backend components and integrate with cloud infrastructure to drive operational excellence.
The Associate Finance Director will serve as a primary finance business partner to leadership, overseeing financial planning, analysis, and strategic modeling. This role is responsible for managing revenue and profit budgets, driving cost efficiencies, and providing leadership to both domestic and offshore teams.
The Subject Matter Expert oversees Optum360 coding services and facility-based operations to ensure quality metrics, workflow efficiency, and standardization are met. They act as a liaison between clinical stakeholders and coding teams to drive continuous quality improvement and maintain strong client relationships.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
The Senior Inpatient Medical Coder will assign ICD-10-CDM and CPT-4 codes for observation services while ensuring documentation meets high quality and productivity standards. They will also provide feedback to providers and maintain up-to-date coding knowledge through departmental meetings and educational events.
The RN Clinical Care Coordinator manages a panel of members with complex medical and behavioral needs by conducting comprehensive assessments and developing person-centered care plans. They collaborate with internal teams and community partners to support member health, facilitate care transitions, and provide ongoing education.
The Sr. Strategic Account Executive manages assigned client accounts by developing trend management strategies, overseeing contract renewals, and cultivating multi-level relationships. They are responsible for presenting performance reviews, ensuring contract compliance, and providing leadership to client services team members.
The auditor is responsible for planning and executing financial, operational, and compliance audits across the healthcare revenue cycle. They will also identify risks, prepare objective audit reports, and collaborate with leadership to implement corrective actions.
The Clinical Manager provides oversight and direction to service coordination staff while identifying process improvements to ensure accurate delivery of waiver and non-waiver services. They are responsible for managing staff productivity, facilitating training, and ensuring compliance with regulatory standards.
The Medical Coder is responsible for assigning accurate diagnostic and procedural codes to patient health records to ensure data accuracy and claims processing. They also provide coding auditing services and generate queries to clarify physician documentation.
The resident will participate in a primary care pathways program involving 1-3 hours of commitment per month to learn value-based care models. They will receive mentorship from experienced physicians while preparing for a post-residency employment agreement.
The Senior Solution Sales Executive will own business development for the Crimson AI platform across a Southeastern territory, managing the full sales lifecycle from prospecting to agreement. They will build relationships with healthcare decision-makers and coordinate internal teams to deliver measurable business value through clinical analytics solutions.
The Senior Strategic Account Executive manages ongoing contract relationships and service delivery for large, complex client accounts. This role acts as the primary point of contact, driving strategic planning, client retention, and growth initiatives while collaborating across internal teams.
The Market Growth Manager is responsible for building and managing a team of sales agents and strategic partners to achieve assigned sales targets. They will execute outreach and marketing strategies while monitoring market trends to ensure compliance and growth.
The Medical Director provides leadership and oversight for the claims review program, ensuring the quality and effectiveness of medical services. They act as a liaison between the organization and medical providers while participating in clinical reviews, appeals, and policy development.
The Medical Director provides leadership and oversight for the claims review program, ensuring the quality and effectiveness of medical services. They are responsible for conducting surgical claim reviews, participating in provider appeals, and serving as a clinical liaison.
The Network Contract Manager is responsible for negotiating and managing contracts with hospitals, ancillary entities, and other facilities to ensure a competitive and stable provider network. This role involves synthesizing financial data to develop renewal strategies and maintaining strong business relationships with providers across the Mid-Atlantic region.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatment. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment responses.
The medical coder will assign ICD-10-CM, CPT, and HCPCS codes for emergency department services while ensuring documentation supports code selection. They are also responsible for resolving facility edits and supporting charge capture reconciliation to meet quality and productivity standards.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
The Account Manager will interface with the New York Health Plan to drive membership growth through strategic business relationships and community outreach. They are responsible for prospecting new business opportunities, conducting product presentations, and managing the enrollment process for eligible members.
The Coding Consultant investigates and resolves healthcare fraud and abuse by reviewing prepay claims and medical records for payment accuracy. They also provide coding guidance to investigators and facilitate communication with internal and external stakeholders.
The Senior Software Engineer will design and deliver production-grade Agentic and Generative AI platforms integrated with LLMs and MCP servers. They will collaborate with cross-functional teams to build secure, scalable, and automated cloud-based architectures for healthcare applications.
The UX Engineer will design user flows, hi-fi mockups, and prototypes to simplify complex security data while collaborating with cross-functional teams. They are also responsible for conducting usability testing and maintaining design systems to ensure consistent, user-centric experiences.
The Support Coordinator will manage a panel of members with intellectual or developmental disabilities, focusing on their medical, behavioral, and socioeconomic needs. Responsibilities include conducting comprehensive needs assessments and developing person-centered care plans to improve health outcomes and service utilization.
The role involves the end-to-end administration, reliability, performance, and security of PostgreSQL, Oracle, and MySQL databases across on-premises and multi-cloud environments. You will collaborate with engineering and infrastructure teams to drive cloud modernization, automation, and continuous improvement initiatives.
The Quality Engineer will analyze software requirements to create and execute test cases while driving the resolution of product defects. They will also develop and maintain automated test scripts to ensure efficient testing and process integrity.
The Production Support Engineer ensures the stability and operational health of enterprise contact center platforms like Amazon Connect and NICE CXOne. This role involves managing production incidents, performing root cause analysis, and coordinating with vendors to maintain reliable service.
The Physician Assistant or Nurse Practitioner provides virtual medical care, including patient triage, assessments, and referrals within Optum Serve operations. They are responsible for maintaining accurate patient records and ensuring compliance with all regulatory and organizational guidelines.
The Corporate Director of Pharmacy is responsible for planning, organizing, and supervising pharmacy operations at various client hospital sites across the U.S. They also lead special projects, implement new contracts, and ensure compliance with legal and accreditation standards.
The Group Service Associate provides support to members, brokers, and business associates by resolving inquiries regarding eligibility, enrollment, and benefits. They also manage small group renewals by conducting outbound calls, explaining processes, and assisting with plan design changes.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
The role involves monitoring system health, developing performance reporting, and delivering recommendations for system optimization. The analyst will also troubleshoot complex incidents and participate in a 24/7 on-call rotation to ensure system stability.
Perform deep dive performance forensics and code reviews to optimize application CPU usage and runtime. Provide technical support, mentorship, and technology proof of concept support while leveraging AI tools to enhance analysis efficiency.
The medical coder will identify and assign appropriate CPT and ICD-10 codes for outpatient ambulatory observation services while ensuring compliance with coding guidelines. They will also analyze and correct coding edits, abstract data during chart reviews, and provide documentation feedback to providers.
The provider is responsible for delivering virtual medical care, including patient triage, assessments, and referrals within Optum Serve operations. They must maintain accurate clinical records and ensure compliance with all regulatory and organizational policies while working in a remote, non-traditional setting.
The resident will participate in a primary care pathways program involving 1-3 hours of commitment per month to learn value-based care models. They will receive mentorship from experienced physicians while contributing to practice initiatives and population health efforts.
The Sales Account Manager will drive membership growth for the Essential Plan by building strategic relationships with key market influencers and community institutions. They are responsible for prospecting, enrolling new members, and conducting product presentations within their assigned territory.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and social determinants of health.
The coder will identify and assign appropriate CPT and ICD-10 codes for outpatient Acute Interventional Radiology services while maintaining quality and productivity standards. They will also provide documentation feedback to providers and analyze CCI and medical necessity edits.
The Medical Director will lead clinical AI model training, testing, and surveillance, focusing on utilization management and evidence-based clinical criteria. This role serves as the primary clinical authority for guideline interpretation and collaborates with data science and AI teams to modernize clinical programs.
The Nurse Practitioner will conduct comprehensive clinical assessments and provide care to high-risk members in nursing homes and assisted living settings. They will collaborate with interdisciplinary teams to manage chronic conditions and facilitate advanced care planning for patients.
The Senior Account Manager is responsible for the quality and economic performance of physician practices to develop a high-performing provider network. They will analyze data, drive process improvements, and maintain strong relationships with stakeholders to meet quality and cost goals.
The Senior Director will lead strategic planning for the transformation of finance and accounting functions into world-class, real-time systems. They will also drive process re-engineering efforts using AI solutions and lead a team of Six Sigma belts to address large-scale organizational challenges.
The Solutions Sales Executive is responsible for identifying, pursuing, and closing new business opportunities with pharmaceutical manufacturers. This role involves managing the full sales cycle, developing executive relationships, and driving revenue growth through strategic account planning.
The Clinical Compliance Auditor performs compliance reviews of medical and administrative documentation to identify healthcare fraud, waste, and abuse. The role involves conducting site visits, desk audits, and collaborating with a team to present findings to clients.
The technician manages high-volume inbound and outbound calls to process prior authorization requests for medications while ensuring accuracy and compliance. They research benefit information, identify missing data, and route clinical questions to pharmacists to support timely patient care.
The Senior Systems Management Analyst will design, optimize, and maintain patient scheduling and referral workflows by partnering with clinical and operational leadership. They are responsible for managing system builds, template optimization, and utilizing access metrics to improve patient access and care delivery.
The Account Executive serves as the primary relationship owner for assigned State Government clients, managing and growing a portfolio of accounts. They lead multi-year account planning and partner across the enterprise to deliver integrated healthcare and technology solutions aligned with state priorities.
The Practice Performance Manager is responsible for driving clinical relationships and provider performance through data-driven strategies and program implementation. They will lead provider education, manage STARs gap closure, and coordinate internal resources to improve health outcomes and reduce medical costs.
The pharmacist will review, decision, and process prior authorization and appeals requests while ensuring compliance with clinical criteria and regulatory guidelines. They will also collaborate with providers and members to resolve inquiries and maintain accurate documentation of all clinical findings.
The representative provides prompt and courteous customer service to policyowners and agents via phone and email. They are responsible for resolving inquiries, documenting interactions, and recommending products while maintaining compliance with HIPAA guidelines.
The Senior Inpatient Medical Coder will manage acute inpatient hospital claim edits, denials, and coding assignments to ensure data integrity. They will also analyze medical records and provide feedback to providers to improve documentation quality and billing accuracy.
The role involves identifying the appropriate assignment of ICD-10 and DRG codes for facility services while adhering to official coding guidelines. Additionally, the coder will perform chart reviews, abstract data, and query physicians when necessary to ensure coding accuracy and productivity.
The resident physician will participate in a paid mentorship program to gain experience in a value-based care model. They will contribute to population health initiatives and receive guidance from experienced physicians to transition into clinical practice.
Join a large radiologist group to perform general radiology duties including radiography and fluoroscopy. Interpret ultrasound and general body CT scans to provide high-quality patient care.
Join a large radiologist group to perform general radiology duties including radiography and fluoroscopy. Interpret ultrasound and general body CT scans to provide high-quality patient care.
Lead the design, development, and support of industrial automation systems across pharmacy fulfillment centers. Ensure maximum uptime and reliability of robotics and conveyor systems through troubleshooting and continuous improvement.
Conduct reviews on suspicious or potentially fraudulent records using CPT, ICD, and HCPCS guidelines. Document decisions in company systems and coordinate with team members to identify billing and coding trends.
Manage and optimize high-performance compute and zSeries storage environments using IBM Flash Systems and AI tools. Provide 24/7 on-call support, perform capacity planning, and collaborate with platform teams to resolve complex production issues.
Assign appropriate ICD-10, CPT, and modifiers for facility outpatient and same day surgery services. Maintain high levels of coding quality and productivity while adhering to ethical standards and official guidelines.
Deliver remote, measurement-informed behavioral health care using evidence-based treatment models. Coordinate patient care, document session notes, and manage high-risk encounters following company safety protocols.
Deliver remote, measurement-informed behavioral health care using evidence-based treatment models. Monitor participant progress, coordinate care, and maintain strict HIPAA confidentiality standards.
Join a large radiologist group to provide general radiology services, including radiography and fluoroscopy. Perform interpretations of ultrasound and general body CT scans to drive high-quality patient care.
Manage unit cost budgets, financial models, and performance reporting to optimize provider networks. Evaluate and negotiate contracts with hospitals, clinics, and ancillary providers to ensure competitive and stable network access.
The Medical Director conducts clinical coverage reviews and renders determinations based on member plan benefits and medical necessity. They collaborate with multidisciplinary teams and providers to ensure cost-effective, high-quality medical care.
Perform physical therapy treatments and provide exercise instruction and patient education based on an established plan of care. Observe and report patient responses to treatment to supervising physical therapists and coordinate care with the healthcare team.
The Medical Director conducts clinical coverage reviews and renders determinations based on member plan benefits and medical necessity. They collaborate with providers and internal partners to ensure cost-effective, quality medical care for members.
Lead production support and incident response for critical customer-facing applications, focusing on reliability and disaster recovery. Coordinate release activities, security remediation, and cloud platform operations using Kubernetes and GCP.
The Network Director manages provider engagement and adequacy strategies to build positive relationships between the health plan and healthcare providers. This includes overseeing provider experience, managing regulatory reports, and leading a team of provider advocates and coordinators.
Lead the design and development of Splunk SOAR playbooks and custom applications to automate security operations. Partner with SOC and incident response teams to integrate AI-powered solutions and optimize defensive workflows.
Assign appropriate medical codes by utilizing reference materials and applying knowledge of anatomy, physiology, and coding guidelines. Manage multiple work demands to maintain productivity standards and provide guidance during quality audits.
The therapist will screen and assess patients for mental health and substance use disorders using evidence-based approaches. They are responsible for tracking treatment response and maintaining accurate clinical documentation in compliance with regulatory requirements.
Perform administrative reviews of short stay inpatient hospital claims based on Federal, State, and client requirements. Responsible for documenting all determinations and maintaining accurate use of screening criteria.
Assign appropriate ICD-10-CM and ICD-10-PCS codes for inpatient hospital services while ensuring DRG accuracy. Provide documentation feedback to providers and maintain high quality and productivity standards.
Acts as a liaison between coding teams and providers to ensure accurate documentation and coding compliance. Conducts provider audits and delivers targeted education to improve quality standards and revenue opportunities.
Lead a squad of AI/ML engineers to design and deploy production-grade AI solutions, including Generative AI and multi-agent frameworks. Own the technical roadmap and ensure all deliverables meet high standards of quality, compliance, and Responsible AI governance.
Participate in a mentorship program designed to ease the transition from residency to professional practice. Engage in a few hours of monthly commitment to learn about value-based care and population health initiatives.
Assign accurate diagnostic and procedure codes for outpatient hospital professional accounts based on clinical documentation. Monitor work queues to ensure timely charging and generate queries for physician clarification.
Conduct reviews of suspicious or potentially fraudulent records using CPT, ICD, and HCPCS guidelines. Document decisions in company systems and collaborate with team members to identify billing and coding trends.
Lead the design and delivery of end-to-end analytics solutions, from Snowflake data modeling to Power BI dashboards. Transform complex healthcare claims and revenue cycle data into actionable business intelligence and decision-support tools.
Design and develop scalable Power BI dashboards and SQL-based data models to provide actionable healthcare insights. Collaborate with stakeholders to define KPIs and transform complex claims and revenue cycle data into decision-support tools.
Responsible for the clinical review and adjudication of appeals and grievances cases across various health plan products. This includes performing regulatory responses for CMS and Department of Insurance and collaborating with medical directors on decision rationales.
Participate in a customized transition program to learn how to operate within a value-based care model. Engage in mentorship and clinical exposure to primary and specialty care with a commitment of a few hours per month.
Participate in a customized program to transition from residency/fellowship into clinical practice within a value-based care model. Engage in mentorship and gain exposure to primary and specialty care settings with a commitment of a few hours per month.
Participate in a customized pathways program to transition from residency/fellowship into professional practice. Engage in a few hours per month of virtual or on-site exposure to primary and specialty care within a value-based care model.
Participate in a customized program to transition from residency/fellowship into clinical practice. Engage in a few hours per month of virtual or on-site activities focusing on value-based care and population health.
Participate in a customized program to transition from residency/fellowship into clinical practice. Engage in a few hours per month of activity focusing on value-based care and population health initiatives.
Participate in a customized pathways program to transition from residency/fellowship into professional practice. Engage with value-based care models and population health initiatives to improve patient outcomes.
Participate in a customized pathways program to transition from residency into professional practice. Engage with primary and specialty care environments to learn value-based care models and population health initiatives.
Participate in a customized transition program to move from residency/fellowship into clinical practice. Engage with value-based care models and population health initiatives within the Reliant Medical Group.
Participate in a customized pathways program to transition from residency/fellowship into clinical practice. Engage in a value-based care model and population health initiatives while providing specialty care.
Responsible for conducting medical coverage reviews and rendering determinations for musculoskeletal and spine surgery services. The role involves coordinating utilization review activities, ensuring regulatory compliance, and collaborating with healthcare providers.
The Medical Director provides leadership and direction for the claims review program, ensuring the quality and effectiveness of medical services. Responsibilities include reviewing surgical claims for correct coding and conducting telephonic discussions with providers regarding medical necessity.
Oversee performance of end-to-end provider servicing and resolve complex problems. Drive the design and implementation of programs that build positive relationships between the health plan, providers, and practice managers.
