The Medical Director will lead the development of clinical decision support content by translating clinical guidelines into structured logic for EHR-embedded applications. They will also collaborate with cross-functional teams to integrate AI and optimize clinical workflows.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams, medication reconciliation, and evidence-based screenings. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health compliance.
The Behavioral Health Care Advocate manages case coordination and treatment plans for members on SED and Autism waivers. They are responsible for conducting patient assessments, monitoring service plan implementation, and collaborating with community mental health centers.
The Senior Software Engineer will drive the development and delivery of scalable enterprise software and AI-powered applications within the Clinical AI domain. They will collaborate cross-functionally to integrate intelligent capabilities and automate workflows to improve healthcare outcomes.
The role involves managing and evaluating supplemental data sources to support quality improvement programs across Commercial, Medicare, and Medicaid lines of business. Responsibilities include identifying data quality improvements, conducting source verification, and developing reports and dashboards to ensure accurate data exchange.
The Associate Director will lead the development and oversight of strategic network initiatives while analyzing provider network performance to improve operational efficiency. They will collaborate with cross-functional teams to execute client-specific network strategies and provide leadership to program staff.
The Associate Tech Support Analyst will serve as the primary point of contact for customers, responding to time-sensitive support cases and troubleshooting production radiology systems. They are responsible for documenting incidents, managing a ticket backlog, and collaborating with internal teams to ensure timely resolution.
The Advanced Practice Clinician conducts comprehensive patient assessments, including physical exams and medication reconciliation, for high-risk health plan members. They also collaborate with interdisciplinary teams to provide counseling, education, and advanced care planning in various clinical settings.
The Claims Representative manages case workflows by processing medical record submissions and ensuring adherence to HIPAA privacy regulations. They act as a subject matter expert while maintaining professional communication with healthcare providers.
The Appeals Representative is responsible for researching and resolving written complaints from consumers and providers while ensuring accurate categorization. They must determine if clinical review is necessary and document final appeal or grievance determinations using established templates.
The Senior Data Engineer will design, develop, and maintain scalable AI-powered data pipelines and systems to support critical healthcare platforms. Responsibilities include KTLO activities such as production support, system reliability, and the implementation of automation to improve engineering efficiency.
The representative will provide exceptional customer service by resolving inquiries regarding benefits, eligibility, and claims while educating members on health incentives and products. They will also research complex issues across multiple databases and intervene with care providers to assist members with scheduling and other needs.
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 Product Manager will oversee strategic vendor relationships and partnerships to advance health and wellness offerings for the UnitedHealthcare Store and Hub. This role involves managing contract negotiations, monitoring vendor performance, and coordinating cross-functional initiatives to ensure operational readiness and business alignment.
The Software Engineer is responsible for designing, developing, and supporting technology solutions that enhance physical corporate security operations. This includes building AI-powered applications, automation workflows, and integrations for security systems like access control and video surveillance.
The engineer will manage and optimize cloud infrastructure, including architectural modifications and server maintenance. They are also responsible for ensuring security compliance, disaster recovery support, and automating workflows using enterprise AI tools.
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 resident will participate in a pathway program to gain exposure to primary care and population health models within a team-based environment. They will contribute to practice initiatives while completing their final year of residency training.
The Senior Appeals Representative is responsible for researching, analyzing, and resolving clinical or administrative appeal requests while maintaining accurate documentation. They act as a subject matter expert on regulatory guidelines and effectively communicate claim outcomes to members and providers.
The Associate Patient Care Coordinator is responsible for verifying patient insurance, managing registration, and coordinating medical appointments. They also provide patient education and maintain clear communication with providers and patients regarding scheduling changes.
The clinician provides telephonic and telehealth care to patients, coordinating with caregivers and facility staff to manage acute and chronic conditions. They are responsible for comprehensive clinical assessments, documentation in the EMR, and facilitating care transitions across various settings.
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 Utilization Management Nurse performs medical necessity assessments and concurrent reviews to ensure appropriate healthcare service utilization. They collaborate with interdisciplinary teams and payers to manage authorizations, prevent denials, and support effective care coordination.
Design, develop, and operate secure cloud platform services while leading a team of engineers to ensure technical alignment. You will also automate repetitive tasks, manage security controls, and deploy AI-powered solutions to address complex business challenges.
The Director of Data Engineering & AI leads the strategy, architecture, and execution of enterprise data platforms to support analytics, machine learning, and generative AI. This role oversees high-performing engineering teams while driving enterprise-wide data transformation and governance initiatives.
Design, develop, and maintain enterprise-grade applications and microservices across the AI software development lifecycle. Collaborate with cross-functional teams to build scalable, AI-powered solutions and data pipelines using modern cloud-native technologies.
The role involves identifying and extracting relevant clinical data to assign accurate medical codes while maintaining productivity and quality standards. You will also perform medical coding audits, mentor team members, and resolve discrepancies in clinical documentation.
The role involves managing relationships with pharmaceutical manufacturers to negotiate rebate discounts and formulary access for enterprise-wide business. The lead will also oversee financial modeling for rebate optimization and coordinate cross-functional efforts across clinical, legal, and contracting teams.
The consultant is responsible for program implementation and provider performance management, focusing on STARs gap closure and coding accuracy. They will build relationships with care providers to provide strategic recommendations, training, and coaching to improve quality outcomes.
The Senior Software Engineer will drive the integration of engineering practices and AI readiness standards across product teams. They will collaborate with cross-functional teams to build secure, resilient applications and provide technical guidance to improve software development lifecycles.
Lead the end-to-end technical integration of AI-enabled solutions and collaborate cross-functionally to drive automation and workflow intelligence. Design and deliver scalable, high-quality enterprise software while mentoring engineering teams on best practices for AI-assisted development.
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 Care Coordinator manages a panel of members with serious mental illness, conducting health risk assessments and developing individualized service plans. This role involves collaborating with physicians and community stakeholders while performing field-based visits to ensure members receive necessary behavioral and medical services.
The role involves managing and manipulating structured data to build business intelligence tools and conduct trend analysis. You will create models, develop actionable insights, and present recommendations to support health optimization initiatives.
The Quality Clinical Analyst supports quality improvement initiatives, including maternal/child health, behavioral health, and value-based programs. This role manages KPI dashboards, analyzes clinical data, and coordinates provider performance tracking to ensure compliance with state and contractual goals.
Conduct comprehensive in-home health assessments for Medicare Advantage members to identify diagnoses and address gaps in care. Educate patients on disease processes and medications while collaborating with primary care providers to improve health outcomes.
Design, develop, and deploy production-grade AI/ML and Generative AI solutions, including LLM-powered applications and data pipelines. Collaborate with cross-functional teams to implement scalable system designs while ensuring operational excellence and adherence to engineering best practices.
The Senior Contact Center Engineer will lead production support, drive observability, and optimize complex CCaaS platforms. They will manage critical incident resolutions, design monitoring frameworks, and utilize AI tools to automate support tasks.
The role involves designing, deploying, and maintaining Enterprise Privileged Access Management (PAM) tools across hybrid-cloud environments. You will also automate vault operations and partner with cross-functional teams to integrate target systems into the PAM architecture.
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 clinical pharmacist performs medication reconciliation, conducts chart reviews, and manages pharmacy quality initiatives to ensure optimal patient care. They also provide clinical support, handle coverage determinations, and collaborate with healthcare providers to discuss medication therapies.
The Strategic Account Executive serves as the primary relationship leader for assigned clients, responsible for driving growth, retention, and operational performance. They coordinate cross-functional teams to execute strategic roadmaps focused on pharmacy trend management, clinical innovation, and member experience.
The Clinical Program Consultant will identify and execute affordability opportunities for medical drug benefits across the commercial book of business. They will lead cross-functional collaboration between network and pharmacy teams to implement strategies that ensure predictable unit costs and trends.
The Behavioral Health Project Manager coordinates the implementation of behavioral health provider networks to meet client, regulatory, and operational requirements. This role facilitates cross-functional collaboration, manages project plans, and monitors network readiness to ensure successful project outcomes.
The supervisor is responsible for the day-to-day coordination and operational performance of the Referral Navigator Department, including managing home health, DME, and authorization support functions. They provide leadership, coaching, and guidance to staff while maintaining an active production workload to ensure departmental goals and regulatory compliance are met.
The role involves performing financial analysis and modeling to set prescription drug prices and manage unit cost budgets. It also requires partnering with cross-functional teams to oversee client performance management and identify cost improvement strategies.
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.
Manage the end-to-end pharmacy billing cycle, including invoicing, collections, and payment posting. Maintain accurate documentation, generate financial reports, and ensure compliance with billing regulations and confidentiality standards.
The architect will design and deliver scalable technology solutions while bridging the gap between technical and non-technical stakeholders. They will also lead architectural planning, mentor engineering teams, and deploy AI-powered solutions to drive process improvements.
The Director oversees the operational functions of DSNP, IB Dual, and MAP plans, ensuring regulatory compliance and efficient business workflows. They lead cross-functional teams to drive quality initiatives, member satisfaction, and strategic execution across the New York Health Plan.
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.
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 educate stakeholders on coverage policies.
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 Data Engineer will manage, optimize, and modernize critical enterprise database environments including Microsoft SQL Server, Azure SQL, and MongoDB. This role involves ensuring high availability, performance tuning, and driving the adoption of AI-assisted database engineering solutions to improve operational efficiency.
Drive the definition, design, and delivery of AI-powered technology solutions including conversational virtual assistants and proactive engagement strategies. Collaborate with cross-functional teams to manage product backlogs and translate business capabilities into technical requirements.
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 Case Manager RN coordinates patient-centered care across the continuum and develops safe discharge plans in collaboration with the multidisciplinary team. They also facilitate efficient resource utilization, manage length of stay, and ensure continuity of care through effective communication with patients, families, and healthcare staff.
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 Accessibility and Accommodations Officer oversees the organization's compliance program to ensure enrollees have adequate access to services in accordance with MassHealth and CMS requirements. This role involves developing monitoring plans, establishing policies, and collaborating with providers and legal counsel to mitigate compliance risks.
The representative will manage patient inquiries regarding pharmacy benefits, claims, and appointments while maintaining accurate documentation in company systems. They will act as a patient advocate, providing superior customer service and coordinating with clinicians and telehealth nurses to ensure quality care.
The Scheduling Coordinator is responsible for managing clinician schedules, verifying patient insurance, and coordinating appointments to ensure maximum capacity. They must provide a positive patient experience while maintaining high productivity and quality standards in a high-volume call environment.
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 role involves supporting the development of provider networks and managing unit cost budgets through financial modeling and analysis. You will also collaborate with national clinics and hospitals to manage provider data and resolve escalated issues.
The Physician Associate is responsible for the clinical review and adjudication of appeals and grievances in collaboration with a Medical Director. They will perform individual case reviews, interpret benefit coverage, and participate in organizational committees to improve clinical processes.
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 and develop individualized care plans while collaborating with internal teams and community resources.
The RN Call Center Nurse provides moderately complex telephonic nursing assessments, evaluations, and advice to patients using established telehealth protocols. They are responsible for documenting patient interactions, managing work queues, and directing patients to appropriate levels of care.
The Provider Relations Advocate will serve as a liaison to build and nurture positive relationships with network providers while assisting with claims and portal enhancements. They will also contribute to network development by identifying service gaps and implementing educational training programs for providers.
The Registered Dietitian will conduct virtual nutrition education and medical nutrition therapy for members with chronic conditions like Type 2 diabetes. They will collaborate with a multidisciplinary care team to monitor member progress, analyze biometric data, and facilitate behavior change through coaching.
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 complex client onboarding, data interface programs, and enterprise-wide initiatives while managing multi-team dependencies and vendor integrations. Drive operational excellence through process innovation, risk management, and the implementation of automation and performance metrics.
The Senior Observability Engineer will lead the design, automation, and operational excellence of enterprise observability platforms using Dynatrace. This role involves developing Python-based automation, managing CI/CD pipelines, and implementing Observability-as-Code practices across hybrid and multi-cloud environments.
The Sales Account Manager will prospect and enroll new members into health plans while building strategic relationships with community influencers and business partners. They are responsible for meeting enrollment goals, conducting product presentations, and managing a sales pipeline within their assigned territory.
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.
Develop and execute a territory business plan to grow specialty prescription referral volume and achieve revenue goals. Build and maintain trusted relationships with healthcare providers to identify and resolve barriers to therapy access.
The RN Call Center Nurse performs telephonic patient assessments and provides advice based on established clinical protocols. They also manage work queues, document interactions in the telehealth record, and coordinate with pharmacies for prescriptions.
Provide accurate inpatient coding services by identifying appropriate ICD-10-CM and PCS codes while adhering to official guidelines. Maintain high standards of documentation, perform chart reviews, and provide feedback to providers to ensure optimal health system performance.
The Senior Software Engineer will design, develop, and maintain enterprise full-stack applications and microservices while leading cloud migration initiatives to Azure. They will also orchestrate complex data integration workflows and deploy AI-powered solutions to optimize business processes.
The Technical Product Manager will oversee team-level execution, product backlogs, sprint delivery, and project budgets within an engineering environment. They will also partner with cross-functional teams to define scalable features and leverage AI tools to optimize workflows and innovation.
The Senior Technical Product Manager will oversee team-level execution, product backlogs, and sprint delivery while managing budgets and forecasting. They will also lead stakeholder intake discussions and drive the development of AI-powered solutions to meet business and technical needs.
The Senior Customer Service Representative acts as a key communicator for providers, resolving customer concerns regarding claims, authorizations, and IPA functionality. They are responsible for educating customers on programs and services while maintaining accurate records in the tracking database.
The Senior Software Engineer will design, develop, and maintain scalable, high-throughput distributed applications across the full engineering stack. They will collaborate with architects to drive system design, implement DevOps practices, and utilize AI tools to streamline engineering workflows.
The Senior Technical Product Manager will lead the strategy, prioritization, and delivery of technology capabilities for health plan products and benefits. This role involves partnering with cross-functional teams to translate complex business needs into actionable roadmaps and reliable technical solutions.
The Intake Coordinator manages chronic infusion referrals from receipt to scheduling readiness, serving as the central point of contact for patients, providers, and payors. They are responsible for facilitating prior authorizations, gathering clinical documentation, and identifying barriers to ensure timely patient access to therapy.
The Senior Software Engineer will design, build, and maintain high-performance, scalable distributed systems for the UHC Rewards platform. Responsibilities include developing backend microservices, optimizing SQL databases, and leveraging AWS to ensure platform reliability and operational efficiency.
Design, develop, and maintain scalable backend services and REST APIs using .NET and C#. Collaborate with cross-functional teams to deliver resilient technical solutions and provide production support.
Design, develop, and deploy AI-powered quality engineering solutions and automated test frameworks to streamline application validation. Collaborate with cross-functional teams to analyze requirements, identify defect patterns, and ensure optimal functionality of health benefit applications.
The Associate Director of Clinical Compensation manages provider compensation programs, ensuring they are market-competitive, compliant with regulations like Stark Law, and aligned with organizational goals. This role also leads annual planning, payroll administration, and financial reporting to support executive leadership and operations.
Design, build, and maintain scalable full-stack AEM solutions using Java, OSGi, and modern frontend frameworks. Collaborate with cross-functional teams to integrate web applications with enterprise services and leverage AI tools to streamline development workflows.
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 systems.
Design, develop, test, and maintain software applications within an Agile environment. Build and manage CI/CD pipelines while ensuring system security and scalability.
The Lead Generation Representative will identify, target, and qualify prospective business opportunities within the Middle Market employer segment. They will execute outbound prospecting campaigns and manage the sales pipeline within Salesforce to support strategic growth.
The Marketing Specialist supports the development and execution of external marketing communications and patient-facing content across multiple digital and physical channels. They collaborate with cross-functional teams and stakeholders to drive patient growth and ensure consistent brand messaging.
The Associate Director leads the strategy, governance, and execution of CAPA processes across Optum Rx to prevent systemic issues. This role manages the CAPAM team while partnering with senior stakeholders to drive continuous improvement and ensure regulatory compliance.
The Director of Social Media Strategy and Operations will lead the development and execution of enterprise-wide social media governance, strategy, and digital communications. This role involves managing tool sets, operational processes, and cross-functional partnerships to ensure alignment and efficiency across the organization.
Design, develop, and maintain scalable enterprise applications using .NET and microservices architecture. Collaborate with cross-functional teams to deliver high-quality solutions while mentoring junior developers and implementing AI-powered features.
The pharmacist will evaluate prescriptions and patient histories to render appeal decisions based on clinical criteria and regulatory guidelines. They will also consult with physicians and patients regarding medication use, drug interactions, and coverage determinations.
The Strategic Client Executive manages a book of National Accounts, focusing on maintenance, growth, and profitability. They coordinate strategic initiatives and maintain intercompany relationships to ensure superior service delivery.
The role involves identifying and assigning accurate ICD-10-CM and ICD-10-PCS codes for inpatient hospital services while ensuring compliance with coding guidelines. Additionally, the coder will perform chart reviews, provide documentation feedback to providers, and maintain high standards of coding quality and productivity.
The Physician Assistant or Nurse Practitioner provides virtual medical care, including patient triage, assessments, and referrals within a remote clinical setting. They are responsible for maintaining accurate medical records, ensuring HIPAA compliance, and collaborating with the healthcare team to deliver quality care.
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 Profee Medical Coder is responsible for assigning accurate diagnostic and procedure codes to professional accounts based on clinical documentation. They must also monitor work queues to ensure timely coding and generate queries for physician documentation clarification.
The RN Care Coordinator manages high-risk patients by facilitating care transitions, conducting telephonic outreach, and coordinating with primary care providers and specialists. They also perform medication reviews, provide patient education, and ensure appropriate site-of-service utilization to improve health outcomes.
The Sales Executive is responsible for driving business development and meeting revenue targets by selling complex revenue cycle and technology solutions to healthcare providers. This role involves managing the full sales lifecycle, from territory strategy and pipeline development to closing deals and fostering executive-level 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 Strategic Client Executive manages a book of National Accounts, focusing on maintenance, growth, and profitability. They coordinate strategic initiatives and maintain intercompany relationships to ensure superior customer service delivery.
The Planning and Communication Consultant will support the E&I Technology leadership team by managing executive reporting, strategic communications, and business planning. They will also act as an integrator for AI transformation initiatives, driving adoption and operational rigor across the portfolio.
The Quality Engineer will design, build, and maintain automated test frameworks to ensure software reliability and performance. They will collaborate with cross-functional teams to execute test strategies, manage defects, and integrate automated tests into CI/CD pipelines.
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.
Manage a dedicated population of patients through high-touch case management, including refill coordination and clinical assessments. Serve as a central point of contact between patients, pharmacists, and medical teams to ensure coordinated care and resolve patient concerns.
Manage a dedicated population of patients through high-touch case management, including refill coordination and clinical assessments. Serve as a central point of contact between patients, pharmacists, and medical teams to ensure coordinated care and accurate prescription processing.
The RN Case Manager will perform clinical operations and medical management activities, including assessing, planning, and coordinating care for members. They will also provide health education, medication reviews, and coaching to support members in managing their health conditions.
You will design, develop, and deploy scalable microservices and cloud-based data solutions using Java, Spring Boot, and Azure technologies. Additionally, you will serve as a primary client-facing engineer to articulate technical solutions and improve healthcare delivery outcomes.
The Sr. Strategic Account Executive manages assigned client accounts by developing trend management strategies, overseeing contract renewals, and cultivating multi-level relationships. They are also responsible for supervising staff, ensuring client requirements are met, and providing leadership on departmental initiatives.
The Principal AI Program Manager will lead the identification, development, and scaling of AI solutions across the Appeals organization. This role acts as a bridge between business operations, clinical leadership, and technology teams to ensure responsible and efficient AI deployment.
The consultant will coordinate and complete strategic projects while defining performance metrics and managing vendors. They are responsible for investigating complex issues, developing innovative solutions, and presenting findings to senior leadership.
The Senior Investigator is responsible for identifying, investigating, and preventing healthcare fraud, waste, and abuse by analyzing claims data and conducting field interviews. They must maintain accurate case documentation, ensure regulatory compliance, and participate in legal proceedings as required.
The role involves leading complex PBM network pricing analysis, financial modeling, and unit cost initiatives to support pharmacy network strategy and client performance. Additionally, the consultant will drive cross-functional transformation by improving pricing tools, data products, and operational workflows.
The Senior Data Engineer will define and own the end-to-end enterprise data architecture while leading the design of scalable data models and platforms. They will also implement cloud-native data flows, ensure robust data governance, and provide technical leadership to cross-functional teams.
The Appeals and Grievances Medical Director performs clinical reviews and adjudications for health plan appeals and grievances. They also collaborate with medical directors and network management to ensure regulatory compliance and improve clinical processes.
The Regional Vice President of Business Development provides sales leadership and sets strategies to achieve admit and census goals across the assigned region. They are responsible for hiring, coaching, and developing a high-performing sales team while fostering a collaborative partnership with operations leadership.
The Manager of Provider Transition and Growth leads membership movement activities related to provider departures, retirements, and site closures to ensure continuity of care and revenue protection. This role develops transition strategies, standardizes operational workflows, and provides performance reporting to regional leadership.
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 and develop individualized care plans while collaborating with internal teams and community resources.
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 Coding Education Consultant conducts coding audits on escalated claims and provides educational feedback to providers regarding billing inaccuracies. They are responsible for creating and delivering training materials to facilitate issue resolution and ensure adherence to industry standards and regulatory mandates.
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 Director leads the Health Plan Enablement team to drive operational readiness, issue resolution, and strategic initiatives across account management and product functions. They serve as a strategic advisor to senior leadership, ensuring team performance, governance, and client satisfaction are maintained at a high standard.
The role involves driving cross-alignment across the Center of Excellence and Trust Office by establishing security frameworks and operational standards. You will manage executive reporting, risk metrics, and program tracking while leveraging automated tools to optimize operational efficiency.
The Associate Director oversees clinical consulting client relationships, manages clinical resource allocation, and drives clinical upsell targets. They are responsible for developing strategies for proactive consultative services and mentoring a team of clinical consultants to ensure client satisfaction and retention.
The HSS Manager supervises HSS Coordinators providing case management services and ensures compliance with LTSS program objectives and regulatory standards. The role involves overseeing staff performance, conducting case conferences, and managing deliverables for the Department of Health Care Policy and Financing.
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 Associate Director of Clinical Consulting oversees client relationships, manages clinical resource allocation, and drives clinical strategy for OptumRx segments. They are responsible for leading a team of consultants, ensuring client satisfaction, and delivering clinically-sound, fiscally responsible recommendations.
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 Provider Enrollment Representative is responsible for processing behavioral health provider applications and re-applications for various payers. They also conduct audits to ensure accuracy and act as a technical resource to resolve complex problems within the team.
The Medical Director conducts acute level of care and length of stay reviews to ensure medical necessity for members. They also collaborate with treating providers and operational partners to improve clinical quality and health outcomes.
The case manager will conduct intake, assessments, and develop support plans while monitoring the health and welfare of members in their homes or long-term care facilities. They are responsible for maintaining accurate documentation and ensuring services align with the LTSS program requirements.
The Account Manager serves as the primary liaison for residential and healthcare partner accounts, focusing on relationship management, service continuity, and operational support. They are responsible for maintaining a quarterly outreach cadence, resolving billing and service issues, and collaborating with internal teams to drive account growth.
The Medical Director is responsible for the clinical review and adjudication of appeals and grievances for various health plan products. They also collaborate with internal teams and regulatory bodies to ensure compliance and improve health care quality.
Design, build, and maintain secure, scalable full-stack web applications and AI-enabled platform capabilities for cybersecurity products. Collaborate with cross-functional teams to integrate LLMs, semantic search, and automated workflows into customer-facing solutions.
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 Senior Manager will lead enterprise Site Reliability Engineering, DevOps, and operational excellence initiatives to improve service reliability and platform resiliency. This role involves driving automation, implementing AI-enabled operational capabilities, and mentoring high-performing teams to meet business and regulatory standards.
The specialist is responsible for charge capture, reconciliation, and denial management to ensure accurate revenue cycle operations. They also analyze reporting to identify revenue opportunities and provide education to administrative staff regarding billing requirements.
The Associate Practice Performance Manager is responsible for program implementation and managing provider performance metrics, including Stars gap closure and coding accuracy. This role involves building consultative relationships with healthcare providers to drive quality improvements and achieve performance goals.
Design, develop, and deploy AI-powered Epic solutions to optimize clinical and revenue cycle workflows. Partner with stakeholders to translate business needs into scalable technical requirements while ensuring system reliability and quality standards.
The Clinical Program Consultant improves clinical quality outcomes by engaging with providers, monitoring performance, and closing care gaps. This role also coordinates with clinical teams and community partners to ensure compliance with state and federal Medicaid requirements.
The Support Coordinator will manage a panel of members with intellectual or developmental disabilities by conducting comprehensive needs assessments and implementing person-centered care plans. They will collaborate with internal teams and community providers to ensure members receive appropriate medical, behavioral, and socioeconomic support.
The Associate Director will lead labor relations strategy, including collective bargaining negotiations and the interpretation of collective bargaining agreements. They will serve as a strategic advisor to senior leadership on complex workforce matters and ensure compliance with labor laws and company policies.
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 Senior Director will lead enterprise-critical strategy initiatives and manage the end-to-end development of industry landscapes and growth strategies. Additionally, they will source, structure, and scale partnerships across product, distribution, and innovation ecosystems.
The Associate Software Engineer will administer and support Kafka infrastructure across cloud and on-premises environments while managing clusters in GCP and Kubernetes. They will also develop infrastructure automation, implement security controls, and collaborate with cross-functional teams to ensure reliable messaging solutions.
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 role involves guiding the development of competitive provider networks and managing unit costs through financial modeling and analysis. You will also direct strategies across a matrixed organization to improve network quality, efficiency, and performance.
Design and build full stack web applications using Go and HTMX while maintaining RESTful services and cloud-native workloads in Azure. Collaborate with cross-functional teams to deliver scalable solutions using agile methodologies and modern CI/CD practices.
The Field Care Coordinator acts as a primary care manager, conducting comprehensive needs assessments and developing person-centered care plans for members with medical and behavioral needs. They collaborate with internal teams, providers, and community resources to implement these plans, provide health education, and support care transitions.
The LPN provides clinical oversight to the centralized scheduling team to ensure patient appointments are scheduled accurately and in alignment with organizational policies. They interpret clinical documentation to ensure patient readiness for infusion therapies and escalate clinical concerns to leadership as needed.
The Care Coordinator applies clinical knowledge to manage care for medically complex members, ensuring appropriate 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 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 analyst will collaborate with clinical and technical teams to design, configure, and optimize Epic Healthy Planet and Cheers workflows to support population health strategies. They will lead initiatives to drive care gap closure, improve clinical quality performance, and manage patient outreach campaigns.
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, staffing models, and performance processes to improve clinical outcomes and advance value-based care initiatives.
Lead financial analysis and modeling for prescription drug pricing and client performance management. Collaborate with cross-functional teams to implement data-driven models and influence senior leadership on pricing strategies.
The resident will participate in a customized program involving primary and specialty care exposure while learning to operate within a value-based care model. The role requires a commitment of 1-3 hours per month to support population health initiatives and professional development.
The Advisory Services Analyst provides technical administration and day-to-day support for digital imaging information systems while consulting with users to define business processes. They are responsible for identifying technical solutions, performing system maintenance, and ensuring systems operate cohesively across the enterprise.
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 role involves developing health plan pricing offerings, conducting financial modeling for prescription drug costs, and managing unit cost budgets. The consultant will partner with cross-functional teams to oversee client performance management and communicate statistical findings to management.
The Lead Software Engineer will provide technical leadership for a backend delivery team while remaining hands-on with the design and implementation of Java-based microservices. They will collaborate with stakeholders to shape technical strategy, mentor engineers, and ensure the delivery of high-quality, scalable software solutions.
The role involves establishing and implementing compliance policies while conducting legal research to mitigate risks. You will also be responsible for monitoring regulatory audits and coordinating data for regulatory filings.
The Psychologist Peer Reviewer applies clinical and benefit plan criteria to make insurance coverage determinations for various outpatient and behavioral health services. They also participate in consultations, staff meetings, and trainings while ensuring all clinical documentation complies with federal and state requirements.
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 Clinical Specialty Program Pharmacist manages client relationships and executes clinical strategies related to specialty pharmacy benefits. They serve as a primary point of contact for clinical needs, lead quarterly business reviews, and provide strategic guidance to optimize health outcomes.
The medical coder will identify and assign appropriate ICD-10, CPT, and modifier codes for facility outpatient 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.
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 the delivery of cost-effective, high-quality medical care.
You will lead the technical design, build, and optimization of Epic Healthy Planet and Cheers workflows to drive population health strategies. You will partner with clinical and operational leadership to implement scalable solutions that improve patient engagement and care gap closure.
The Scheduling Coordinator is responsible for managing patient appointments, maximizing clinician schedules, and verifying insurance eligibility. They must maintain high productivity and quality standards while communicating effectively with clinical teams and managing patient data in the electronic health record.
The Client Service Analyst provides system and operational training while managing inquiry research and resolution for member-level issues. They are responsible for logging and tracking issue progress, providing website assistance, and handling ad-hoc client requests.
The Senior Manager will lead the Digital Identity Operations team to ensure operational excellence, incident management, and service reliability for enterprise identity platforms. This role involves driving process improvements, leveraging AI and automation, and collaborating with cross-functional teams to support high-availability services.
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 Senior Investigator gathers and analyzes data to identify and document fraud, waste, and abuse (FWA) within healthcare schemes. They collaborate with clinical consultants, legal teams, and law enforcement to articulate findings and ensure compliance with regulatory standards.
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 Care Coordinator applies clinical knowledge to manage care for medically complex members, ensuring access to services and coordinating across acute and home settings. They conduct assessments, develop individualized care plans, and collaborate with multidisciplinary teams to improve health outcomes and service efficiency.
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 consultant will analyze and optimize customer enterprise imaging workflows, including Radiology and Cardiology PACS environments. They will serve as a primary resource for technical support, system integration, and the development of best practices for clinical imaging systems.
The Specialty Operations Manager leads client relationships and manages the day-to-day operations of specialty pharmacy programs. They are responsible for delivering clinical strategies, conducting pharmacy benefit analysis, and ensuring high-quality performance through data-driven insights.
The Medical Director provides leadership and direction for the claims review program, including conducting surgical and spinal claim reviews. They also facilitate telephonic discussions with providers regarding clinical coding and support regulatory compliance standards.
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.
This position provides leadership and accountability for the performance and direction of the Health Services team and senior professional staff. The role impacts statewide membership across multiple programs by managing clinical operations and ensuring high-quality healthcare outcomes.
The medical coder will identify and assign appropriate CPT and ICD-10 codes for interventional radiology and various facility encounters. They will also collaborate with clinical and revenue cycle teams to resolve coding queries, denials, and ensure documentation compliance.
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 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 Account Manager serves as the primary liaison for residential and healthcare partner accounts, focusing on relationship management, service continuity, and operational support. They are responsible for maintaining a quarterly outreach cadence, resolving billing and service issues, and collaborating with internal teams to drive account growth and retention.
The Associate Director will define the strategic vision and modernize sales readiness programs by leveraging AI-powered learning technologies and digital solutions. They will lead cross-functional teams to develop scalable training experiences and certification frameworks that enhance sales performance across the Provider commercial organization.
The role involves analyzing business requirements to develop database solutions for healthcare and reporting systems while ensuring service availability and stability. You will also be responsible for resolving production issues through debugging, log analysis, and performing root cause analysis.
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 Senior Associate General Counsel will act as internal antitrust counsel, providing legal guidance on M&A, litigation, and competition issues across the enterprise. They will also develop legal strategies, manage regulatory inquiries, and conduct antitrust training for business colleagues.
The Case Manager will conduct intake, assessments, and develop support plans for members while monitoring their health and welfare in home or facility settings. They are responsible for maintaining accurate documentation and ensuring services align with the LTSS program requirements.
The psychologist will conduct clinical peer reviews to determine the medical necessity and coverage for outpatient mental health and substance abuse services. They will also evaluate treatment plans, psychological testing requests, and appeals to ensure compliance with federal, state, and local guidelines.
The Care Coordinator applies clinical knowledge to manage care for medically complex members, ensuring access to services and providers. They develop individualized care plans, conduct assessments, and collaborate with multidisciplinary teams to improve health outcomes.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Educate patients on disease processes and collaborate with primary care providers to address care gaps.
The Appeals and Grievances Medical Director is responsible for the clinical review and adjudication of appeals and grievances for various health insurance products. They also communicate with internal medical directors and regulatory bodies to ensure compliance and quality in medical service determinations.
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 Coding Supervisor manages daily operations, productivity, and quality metrics for the coding team while ensuring adherence to regulatory and payer guidelines. They also facilitate staff development, process improvements, and cross-departmental collaboration to support revenue cycle performance.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Educate patients on disease processes and collaborate with primary care providers to address care gaps.
The Senior PBM Strategic Account Executive manages health plan client relationships, focusing on strategic plan development, contract renewals, and pharmacy benefit trend management. They are responsible for ensuring client requirements are met, overseeing implementation plans, and providing leadership to client services team members.
The Community Health Worker assesses, plans, and implements individualized care strategies while acting as a liaison for Medicaid members. They manage care plans, address social determinants of health, and facilitate referrals to community and social service programs.
The National Medical Director will lead clinical program governance, oversee disciplined program evaluations, and manage a team focused on testing innovative care models. This role involves collaborating with the National CMO to optimize clinical investments and ensure programs improve health outcomes and member experience.
The Associate Finance Director manages quarterly forecasting models and performs variance analysis to support executive decision-making. They serve as a strategic partner to the VP of FP&A by synthesizing complex financial data into actionable business insights.
The Associate Healthcare Advocate manages provider groups within a defined territory to ensure compliance with network requirements and program implementation. They perform data collection, quality monitoring, and provide actionable solutions to improve documentation and coding accuracy for Medicare and Medicaid Advantage members.
The clinical pharmacist is responsible for performing and supervising clinical pharmacy services, including medication reconciliation, chart reviews, and patient counseling. They also manage pharmacy quality initiatives, conduct drug utilization reviews, and provide clinical support for coverage determinations.
The case manager is responsible for conducting intake, assessments, and developing support plans for members receiving long-term services and supports. They must also monitor member health, document activities, and ensure compliance with program requirements and safety protocols.
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 Strategic Client Executive manages a book of National Accounts, focusing on maintenance, growth, and profitability. They coordinate strategic initiatives and maintain intercompany relationships to ensure superior customer service delivery.
The Director of Specialty Strategy is responsible for developing and executing the specialty pharmacy strategic plan for HealthTrust while serving as the primary subject matter expert. This role acts as the principal liaison between internal stakeholders and the client to drive clinical excellence, optimize financial performance, and enhance member experience.
The clinical reviewer analyzes hospital facility bills and medical records to identify adjustments for payment as part of forensic reviews. They also conduct research to support audit adjustments and maintain documentation in accordance with departmental guidelines and HIPAA standards.
The medical coder will identify and assign appropriate ICD-10, CPT, and modifier codes for facility outpatient observation services. They are responsible for maintaining high levels of coding quality and productivity while adhering to official and client-specific coding guidelines.
The Strategic Account Executive serves as the primary point of contact for key Provider clients, developing and executing strategic plans to drive growth and profitability. They lead matrixed teams to deliver value, manage client relationships, and ensure the successful deployment of Optum solutions.
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.
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 facilitate their transition into clinical practice.
The role involves conducting educational outreach to providers regarding coding and documentation guidelines via phone and email. Additionally, the coder will audit outpatient claims to validate services and ensure accurate use of procedure codes and modifiers.
The Network Contract Manager develops and maintains a geographically competitive provider network while managing unit cost budgets and financial performance. They are responsible for negotiating contracts, ensuring network adequacy, and building trusted relationships with providers and internal stakeholders.
Perform expert-level reviews of inpatient clinical records to identify documentation gaps and ensure accurate code assignment. Collaborate daily with providers to clarify clinical specificity and improve overall documentation quality.
Design and develop state-of-the-art NLP and AI solutions for medical applications, focusing on clinical knowledge resources. Maintain production systems and collaborate with engineering teams to enhance NLP modules and functionality.
Bridge the gap between mainframe system architecture, finance, and IT leadership to translate technical z Platform data into financial results. Design and deploy AI-powered solutions to automate workflows and manage complex system processing requirements.
Join a large radiologist group to perform general radiology duties including radiography and fluoroscopy. Responsibilities include the interpretation of ultrasound and general body CT scans to drive 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.
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.
Provides licensing and commission support to external producers and agencies while ensuring compliance with processing requirements. Acts as a liaison for policy and premium questions and maintains producer information within the system.
Assign appropriate ICD-10 and DRG codes for facility services while adhering to official and client guidelines. Maintain high quality and productivity standards and query physicians when necessary to ensure coding accuracy.
Design, implement, and manage cloud infrastructure and CI/CD pipelines on Microsoft Azure to automate software delivery. Develop and deploy AI-powered solutions using low-code and advanced platforms to enhance business workflows and decision-making.
Oversee a remote team of Behavioral Health Advocates providing case management for diverse populations across MO, WI, and KY. Manage professional staff, coordinate care with internal and external partners, and ensure adherence to key performance metrics and regulatory audits.
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 resources to implement interventions that address medical, behavioral, and socioeconomic needs.
The Strategic Account Executive serves as the primary relationship leader for assigned national clients, focusing on retention, growth, and strategic roadmap execution. This role coordinates cross-functional teams to ensure operational excellence, financial performance, and the delivery of clinical and digital pharmacy solutions.
The Strategic Account Executive serves as the primary relationship leader for assigned clients, managing complex national employer partnerships to ensure operational performance and business retention. They are responsible for developing multi-year strategic roadmaps focused on pharmacy trend management, clinical innovation, and measurable business outcomes.
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.
Deliver remote, measurement-informed behavioral health care using evidence-based treatment models. Monitor participant progress, coordinate care, and maintain strict confidentiality in accordance with HIPAA policies.
The Medical Director will oversee prior authorization and utilization management for Medicare Advantage members in the California market. Responsibilities include reviewing high-value procedure cases and promoting evidence-based medicine to improve quality and efficiency of care.
The Provider Relations Advocate manages end-to-end HCBS provider claims and builds positive relationships between the health plan and atypical service providers. They are responsible for resolving servicing issues, identifying network gaps, and conducting provider education and outreach.
The Director will manage the end-to-end Medicare Supplement rate filing process and engage directly with state regulators to obtain approvals. They will also conduct analytical assessments of claim trends and business performance to inform regulatory advocacy and strategic decision-making.
The Psychologist Peer Reviewer applies clinical and benefit plan criteria to make insurance coverage determinations for Commercial, Medicaid, and Medicare cases. Responsibilities include conducting clinical reviews for outpatient services and composing determinations that comply with federal and state requirements.
The specialist provides telephonic and digital behavioral health support, conducting risk assessments and developing individualized action plans for members. They coordinate care, evaluate medical necessity for treatments, and guide members toward appropriate employer and community resources.
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, quality medical care.
Design and deploy AI/ML and Generative AI solutions to build intelligent data products and digital experiences. Develop full-stack applications and cloud-native data solutions to enable self-service analytics and operational insights.
The physician will participate in a customized pathways program to transition from training into practice within a value-based care model. They will contribute to population health initiatives and engage in mentorship to improve care for patients.
Responsible for enrolling behavioral health providers with appropriate payers and processing applications into database tracking systems. The role involves conducting audits to reduce errors and acting as a technical resource for the team.
Lead a team of Registered Nurse Clinical Annotators to label and validate medical data for AI-driven prior authorization automation. Oversee daily workflows, ensure clinical accuracy, and collaborate with data science and engineering teams to align annotation with model goals.
Serve as the senior liaison for assigned client accounts, focusing on trend management, strategic plan execution, and contract renewals. Manage client performance reviews and lead the client services team to ensure high service standards and profitability.
Responsible for the reliability, scalability, security, and automation of enterprise-scale OpenShift Kubernetes platforms. This includes designing automated deployment solutions and collaborating with developers to improve application performance and observability.
Configure, maintain, and optimize CICS environments on IBM z/OS across multi-LPAR and Parallel Sysplex environments. The role involves managing CICS regions, troubleshooting stability issues, and utilizing AI tools to streamline operational workflows.
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.
Support the prior authorization and appeals process by researching and processing medication requests through various intake channels. Manage high-volume inbound and outbound calls while ensuring compliance with regulatory requirements and service level agreements.
Design and deploy production agentic AI systems and multi-agent orchestration frameworks to power conversational healthcare experiences. Develop backend services and integrate LLMs with healthcare systems while implementing safety guardrails and monitoring performance.
Lead and coach a team of IG Care Specialists and Clinical Liaisons to achieve regional sales goals for infusion services. Collaborate with pharmacy operations, marketing, and pharmaceutical manufacturers to ensure superior customer service and business growth.
Lead actuarial efforts including data analysis and Excel modeling to support the Medicare Advantage bid process. Conduct studies on pricing, utilization, and health care costs to provide statistical findings for management decision-making.
The Clinical Appeals RN represents MassHealth at appeal hearings to defend prior authorization decisions using medical necessity guidelines. They are also responsible for performing clinical coverage reviews for inpatient and outpatient services.
The role involves intensive outbound phone outreach to engage members, assess clinical needs, and provide guidance on behavioral health and substance use disorder services. The nurse acts as a clinical liaison to coordinate efficient care between members, providers, and internal clinical teams.
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.
Assign appropriate ICD-10, CPT, and modifiers for facility emergency department services while adhering to official coding guidelines. Maintain high quality and productivity standards and query physicians when necessary to ensure accuracy.
Guide the development of competitive provider networks and manage unit cost performance through financial modeling and analysis. Develop market-level strategies and resolve operational problems to improve healthcare quality and efficiency.
Acts as the primary bridge between business and technology teams to improve Advocate Central's capabilities. Responsibilities include owning backlog prioritization, translating business needs into user stories, and driving Agile delivery.
Lead strategic relationships with high-profile Health Plan clients to drive growth, retention, and financial performance. Manage a high-performing team of client management professionals while serving as a trusted advisor to C-suite executives.
Manage unit cost budgets and financial models to guide the development of competitive provider networks. Evaluate and negotiate contracts while ensuring appropriate distribution of provider specialties.
Acts as the primary clinical liaison for Fee-for-Service Medicaid clients, providing pharmacy benefit analysis and consultative recommendations. Manages P&T committees and implements preferred drug list (PDL) initiatives to optimize health outcomes and manage trends.
Deliver remote, measurement-informed behavioral health care using evidence-based treatment models. Monitor participant progress, coordinate care, and maintain strict confidentiality in accordance with HIPAA policies.
Acts as the key operational partner to the SVP of Sales to drive growth and profitability for Provider solutions. Leads high-value strategic projects and manages market-based initiatives covering over $1B in annual revenue.
The role focuses on analyzing and repricing pharmacy claims to ensure accurate cost management using SQL server databases. It involves developing analytical models, conducting financial pricing modeling, and collaborating with finance and sales teams.
Provide strategic legal counsel to the Digital Pharmacies and Payer Relations Team regarding operations, regulatory requirements, and growth initiatives. Lead the negotiation and drafting of complex commercial, technology, and data-related agreements while managing legal and reputational risks.
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.
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 standards of coding quality and productivity.
Perform concurrent review of FFS coding rules within Epic to ensure accurate CPT and E/M code assignment for maximum reimbursement. Responsibilities include interpreting clinical documentation, generating provider queries, and mentoring others to improve coding quality.
The Market CMO serves as the senior clinical executive responsible for achieving clinical outcomes, affordability goals, and growth targets. They lead provider engagement, manage market relationships with regulatory entities, and ensure clinical compliance and quality improvement.
Lead and manage contract relationships and pharmacy benefit analysis for large, complex health plan clients. Serve as the primary clinical liaison to provide proactive recommendations on pharmacy trends and program optimization.
Deliver remote, measurement-informed behavioral health care using evidence-based treatment models. Monitor participant progress, coordinate care, and maintain strict HIPAA confidentiality standards.
Oversee initial inpatient admissions for psychiatric and chemical dependency patients and determine appropriate levels of care. Coordinate transitions between care areas and manage outpatient treatment requests.
The Field Care Coordinator facilitates and advocates for enrollees' independence by conducting in-depth assessments and developing person-centered care plans. They collaborate with interdisciplinary teams and community resources to coordinate cost-effective care and manage transitions from acute facilities.
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.
Develop analytical frameworks and data models to support Medicaid quality analytics and value-based care programs. Collaborate with cross-functional stakeholders to translate complex requirements into actionable insights and strategic recommendations.
The Market CMO serves as the senior clinical executive responsible for achieving clinical outcomes, affordability goals, and growth targets. They lead provider engagement, manage market relationships with regulatory entities, and ensure compliance with government mandates.
Oversee clinical consulting client relationships and manage resource allocation for OptumRx segments. Develop strategies for proactive consultative services, drive clinical upsell targets, and maintain strategic relationships with stakeholders and brokers.
Directs the Clinical Documentation Integrity (CDI) department across multiple hospital systems in PA, MA, and NY. Responsible for driving program performance through KPIs, managing a team of 15+ FTEs, and partnering with hospital executives to improve documentation quality.
Develop and execute strategic payor contracting and revenue growth plans for the Washington market. Lead the negotiation process to achieve reimbursement terms while maintaining strong relationships with health plans and insurance brokers.
Responsible for the administration, maintenance, and performance optimization of Oracle Exadata engineered systems across on-premises and cloud environments. The role involves developing automation solutions and ensuring the scalability and security of mission-critical platform environments.
Deliver remote, measurement-informed behavioral health care using evidence-based treatment models. Monitor participant progress, coordinate care, and maintain strict confidentiality in compliance with HIPAA policies.
Responsible for coding a variety of medical records using CPT, HCPCS, and ICD-10 codes across multiple healthcare settings. The role involves preparing claims, managing denials and appeals, and ensuring compliance with government and insurance regulations.
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.
Design and build Amazon Connect contact flows to support modernized contact center operations. Collaborate with cross-functional teams to translate functional requirements into scalable technical solutions.
The Essential Plan Account Manager will enroll eligible members in the UHC Essential Plan and build relationships with key accounts. They will also present health plan information and manage sales pipelines to meet enrollment goals.
Responsible for selling new fully insured and level-funded Medical and Specialty products to employers with 51-99 employees. Focuses on developing broker relationships and managing the sales process from prospecting to implementation.
Lead the quality engineering strategy and design AI-powered automation frameworks for web, API, and mobile applications. Establish engineering standards and mentor QE engineers to ensure the scalability and reliability of claims processing systems.
Design and maintain scalable data quality frameworks to ensure the accuracy and consistency of enterprise data across multiple domains. Implement automated checks within ETL pipelines and validate Power BI reports using AI-assisted practices and AIOps observability.
Deliver clinical and financial formulary strategies to clients to maximize pharmaceutical rebate revenues and reduce costs. Develop client-facing materials and collaborate cross-functionally to manage deliverables and operational timelines.
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.
Lead end-to-end software engineering activities, providing technical direction and hands-on contribution to build scalable software solutions. Mentor engineers and drive innovation through the adoption of microservices architecture and engineering best practices.
Prepare for a permanent practice role through a transitional program involving mentoring and learning experiences. Focus on mastering value-based care models and the Quadruple Aim framework to ensure a smooth transition from residency to professional practice.
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.
The VP of Sales is responsible for driving new business growth and developing regional sales strategies within the National Accounts business. This includes fostering consultant relationships and representing the company as an industry expert to achieve annual membership goals.
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.
Conduct telephonic clinical reviews with providers to ensure members receive effective outpatient psychotherapy and community-based treatment. Assess member care against coverage guidelines and partner with providers to implement best practices.
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, quality medical care.
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.
The role involves conducting business research and managing large datasets to provide actionable insights and reports for stakeholders. It also requires coordinating projects, maintaining process documentation, and collaborating with cross-functional teams to support strategic initiatives.
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.
Support provider network contracting and unit cost management through financial modeling, utilization analysis, and reporting. Develop data management strategies and influence pricing strategies to reduce the overall total cost of care.
Provide legal support for employee benefits regarding mergers, acquisitions, and joint ventures. Manage ERISA document requests, regulatory filings, and the drafting of benefit plan documents and policies.
Provide strategic financial direction and leadership for the Optum Care Delivery West Region, overseeing financial planning, budgeting, and performance management. Lead M&A activity, capital allocation, and cost management strategies to optimize unit costs and utilization.
Negotiate and manage contracts for hospitals and ancillary facilities across the Mid-Atlantic region to ensure a competitive and affordable provider network. Develop renewal strategies using healthcare economics data and maintain strong business relationships with providers.
Oversee analytic functions to monitor financial performance and identify medical cost improvement opportunities for health plans and provider risk contracts. Lead a team of analysts to produce data-driven insights on utilization and cost trends for the executive team.
Drive membership growth for Individual & Family Plans across the West Region by managing a network of independent agents and agencies. Build community partnerships and ensure all sales activities comply with ACA, CMS, and state regulations.
Secure IBMi servers and applications to prevent unauthorized access to client data and system configurations. Manage security reporting, investigate potential breaches, and provide evidence for various regulatory audits.
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.
Develop and execute a territory sales plan to identify targets and close sales for specialty medications. Coordinate with manufacturing and distribution partners while supporting medical practice clients.
Lead the development and support of provider networks and manage unit cost activities through financial modeling and reporting. Negotiate value-based care contracts and guide the creation of geographically competitive networks to achieve performance objectives.
The Senior Investigator identifies and prevents healthcare fraud, waste, and abuse by analyzing claims data and conducting field investigations. They are responsible for managing complex cases, securing evidence, and reporting findings to government regulators.
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.
Lead the definition and management of business and functional requirements for the MedMonitor platform to support clinician network growth and CMR program expansion. Act as the primary liaison between clinical operations, IT, and external healthcare partners to ensure scalable platform capabilities.
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.
The therapist will screen and assess patients for mental health and substance use disorders while providing evidence-based treatment to individuals, couples, and families. They are also responsible for maintaining accurate electronic medical records in compliance with regulatory requirements.
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.
Lead business development and execute sales efforts for Optum's core capabilities within designated state government territories. Develop strategies aligned with state goals and coordinate cross-functional teams to deliver complex health services and technology solutions.
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.
Serve as the subject matter expert for Palo Alto Networks firewalls to manage enterprise security policies and ensure compliance. Collaborate with technical leadership to develop secure solutions and lead the response to cybersecurity audits and incidents.
Lead Patient Access operations across the western region, overseeing the design and maintenance of Epic technologies and workflows. Manage regional staffing, lead large-scale technology initiatives, and partner with operational leaders to improve patient outcomes.
The role involves driving sales of Optum Financial payment and member communication solutions by engaging C-suite and VP-level contacts at health plans. Responsibilities include building a sales pipeline, delivering value propositions, and collaborating with internal matrix partners to achieve sales quotas.
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.
Own the inference and delivery of machine learning insights to customers by managing and scaling ML systems. Partner with cross-functional teams to implement scalable pipelines and process high-volume healthcare datasets.
Design and implement enterprise-scale machine learning systems and production-ready MLOps pipelines to improve behavioral health outcomes. Provide technical leadership and mentorship to engineers while ensuring the ethical and responsible use of AI.
Lead the design and implementation of scalable AI/ML, GenAI, and agentic solutions to improve healthcare outcomes and operational efficiency. Own MLOps practices and develop production-grade APIs to expose AI capabilities at scale.
Oversees testing, training, and quality control for Epic Tapestry and Benefits Engine configurations. Provides subject matter expertise to resolve complex benefit issues and maintains system process documentation.
Provide clinical leadership and oversight for utilization management regarding advanced molecular and genetic testing in oncology. Ensure evidence-based decision-making and compliance with regulatory standards to optimize patient outcomes.
Drive sales of Optum Financial payment and member communication solutions by building relationships with C-suite and VP-level contacts at health plans. Manage the full sales process from pipeline generation and proposal to contract execution and long-term partnership maintenance.
Lead the development of advanced AI/ML and Generative AI systems to solve complex healthcare problems and optimize business growth. Collaborate with stakeholders to translate business requirements into data models and mentor other data scientists on technical architecture.
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.
Supervise a remote team of edit coders, monitoring productivity, attendance, and performance for up to 25 employees. Coordinate with HR, IT, and billing managers to streamline processes and ensure high-quality coding outcomes for hospital clients.
Deliver remote, measurement-informed behavioral health care using evidence-based treatment models. Monitor participant progress, coordinate care, and maintain strict confidentiality in accordance with HIPAA policies.
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.
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.
The Senior Architecture Analyst designs and documents technical architectures while assessing existing platforms for scalability, security, and cost efficiency. They provide technical leadership to implement AI-powered solutions and align technical blueprints with business goals.
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.
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 communicating decision rationales to medical directors.
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 activity focusing on value-based care and population health initiatives.
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 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.
The Investigator identifies and prevents healthcare fraud, waste, and abuse through claims data analysis and investigative methodologies. Responsibilities include conducting interviews, collecting evidence, and preparing detailed investigative reports for regulatory compliance.
Assign CPT and ICD-10 codes for outpatient ambulatory observation services while adhering to official and client guidelines. Analyze CCI and Medical Necessity edits and provide documentation feedback to providers through physician queries.
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.
The radiologist will perform general radiology interpretations including radiography, fluoroscopy, and procedures. They will also provide expertise in ultrasound, body CT, and potentially MSK or PET imaging within a multi-specialty group.
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 to deliver coordinated and accountable patient care.
The Travel Psychologist will conduct thorough mental health evaluations and medical opinions for veterans in accordance with VA guidelines. They will also collaborate with multidisciplinary teams and act as a subject matter expert on mental health disability benefits questionnaires.
The Sales Account Manager is responsible for enrolling Medicare beneficiaries into the UnitedHealthcare Institutional Special Needs Plan by generating leads and managing facility relationships. They must document all sales activities to ensure compliance with Medicare Marketing Guidelines while meeting territory enrollment targets.
The radiologist will join a group to perform general radiology duties including radiography, fluoroscopy, and procedures. They are expected to provide high-quality patient care and may rotate between the main campus and satellite clinics.
The radiologist will join a group to perform general radiology duties including radiography, fluoroscopy, and procedures. They will also be responsible for the interpretation of ultrasound and general body CT scans.
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 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 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 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 clinical documentation and monitoring patient treatment progress.
The radiologist will perform general radiology duties including radiography, fluoroscopy, and various procedures. They will also be responsible for the interpretation of ultrasound and general body CT scans.
Perform general radiology duties including radiography, fluoroscopy, and various procedures. Interpret ultrasound and general body CT scans while contributing to high-quality, coordinated patient care.
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 patients on disease processes and health management.
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 program needs and facilitate quality improvement initiatives to enhance health outcomes.
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 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 patient growth strategies.
The Social Worker will provide individual or group therapy and develop comprehensive treatment plans for patients with various mental health conditions. They will also assist patients in accessing community resources and maintain accurate medical documentation.
Deliver remote measurement-informed care using evidence-based treatment models and monitor participant progress. Coordinate care, document session notes, and respond to high-risk encounters while maintaining HIPAA compliance.
Participate in a primary care pathway program while completing residency training. Engage in value-based care initiatives and receive mentorship from experienced physicians.
The Community Health Worker acts as a liaison for Medicaid members, providing home assessments, health education, and support to ensure access to quality care. They spend 50-75% of their time in the field engaging directly with members to drive quality performance and health outcomes.
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 communicate with internal medical directors regarding clinical rationales and network quality issues.
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 health management.
The Director of Pharmacy oversees all pharmacy operations, including planning, organizing, and supervising activities in accordance with hospital policies and legal standards. They also provide professional guidance to pharmacy personnel and drive clinical and operational performance for the health system.
The candidate will provide technical leadership for data engineering efforts on the public cloud for the Optum Rx Data Estate team. They will design and build scalable, cost-effective Azure-native solutions while managing team deliverables in collaboration with product owners.
The Clinical Quality Consultant provides guidance and support for utilization management concerning advanced molecular and genetic testing within the oncology program. This involves ensuring evidence-based decision-making, compliance with standards, and optimal patient outcomes through expert genomic data interpretation and team collaboration.
The Medical Director will support utilization management by making determinations, identifying utilization trends, and suggesting improvements to the utilization management program. Responsibilities also include assisting in developing and maintaining an efficient UM program and overseeing physician compliance with the UM plan.
This executive role focuses on bringing new, innovative solutions and services to health plan partners by developing and closing product and service opportunities within the payer market. Responsibilities include building a sales strategy for new solutions, creating compelling value propositions, and managing the full sales cycle from lead identification to contract negotiation.
The RN Health Coordinator will assess, plan, and implement individualized care strategies, acting as a single point of contact to manage the care plan throughout the continuum of care. This involves identifying and initiating referrals for social service programs and communicating necessary health information to all stakeholders to ensure coordinated, quality care.
The role involves applying sales acumen to generate and close leads while developing and managing relationships to meet business goals, including conducting presentations to various community groups to sell and promote Medicare products. Responsibilities also include managing time efficiently for appointments, lead generation, territory development, and enrolling eligible members into specific UHC plans while meeting monthly sales goals.
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.
