The Senior Business Analyst will support financial business analysis for the Payment Integrity business area, including data mapping, transformation, and quality assurance. They will collaborate with cross-functional teams to design, automate, and document financial reporting requirements.
The Clinical Coordinator assesses, plans, and implements individualized care strategies while serving as a single point of contact for patients. They also manage care plans across the continuum and advocate for patient needs to ensure quality coordinated services.
The Clinical Claim Review Nurse performs clinical reviews of professional or facility claims against medical records to verify correct coding and charges. They are responsible for documenting findings, ensuring adherence to state and federal compliance policies, and providing clinical logic for claims and appeals.
The Clinical Coordinator will assess, plan, and implement person-centered strategies while connecting members with essential community and financial resources. They will also coordinate care across the continuum and collaborate with providers and caregivers to improve health outcomes.
The Clinical Pharmacist will conduct telephonic outreach to improve medication adherence and optimize therapy outcomes for members. They will also collaborate with healthcare providers and manage pharmacy-related projects to enhance the overall member experience.
The COBRA Client Services Leader manages a team of professionals to ensure compliant and efficient COBRA administration for diverse clients. This role drives operational excellence, mitigates risk, and fosters strategic partnerships across internal departments to support business growth.
The Clinical Coordinator will assess, plan, and implement person-centered strategies while connecting members with essential community and financial resources. They will also coordinate care across the continuum and advocate for members to ensure their health needs and preferences are met.
The Business Development Manager will source, evaluate, and execute strategic lending opportunities and third-party partnerships for Optum Bank. This role involves building financial models, analyzing credit performance, and leading cross-functional teams to drive revenue and platform growth.
The Senior Enrollment Representative manages end-to-end provider enrollment workflows, including roster submissions and revalidations across multiple payers. They also conduct audits, identify process improvements, and resolve complex billing and credentialing issues to ensure compliance.
The National Vice President of Sales is responsible for establishing strategy and providing senior-level oversight to achieve revenue and membership targets across a large network of skilled nursing and assisted living facilities. This role involves managing regional vice presidents, driving organic growth, and partnering with cross-functional teams to ensure operational and financial goals are met.
The resident physician will participate in a mentorship program to transition from training into a value-based care model. They will contribute to population health initiatives while providing clinical care to patients.
The Senior Provider Engagement Specialist analyzes provider group performance and develops strategic action plans to improve revenue, quality outcomes, and operational efficiency. They serve as a liaison between the health plan and providers, fostering relationships and implementing business solutions to meet organizational goals.
The Acute Intake Manager provides operational leadership for the intake team, overseeing patient access, referral progression, and prior authorization workflows. This role is responsible for managing workforce performance, ensuring compliance, and driving continuous process improvement to enhance the patient journey.
The Provider Advocate serves as the primary point of contact for healthcare providers, resolving issues related to benefits, billing, and clinical authorizations via phone and chat. They must navigate multiple internal systems to extract information and promote self-service digital tools to enhance provider satisfaction.
The EAP Specialist provides telephonic behavioral health assessments, crisis intervention, and solution-focused consultations to clients. They are responsible for triaging calls, initiating counseling referrals, and documenting clinical notes within the care management database.
The Health Services Nurse provides comprehensive telephonic clinical services, including transitions of care, medication adherence, and management of care gaps. They act as the primary point of contact for patients, coordinating with providers and pharmacists to improve patient outcomes and prevent readmissions.
This role provides strategic leadership for culture, health optimization, and social responsibility initiatives across Missouri and Iowa health plans. The director identifies health disparities and develops innovative solutions to improve access, affordability, and outcomes for Medicaid and DSNP populations.
Perform concurrent and retrospective chart reviews to improve clinical documentation completeness and accuracy. Communicate effectively with providers to clarify diagnoses and ensure documentation meets severity of illness and risk of mortality requirements.
The Collections Representative handles escalated and complex facility insurance claims by contacting insurance companies to negotiate payments and resolve outstanding balances. They are also responsible for researching claim statuses, preparing appeals for denials, and documenting all relevant information in computer systems.
The Senior Recruiter manages the end-to-end recruitment lifecycle for physicians and advanced practice clinicians, including sourcing, screening, and offer management. They act as a talent advisor to senior leadership, collaborating on pipeline strategy, job scoping, and market compensation analysis.
The Case Manager will visit members in hospitals prior to discharge to facilitate safe transitions and coordinate care resources. They act as an intermediary between providers and members to provide education, medication reviews, and service coordination.
Respond to and resolve customer inquiries regarding health benefits, eligibility, and claims while educating members on plan options. Assist customers in navigating company websites and facilitate communication with healthcare providers to ensure quality care.
The Behavioral Health Care Advocate conducts telephonic clinical reviews with providers to ensure members receive effective and efficient outpatient care. They assess treatment plans against coverage guidelines to promote best practices in behavioral health services.
The Billing Representative is responsible for reviewing and prioritizing open accounts receivable, handling inbound patient calls, and conducting outbound collections outreach. They collaborate with cross-functional teams to ensure accurate, timely, and compliant resolution of patient balances.
The Associate Director will develop and manage programs to optimize behavioral health quality and reduce costs through partnerships with payer accounts and enterprise stakeholders. They are responsible for creating project plans, operational workflows, and analyzing data to drive program performance and clinical outcomes.
The Nurse Practitioner provides telephonic and telehealth care, managing acute and chronic conditions for patients across various settings. They coordinate care between caregivers, facilities, and providers while ensuring all clinical encounters are documented according to CMS regulations.
The Nurse Practitioner provides telephonic and telehealth care to patients across various settings, managing both acute and chronic conditions. They coordinate care between caregivers, facilities, and providers while ensuring all clinical encounters are documented in compliance with CMS regulations.
The Behavioral Health Nurse Practitioner will conduct telehealth-based psychiatric evaluations and provide evidence-based pharmacologic and non-pharmacologic interventions for patients with complex needs. They will also act as a consultant to an interdisciplinary care team to ensure effective care coordination and connection to community mental health services.
The PMHNP will conduct telehealth-based psychiatric evaluations and provide evidence-based pharmacologic and non-pharmacologic interventions for patients with complex behavioral health needs. They will also act as a consultant to an interdisciplinary care team to ensure effective care coordination and treatment planning.
The Senior Provider Relations Advocate manages complex provider escalations, including claims, payments, and operational issues, while acting as a liaison between internal partners and providers. This role involves conducting root cause analysis, driving process improvements, and ensuring timely resolution of systemic barriers to enhance provider experience.
The PMHNP will conduct telehealth-based psychiatric evaluations and provide evidence-based pharmacologic and non-pharmacologic interventions for patients with complex behavioral health needs. They will also act as a consultant to an interdisciplinary care team to ensure effective care coordination and connection to community resources.
The Clinical Operations Director will lead clinical strategy and solution enablement by identifying and advancing scalable AI solutions across inpatient, claims review, and appeals operations. This role involves cross-functional collaboration to translate clinical needs into prioritized AI initiatives while providing clinical insight for governance and operational modernization.
The Care Coordinator applies clinical knowledge to manage the care of 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 and service efficiency.
The Account Manager will drive membership growth for the Essential Plan by building strategic relationships with key market influencers and community institutions. They are responsible for conducting sales presentations, managing the sales pipeline, and enrolling eligible members within their assigned territory.
The Medical Coder analyzes and codes claim information for various specialties to ensure accurate documentation and adherence to industry standards. They are responsible for managing and prioritizing claims while maintaining high-quality data and meeting department benchmarks.
Customer Service Advocates act as a single-stop resource for members, managing inbound and outbound communications regarding medical and pharmacy benefits, eligibility, and claim resolution. They are responsible for educating members on health care literacy and navigating complex benefit issues while meeting performance goals for quality and efficiency.
The representative will receive and resolve customer concerns regarding claims, authorizations, and IPA functionality while acting as a liaison between physicians and health plans. They are also responsible for logging issues into tracking databases and maintaining quality standards for call resolution.
The Patient Liaison coordinates services between OptumRx and patients by managing recruitment, retention, and educational activities. They are responsible for developing consumer relationships, conducting workshops, and identifying new business opportunities within the bleeding disorder community.
The role involves supporting sales enablement through tasks such as agent onboarding, training delivery, and workforce management. Responsibilities also include tracking dependency issues, generating schedules, and maintaining business relationships.
The 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 collaborate with internal teams and community resources to ensure quality service delivery.
The Healthcare Advocate acts as a strategic partner to medical providers to ensure accurate documentation, coding, and quality performance. The role involves traveling to provider sites to implement risk adjustment programs and provide actionable feedback to improve health outcomes.
The Registered Nurse will manage patient care within the pediatric department, including telephone triage and clinical procedures. They will also build supportive relationships with families and coordinate care transitions to ensure high-quality outcomes.
The Technical Program Leader orchestrates execution across multiple engineering organizations to ensure the delivery of strategic initiatives. They manage dependencies, facilitate Agile release planning, and drive cross-functional coordination to meet technical and operational goals.
The Recovery Resolution Consultant will provide subject matter expertise on complex coding cases, claims resolution, and process improvement initiatives. They are responsible for supporting quality metrics, mentoring staff, and acting as a point of contact for administrative duties.
The Sales Account Manager is responsible for prospecting and enrolling new members in the Essential Plan through strategic business-to-business relationships and community outreach. They will manage a sales pipeline, conduct product presentations, and track performance metrics within their assigned New York territory.
The Account Manager will drive membership growth for the Essential Plan by building strategic relationships with community influencers and providers. They are responsible for prospecting, conducting product presentations, and enrolling eligible members within their assigned territory.
The provider is responsible for delivering virtual medical care, including patient triage, assessments, and referrals within Optum Serve operations. They must maintain accurate medical records, ensure HIPAA compliance, and provide support in emergent situations while working collaboratively with the healthcare team.
The Patient Relations Specialist serves as an organizational expert for escalated patient complaints and provides guidance on handling complex, sensitive issues. They coordinate investigations, collaborate with leadership to improve service quality, and ensure timely resolution of patient concerns.
Plan, develop, and manage pharmacy order-related consumer communications across email, SMS, letters, prescription forms, and supplemental drug information. Lead creative development and approvals, coordinate stakeholders and agency partners, manage project schedules and budgets, and improve the clarity and effectiveness of the pharmacy patient experience.
Design, build, and optimize scalable ETL/ELT pipelines and data models that integrate on-premises and cloud data for analytics and reporting. Implement data quality, security, masking, and CI/CD controls, and collaborate with Agile teams to deliver data and AI solutions.
The Account Manager will drive membership growth for the Essential Plan by building strategic relationships with community influencers and business partners. They are responsible for prospecting, enrolling eligible members, and conducting product presentations within their assigned territory.
You will lead and mentor a team of technical product and project management professionals to define and deliver high-impact technology solutions. Additionally, you will manage portfolio operations, including executive reporting, budget oversight, and strategic roadmap development.
The Lead Technical Product Manager will drive product strategy, backlog management, and technical feature execution for HEDIS quality platform solutions. They will collaborate with cross-functional teams to translate clinical data requirements into technical specifications and monitor platform performance metrics.
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 the care team to improve health outcomes and service efficiency.
The Patient Service Representative screens incoming patient inquiries and resolves issues related to patient satisfaction, flow, and administrative needs. They also maintain accurate patient records and facilitate communication between patients, providers, and the interdisciplinary team.
The Field Care Coordinator facilitates patient independence by conducting comprehensive needs assessments and developing person-centered care plans. They collaborate with interdisciplinary teams and community partners to manage care transitions and ensure the delivery of efficient, cost-effective health services.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease management and social determinants of health.
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 and service efficiency.
The Nutrition Support Dietitian serves as a subject matter expert to drive the nutrition care process for patients receiving home parenteral nutrition. They collaborate with cross-functional teams to develop nutritional plans, monitor patient responses, and provide clinical education to healthcare providers and staff.
The specialist develops and delivers educational resources and training programs to support provider network success. They also serve as a primary point of contact for providers to ensure understanding of policies, procedures, and program requirements.
The provider is responsible for delivering virtual medical care, including patient triage, assessments, and referrals within a non-traditional clinical setting. They must maintain accurate medical records, ensure compliance with regulatory guidelines, and provide support during emergent situations.
The Care Coordinator applies clinical knowledge to manage care for medically complex members, ensuring access to services and providers across the continuum. They develop individualized care plans, conduct assessments, and collaborate with multidisciplinary teams to improve health outcomes and service efficiency.
The Clinical Nurse Liaison is responsible for patient education, strategic oversight of infusion referrals, and managing clinical and account liaison teams. They collaborate with regional leadership to develop growth strategies while ensuring high-quality patient care and provider relationship management.
The registered nurse is responsible for assessing incoming patient calls using nursing protocols and triage guidelines to determine appropriate care options. They also facilitate referrals to healthcare providers and coordinate communication between patients and medical organizations.
The Care Coordinator applies clinical knowledge to manage care for medically complex members, ensuring access to services and coordinating across the continuum of care. They conduct assessments, develop individualized care plans, and collaborate with multidisciplinary teams to improve health outcomes and service efficiency.
The Field Care Coordinator applies clinical knowledge to manage care for medically complex members, ensuring access to services and providers. They conduct assessments, develop individualized care plans, and collaborate with the care team to improve health outcomes and service efficiency.
The Marketing Specialist supports the development and execution of external marketing communications and patient-facing content across multiple digital and physical channels. They coordinate with cross-functional teams and stakeholders to ensure consistent messaging and effective project management for Optum Massachusetts practices.
The Clinical Quality Analyst serves as a subject matter expert providing guidance on coding and documentation to providers and coding teams. They are responsible for conducting audits, analyzing trends, and delivering educational initiatives to ensure compliance and revenue integrity.
The Care Coordinator applies clinical knowledge to manage the care needs of medically complex members, ensuring access to services and providers. They conduct assessments, develop individualized care plans, and collaborate with the care team to improve health outcomes and service efficiency.
The Senior Software Engineer will design, develop, and maintain enterprise-class full-stack solutions and microservices while leading cloud migration initiatives to Azure. They will also orchestrate complex data integration workflows and deploy AI-powered automations to streamline business processes.
The Patient Service Representative screens incoming patient inquiries and resolves issues related to patient satisfaction, flow, and administrative needs. They also maintain accurate patient records and facilitate effective communication between patients, providers, and the interdisciplinary team.
The Intake Specialist is responsible for receiving and processing referrals, verifying patient insurance benefits, and obtaining necessary prior authorizations. They also manage patient documentation, communicate with families and referral sources, and ensure all intake requirements are met in a timely manner.
The Senior Cloud Platform Engineer will build, manage, and secure foundational infrastructure for identity services using Infrastructure as Code and automation. They will also focus on designing for high resiliency, scalability, and security while implementing comprehensive monitoring and alerting solutions.
The Patient Service Representative screens incoming patient inquiries and resolves issues related to patient satisfaction, flow, and administrative needs. They also maintain accurate patient records and facilitate communication between patients, providers, and the interdisciplinary team.
Manage inbound and outbound call center communications to support patient case management and coordinate care with pharmacists, sales, and nursing teams. Process prescriptions, verify benefits, and ensure accurate documentation of patient inquiries to achieve resolution.
The Vice President of Pharmacy Services provides strategic, operational, and financial leadership for all pharmacy operations across the clinic enterprise. This role oversees multi-site pharmacy services, drives growth and quality outcomes, and collaborates with executive leadership to develop innovative pharmacy solutions.
The role involves assigning accurate diagnostic and procedure codes for palliative care services while monitoring work queues to ensure timely processing. Additionally, the coder will generate documentation queries and stay updated on evolving coding conventions and regulations.
The Associate Director leads enterprise pharmacy informatics strategy and delivers technology-enabled solutions to improve medication safety and clinical effectiveness. They oversee the design, configuration, and implementation of EHR tools while partnering with cross-functional stakeholders to drive clinical and business value.
The specialist coordinates and facilitates internal and external authorizations for medical procedures while ensuring clinical documentation meets insurance carrier requirements. They also manage the denial and appeal process, communicating effectively with physicians, clinical staff, and insurance companies.
The Plan Pharmacy Director is responsible for setting the strategic direction, operational execution, and financial oversight of the pharmacy program for the UnitedHealthcare Community Plan of Hawaii. This role serves as the primary subject matter expert and point of contact for internal and external stakeholders regarding pharmacy benefits, compliance, and affordability initiatives.
The Inside Sales Representative is responsible for sourcing sales leads within behavioral health and addiction treatment facilities to generate new sales meetings. They will manage customer relationships using CRM tools and partner with Business Development Representatives to drive territory growth.
The New Patient Onboarding Coordinator serves as the primary point of contact for new patients, managing registration, insurance verification, and appointment scheduling. They are also responsible for collecting and uploading medical records into the EHR while ensuring compliance with HIPAA regulations.
The Patient Service Representative screens incoming patient inquiries and resolves issues related to patient satisfaction, flow, and administrative needs. They also maintain accurate patient records and facilitate communication between patients, providers, and the interdisciplinary team.
The Life Claims Analyst is responsible for reviewing, investigating, and adjudicating life insurance claims while ensuring compliance with ERISA standards and federal guidelines. They must provide accurate claim decisions and maintain clear communication with internal and external stakeholders throughout the review process.
Resolve escalated customer issues and provide compassionate guidance to members on health benefits, care options, and provider access. Support appointment scheduling, help customers use online health tools, and serve as a subject matter resource for team members or internal customers.
The Referral Navigator Representative serves as a centralized resource for care coordination, managing referral completion, home health services, and durable medical equipment requests. This role performs clinical documentation review and triage while ensuring effective communication between providers, facilities, and patients to facilitate care progression.
The Associate Tech Support Analyst will serve as the primary point of contact for resolving time-sensitive technical issues related to radiology systems. They are responsible for documenting incidents, managing a ticket backlog, and collaborating with internal teams to ensure effective resolution.
The role provides oversight to Optum360 coding services, managing facility-based operations and driving quality metrics and workflow improvements. It involves collaborating with CDI and Quality teams to ensure coding accuracy, compliance, and the achievement of Service Level Agreement commitments.
Design, develop, and deploy scalable, cloud-native fullstack applications and microservices to address complex identity risk and fraud intelligence challenges. Collaborate with cross-functional teams to build intuitive portals and leverage AI-powered solutions to optimize engineering productivity.
The Associate Tech Support Analyst will respond to time-sensitive support calls and act as the primary point of contact for resolving reported incidents. They will also troubleshoot production radiology systems and collaborate with internal teams to ensure effective issue resolution.
The Senior AI/ML Engineer will lead the design, development, and enterprise deployment of machine learning models and generative AI architectures to improve patient health outcomes. They will collaborate with cross-functional teams to translate complex clinical data into actionable intelligence and streamline healthcare workflows.
The Clinical Administrative Coordinator organizes and maintains health information records while processing release of information requests. They also review electronic chart documentation for accuracy and provide training and mentorship to staff members.
The Acute Intake Manager provides operational leadership for the intake team, overseeing patient access, referral progression, and prior authorization workflows. This role is responsible for managing team performance, ensuring compliance with regulatory requirements, and driving continuous process improvement to enhance the patient journey.
The Lead Technical Product Manager will drive AI and digital transformation initiatives to improve operational performance and member experience within the Indiana Health Plan. This role involves partnering with cross-functional teams to translate business and regulatory needs into actionable technology roadmaps and scalable solutions.
The Care Coordinator provides telephonic customer service and schedules medical services for TRICARE beneficiaries based on triage dispositions and contract guidelines. They are responsible for resolving eligibility inquiries and identifying emergent concerns while maintaining performance metrics in a 24/7 contact center environment.
The analyst provides qualitative analysis of departmental functions and procedures to improve institutional efficiency and cost-effectiveness. They also coordinate user requirements for automated systems and act as a liaison with data processing personnel.
The ERP Systems Analyst is responsible for designing, implementing, and maintaining PeopleSoft HR technology solutions. They also coordinate with technical teams to develop integrations, manage project documentation, and provide training on new HR processes.
The specialist is responsible for improving the quality and accuracy of medical record documentation through collaboration with physicians and coding staff. They conduct concurrent reviews of inpatient admissions to ensure documentation reflects the appropriate level of service, severity of illness, and risk of mortality.
This role involves the design, configuration, and maintenance of clinical applications, including managing the Epic Master Training Environment. The analyst will also collaborate with technical teams on system upgrades and provide support for clinical documentation and security-related issues.
The position is responsible for analyzing business problems and providing technical solutions through the administration and maintenance of enterprise systems like OnBase, Archibus, and RightFax. The analyst will also lead project meetings, automate business processes, and support system integrations to ensure optimal performance.
The Software Engineer will maintain and advance in-house products for the Security Operations Center to streamline and automate operational workflows. They will architect innovative solutions, participate in code reviews, and drive automation across Enterprise Information Security projects.
The Principal Project-Program Manager will lead the execution and adoption of AI-enabled delivery practices across Optum Health Technology. This role involves managing complex transformation initiatives, establishing program strategy, and coordinating across cross-functional teams to drive measurable business outcomes.
You will lead the design and development of scalable, cloud-native data pipelines and machine learning architectures on Azure and Databricks. Additionally, you will collaborate with Data Science and AI teams to operationalize models and ensure data quality across healthcare ecosystems.
The Lead Customer Service Representative coordinates daily support operations and acts as a resource for staff while performing patient service representative duties. They ensure high-quality department workflow, manage incoming calls, and provide leadership in the absence of a supervisor.
The Patient Service Representative screens incoming patient inquiries and resolves issues related to patient satisfaction, flow, and administrative needs. They also facilitate updates to patient records and maintain effective communication with the interdisciplinary team and providers.
The Patient Service Representative II manages high-volume incoming calls and patient inquiries to provide resolution or direct them to the appropriate care team member. They also serve as a mentor to level I staff, participate in process improvement projects, and ensure accurate documentation in electronic medical records.
The Care Coordinator serves as the primary manager for members with chronic health needs, conducting comprehensive assessments and developing person-centered care plans. They collaborate with internal teams and community providers to implement interventions, remove barriers to care, and support successful transitions between health settings.
The specialist performs DRG validation reviews and provides clinical coding expertise to ensure accuracy in medical records and claim adjudication. They also identify trends in provider coding practices and support strategies to prevent overpayments through pre-payment and retrospective audits.
The role involves reconciling complex accounts, managing claims appeals, and resolving billing or payment issues through research and correspondence. The representative will work with various hospital departments and payers to ensure accurate reimbursement and maintain high-quality patient financial services.
The Care Coordinator serves as the primary care manager for members with chronic and complex health needs, conducting assessments and developing person-centered care plans. They collaborate with internal teams and community providers to implement interventions, remove obstacles to care, and support successful transitions between care settings.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including medication reconciliation and physical exams. Collaborate with primary care providers to address care gaps and educate patients on disease processes and social determinants of health.
The Technical Product Owner manages the product backlog for enterprise GRC platforms, translating risk and compliance requirements into actionable user stories. They partner with engineering and vendors to ensure platform stability, scalability, and operational excellence.
The representative performs collection activities on past due patient accounts and manages inquiries regarding billing, insurance, and patient responsibility. They are responsible for maintaining account integrity, updating demographics, and resolving billing issues to ensure accurate financial records.
The Virtual Visit Specialist facilitates virtual healthcare appointments by assisting members and providers with technology setup and troubleshooting. They manage inbound and outbound calls in a call center environment while ensuring high-quality member support and adherence to HIPAA regulations.
The Appeals and Grievances Medical Director is responsible for the clinical review and adjudication of appeals and grievances related to various health plan products. They also communicate with medical directors and network management staff regarding clinical rationales, quality issues, and regulatory responses.
The Data Architect will define and evolve target-state data architecture, standards, and roadmaps while leading the design and implementation of scalable data pipelines. This role also involves mentoring engineering teams and ensuring data quality, security, and performance across cloud-based data platforms.
The Accounts Receivable Clerk validates charge data, submits accurate claims, and manages follow-up on claim status and payment accuracy. They also handle appeals, insurance correspondence, and coordinate with clinics to resolve denials related to medical necessity and eligibility.
The clinician will evaluate and manage patient concerns through virtual and telephone encounters, providing clinical recommendations and appropriate dispositions. They will also document interactions in the electronic medical record and participate in weekend and holiday coverage schedules.
The Medical Behavioral RN Case Manager acts as a clinical liaison to assess, plan, and coordinate care for high-risk members across various settings. They develop individualized care plans, monitor utilization, and collaborate with interdisciplinary teams to ensure quality and cost-effective health outcomes.
The Infrastructure & Operations Engineer will design, deploy, and maintain robust enterprise infrastructure solutions while collaborating with cross-functional teams to ensure service availability. Responsibilities include implementing automation, managing security patching, performing incident triage, and maintaining technical documentation to support healthcare operations.
The Associate Patient Care Coordinator is responsible for verifying patient insurance, managing patient registration, and coordinating medical appointments. They also provide patient education regarding managed care plans and maintain accurate patient schedules while supporting the clinical team.
The Peer Support Specialist collaborates with clinical teams to implement care coordination and provide direct support to consumers to stabilize their conditions. They also advocate for consumers, facilitate access to community services, and assist in the development of recovery and crisis plans.
The Patient Care Coordinator manages patient scheduling, verifies insurance information, and coordinates medical procedures while maintaining clear communication with patients and providers. They also provide patient education regarding managed care plans and respond to urgent patient needs within established guidelines.
You will design, develop, and deploy scalable AI/ML models and GenAI applications within a cloud-based healthcare environment. The role involves building robust Python APIs, managing agentic frameworks, and ensuring efficient model inference on Kubernetes infrastructure.
The associate software engineer designs, codes, tests, and debugs applications to meet technical and business requirements. They also collaborate closely with business analysts to develop and refine project requirements.
The General Agent Growth Manager is responsible for driving sales growth by managing and educating General Agency partners within a specific market. This role involves building strategic relationships, monitoring performance metrics, and collaborating with internal teams to meet sales targets.
The Sales Executive is responsible for driving business development and selling complex revenue cycle solutions to healthcare providers within a defined territory. This role involves managing the full sales lifecycle, from pipeline development to deal closure, while leveraging AI tools to enhance productivity and client engagement.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatments. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment responses.
The Medical Behavioral RN Case Manager acts as a clinical liaison to assess, plan, and coordinate care for high-risk members across various settings. They are responsible for developing individualized care plans, monitoring utilization, and collaborating with interdisciplinary teams to ensure quality, cost-effective outcomes.
The Physician Associate is responsible for the clinical review and adjudication of appeals and grievances cases in collaboration with medical directors. They will participate in team meetings to provide clinical input and support process improvements for health plan products.
The Sales Implementation Manager leads the opening of new skilled nursing facility accounts and manages the transition process for partners. They act as a bridge between strategy and execution, ensuring project timelines are met while fostering strong, trust-based relationships.
The Care Coordinator applies clinical knowledge to manage care for medically complex members, ensuring access to services and providers. They conduct assessments, develop individualized care plans, and collaborate with the care team to improve health outcomes and service efficiency.
The role involves managing high volumes of inbound and outbound calls while coordinating member intake, admissions, and discharges. You will also process referrals and prior authorizations while collaborating with hospitals, clinics, and the clinical team.
The auditor performs compliance reviews of medical and administrative documentation to identify healthcare fraud, waste, and abuse. They conduct site visits and desk audits to ensure provider adherence to state and federal policies.
The Network Contract Manager develops and maintains a competitive provider network by negotiating contracts and managing provider relationships. They are responsible for unit cost budgets, financial modeling, and ensuring network compliance with company standards.
The Workforce Planning Analyst will analyze, review, and forecast data to support operational business planning and contact center performance. They will lead projects, collaborate with cross-functional teams, and implement creative solutions to optimize resource utilization and process efficiency.
The Care Coordinator applies clinical knowledge to manage the care needs of medically complex members, ensuring access to services and providers. They conduct assessments, develop individualized care plans, and collaborate with the care team to improve health outcomes and service efficiency.
The Credit Specialist researches and resolves patient and insurance credit balances within the healthcare revenue cycle. This role involves initiating refunds, processing transfers and adjustments, and coordinating with internal teams to ensure accurate account documentation.
The role involves defining product success metrics and leveraging AI tools to analyze user engagement, retention, and business performance. You will partner with cross-functional teams to translate data into actionable insights that influence product strategy and roadmap decisions.
The analyst will provide first- and second-tier technical support, troubleshooting hardware, software, and network issues to ensure operational efficiency. They will also document support tickets, assist with user onboarding, and deploy AI-powered solutions to address business challenges.
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 facilitating access to community resources.
Assign accurate diagnostic and procedure codes for Primary Care and Family Medicine services based on clinical documentation. Monitor work queues to ensure timely coding and generate queries for physician documentation clarification.
Design and prioritize end-to-end AI solutions for healthcare provider clients, redesigning clinical, revenue cycle, and administrative workflows with appropriate human oversight. Advise client stakeholders, translate designs into implementation plans and success measures, support deployment and training, and ensure solutions align with responsible AI and governance standards.
The Strategic Client Executive manages a book of National Accounts, focusing on maintenance, growth, and profitability. They develop client-specific business plans and coordinate superior service delivery through strong intercompany relationships.
The VP of Sales Operations will lead revenue operations, commercial analytics, and distribution infrastructure to support Optum Financial Provider Products. This role is responsible for establishing operating systems, governance structures, and AI-enabled automation to scale provider acquisition and optimize commercial performance.
Lead enterprise social media and digital communications strategy, governance, operations, and tool management across UnitedHealth Group businesses. Improve processes and adoption, coordinate with legal, compliance, procurement, marketing, and other stakeholders, and support content execution, research, onboarding, and team development.
Own assigned mobile platform features and workstreams from discovery through delivery, translating stakeholder needs into requirements, prioritizing capabilities, and coordinating releases. Partner across product, engineering, security, compliance, and operations to improve mobile delivery reliability, efficiency, compliance readiness, and user experience.
Manage a panel of dual-eligible members with chronic or complex needs by assessing their medical, behavioral, functional, cultural, and social needs and developing individualized care plans. Coordinate with care teams, providers, and community resources; support services and care transitions; educate and advocate for members; and address provider and facility questions.
Lead cross-functional provider network initiatives from planning through implementation, managing timelines, risks, deliverables, stakeholders, vendors, and technology partners. Improve operational processes and reporting by analyzing data, developing dashboards and documentation, and recommending measurable improvements.
This role is responsible for securing IBMi servers and applications to prevent unauthorized access and ensuring system integrity. The position also involves managing security reporting, investigating potential breaches, and providing evidence for various regulatory audits.
The Clinical Care Team Manager leads a team of care managers while overseeing day-to-day clinical operations and program initiatives. They are responsible for performance management, ensuring compliance with contractual requirements, and coordinating workflow processes across multidisciplinary teams.
Design, develop, and deploy AI-powered agentic solutions to address complex business challenges within an enterprise platform. Manage the end-to-end lifecycle of agents, including orchestration, evaluation, and production monitoring.
Provide telephonic and telehealth clinical direction to patients, caregivers, and facility staff across various settings. Coordinate care transitions and manage both acute and chronic medical and behavioral conditions in collaboration with the interdisciplinary team.
The Patient Care Coordinator manages the initial patient intake process and coordinates infusion nursing services for Optum Infusion Pharmacy patients. They are responsible for maintaining accurate documentation, scheduling visits, and communicating effectively with patients, families, and healthcare providers.
The RN Assessor performs in-person UAS-NY assessments in members' homes to develop and manage person-centered service plans. They coordinate care strategies, initiate social service referrals, and advocate for members to ensure quality health outcomes.
Conduct thorough mental health compensation and pension evaluations for veterans in accordance with VA guidelines. Collaborate with multidisciplinary teams and provide objective, evidence-based medical opinions.
Provide high-quality child and adolescent psychiatric care through various modalities including psychotherapy, medication management, and collaborative care. Work within a multi-specialty team to deliver integrated behavioral health services across an outpatient continuum.
The consultant will provide oversight and performance evaluation for CMARC/CMHRP programs while building strategic relationships with OB providers and local health departments. They will also analyze data to identify trends and facilitate quality improvement initiatives to ensure contractual and clinical requirements are met.
The therapist will screen and assess patients for mental health and substance use disorders while providing evidence-based psychotherapeutic interventions. They are also responsible for maintaining accurate clinical documentation and tracking patient treatment progress within an integrated care setting.
The Software Engineer will design, develop, test, and maintain software applications and services within an Agile team environment. They will also build and scale AI-powered solutions, platform automations, and modern APIs to support enterprise-scale healthcare applications.
The Director of Growth & Distribution will lead the development and activation of sales and marketing campaigns for Optum Financial Provider Products. They will identify new growth sources, build strategic partnerships, and collaborate across internal teams to improve provider engagement and product adoption.
The Sales Enablement Manager will develop sales playbooks, training materials, and launch readiness resources to support provider-facing teams. This role also involves maintaining content governance, managing sales communications, and capturing field feedback to improve seller effectiveness.
The Clinical Coordinator RN manages the initial patient intake process, including assessing referrals, verifying physician orders, and coordinating nursing care needs. They act as a clinical liaison to ensure the quality and continuity of patient care while maintaining compliance with regulatory standards.
The role involves managing provider networks, assisting with claims, and enhancing call quality while nurturing positive relationships between the health plan and providers. You will also contribute to the design of programs and provide training to external providers to improve network composition.
The Senior Rebate Audit Analyst facilitates end-to-end management of external client audits focused on rebate administration and billing. They act as a liaison between internal teams and external audit firms to ensure accurate financial reconciliation and timely resolution of audit findings.
The Associate Healthcare Advocate manages provider groups within a defined territory to ensure compliance with network requirements and program implementation. They partner with clinical and administrative staff to improve documentation accuracy, close gaps in care, and educate providers on quality programs.
Lead the strategy, design, and technical delivery of enterprise software platforms and AI-powered solutions. Collaborate with cross-functional teams to modernize procurement capabilities and drive operational continuous improvement.
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 Senior IBMi Engineer will evaluate system specifications and infrastructure to enhance reliability, scalability, and performance. They will also lead complex infrastructure projects and collaborate with cross-functional teams to solve technical problems and automate workflows.
The role involves supporting and validating the lifecycle management of capitation agreements with providers while conducting performance analysis and reporting. You will also interface with senior leadership to manage revenue recovery efforts and create SQL queries to support business needs.
The Integrated Care Coordinator serves as the primary care manager for older adults with complex medical and behavioral health needs. They conduct comprehensive needs assessments, develop person-centered care plans, and collaborate with internal teams and community resources to improve health outcomes.
The Sales Account Manager is responsible for enrolling Medicare beneficiaries into the UnitedHealthcare Institutional Special Needs Plan by managing account strategies and engaging facility personnel. They must document all sales activities to ensure compliance with Medicare Marketing Guidelines while meeting established enrollment targets.
The VP of Payer Contracting will lead the development and execution of strategic payer and preferred provider relationships within the New England market. This role involves managing high-performing teams, negotiating value-based reimbursement arrangements, and ensuring financial sustainability across provider networks.
The Care Coordinator applies clinical knowledge to manage the care needs of medically complex members, ensuring access to services and providers. They conduct assessments, develop individualized care plans, and collaborate with multidisciplinary teams to improve health outcomes and service efficiency.
The Sr. Software Engineer will design, develop, and deploy end-to-end data integration solutions for clinical reporting platforms while driving the adoption of AI tools. They are also responsible for providing production support, resolving complex technical issues, and maintaining system availability.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and social determinants of health.
The Care Coordinator applies clinical knowledge to manage the care needs of medically complex members, ensuring access to services and providers. They conduct assessments, develop individualized care plans, and collaborate with the care team to improve health outcomes and reduce hospital encounters.
The Manager, Market Advocacy acts as a strategic liaison between market leadership, providers, and shared services to drive operational excellence. This role leads cross-functional efforts to resolve complex operational issues, manage escalations, and implement sustainable solutions to improve provider and customer experiences.
The Patient Liaison coordinates services between OptumRx and patients by managing recruitment, retention, and educational activities. They are responsible for developing consumer relationships, facilitating patient workshops, and identifying new business opportunities within the bleeding disorders community.
Wellness Coordinators provide care coordination and administrative support to members with behavioral health and substance abuse needs. They act as primary care navigators by identifying gaps in care, addressing social determinants of health, and developing individual care plans.
The Clinical Transformation Consultant leads multi-disciplined practice performance improvement initiatives to achieve quality, efficiency, and utilization goals within value-based care programs. They serve as the primary clinical contact for physician practices, utilizing data analytics to drive transformational change and monitor milestone achievement.
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 Associate Director leads clinical operations for itemized bill reviews, managing staff to achieve productivity and financial objectives. They serve as the primary clinical subject matter expert, influencing product strategy and ensuring compliance with CMS guidelines.
The Senior Clinical Transformation Consultant leads multi-disciplinary practice improvement initiatives to enhance quality, efficiency, and utilization within ACO and value-based programs. They act as the primary clinical point of contact, facilitating meetings and implementing action plans to achieve performance milestones.
The Network Contract Manager is responsible for developing and maintaining a competitive provider network by negotiating contracts with physicians and medical groups. They manage unit cost budgets, performance reporting, and foster strong business relationships with providers to ensure network stability and affordability.
The MCH Manager provides operational, clinical, and strategic oversight for the maternity case management program, leading staff in member outreach, risk stratification, and care coordination. They partner with market leadership and providers to ensure regulatory compliance, improve member engagement, and advance maternal and infant health outcomes.
The Advisory Services Analyst provides technical administration and day-to-day support for digital imaging information systems across clinical departments. They consult with users to define business processes, troubleshoot complex technical issues, and develop automated solutions to improve operational efficiency.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
The RN Care Coordinator manages patient care transitions, high-risk patient management, and referral coordination within an ACO practice. They conduct telephonic outreach, provide patient education, and collaborate with clinical teams to improve health outcomes.
Conduct behavioral health treatment record audits, provide feedback, and initiate and monitor provider corrective action plans. Analyze quality metrics, develop and present improvement recommendations, support quality initiatives, and coordinate customer audits, including occasional on-site provider visits in Tooele and Salt Lake Counties.
Own the technical product strategy and roadmap for a large curated healthcare claims data layer, translating business and conversational AI needs into data specifications, schemas, and prioritized features. Lead cross-functional teams to deliver secure, governed, high-performance AI-ready data products and pipelines, while monitoring quality, usage, and performance.
Build and maintain a high-performing specialty provider network by recruiting providers, negotiating contracts, and ensuring network adequacy, compliance, and alignment with organizational strategy. Manage provider relationships and coordinate with operational, clinical, finance, and pricing teams to support implementation, performance improvement, and appropriate reimbursement arrangements.
Support core accounting activities, including general ledger review, account reconciliations, financial analysis, journal entries, and financial close, while ensuring compliance with GAAP. Assist with projects and business integrations, advise business partners on accounting impacts, prepare audit documentation, and improve operational efficiency.
Lead AI engineering teams in developing AI and large language model applications for clinical platforms, while providing software engineering leadership and mentoring development teams. Partner with stakeholders to deliver projects end to end, and oversee production support, troubleshooting, and deployment activities.
Design, develop, and deploy scalable backend microservices and cloud-native solutions using Python and FastAPI. Utilize AI tools to automate engineering processes and build intelligent capabilities into enterprise-scale healthcare systems.
Support and validate the lifecycle management of provider capitation agreements while conducting performance analysis and reporting. Interface with providers and senior leadership to manage revenue recovery efforts and maintain SQL queries.
The Field Services Tech is responsible for taking ownership of tickets, providing support to end-users via phone, email, or in person, and documenting all resolutions. They will also assist with basic networking tasks, hardware installation, and ensure adherence to Service Level Agreements.
The Technical Product Manager will partner with cross-functional teams to define and deliver innovative digital healthcare experiences. They are responsible for maintaining an executable feature backlog and translating business needs into technical requirements using AI-enabled tools.
Wellness Coordinators provide care coordination and administrative support to members with behavioral health and substance abuse needs. They act as primary care navigators by screening for gaps in care, developing individual care plans, and connecting members with community resources.
Evaluate and manage patient concerns through telephone and virtual encounters while determining appropriate clinical dispositions. Maintain operational workflows, document interactions in the electronic medical record, and provide clinical guidance to support staff.
The role involves identifying and extracting relevant clinical data to assign accurate medical codes while ensuring compliance with federal and professional guidelines. Additionally, the position requires performing medical coding audits, mentoring team members, and managing multiple work demands to meet productivity standards.
The Care Coordinator serves as the primary manager for members with chronic and complex health needs, conducting assessments and developing person-centered care plans. They collaborate with internal teams and community providers to facilitate service access, manage care transitions, and support member self-management.
The Outreach Care Coordinator organizes, collects, and reports health and social information through member home visits and community outreach. They serve as a consultant to care teams, conduct member assessments, and facilitate access to preventive and disease management services.
The Specialty Pharmacy Technician is responsible for interpreting and entering prescription data into the pharmacy system while managing inbound and outbound calls with patients and providers. They must maintain high levels of accuracy and productivity while navigating multiple computer systems to provide clinical information.
The Care Coordinator serves as the primary manager for members with chronic and complex health needs, conducting comprehensive assessments and developing person-centered care plans. They collaborate with internal teams and community providers to facilitate service delivery, manage care transitions, and advocate for member needs.
The Care Coordinator serves as the primary manager for members with chronic needs, conducting comprehensive assessments and implementing person-centered care plans. They collaborate with internal teams and community providers to facilitate care transitions, remove obstacles to health, and advocate for member needs.
The Care Coordinator serves as the primary manager for a panel of members with chronic health needs, conducting assessments and implementing person-centered care plans. They collaborate with internal teams and community resources to remove barriers to care and support member health outcomes.
The Care Coordinator serves as the primary manager for a panel of members with chronic and complex health needs, conducting comprehensive assessments and implementing person-centered care plans. They collaborate with internal teams and community providers to remove obstacles to care and support members in achieving improved health outcomes.
The Care Coordinator serves as the primary manager for members with chronic health needs, conducting assessments and developing person-centered care plans. They collaborate with internal teams and community providers to remove barriers to care and support successful transitions between health settings.
The Care Coordinator serves as the primary manager for a panel of members with chronic and complex health needs, conducting assessments and implementing person-centered care plans. They collaborate with internal teams and community providers to remove barriers to care and support successful transitions between health settings.
The Care Coordinator serves as the primary manager for a panel of members with chronic and complex health needs, conducting comprehensive assessments and implementing person-centered care plans. They collaborate with internal teams and community resources to remove obstacles to care and support members in achieving improved health outcomes.
The Care Coordinator serves as the primary manager for a panel of members with complex health needs, conducting comprehensive assessments and implementing person-centered care plans. They collaborate with internal teams and community providers to facilitate service access, manage care transitions, and advocate for member needs.
The Home Infusion Nurse provides clinical care and education to patients receiving parenteral medications in home and ambulatory settings. They collaborate with a multi-disciplinary team to manage vascular access, administer medications, and maintain thorough clinical documentation.
Manage a panel of dual-eligible members with chronic or complex needs by assessing medical, behavioral, functional, cultural, and social needs and developing individualized care plans. Coordinate with care teams, providers, and community resources; support services and care transitions; educate and advocate for members; and direct provider and facility questions to appropriate resources.
Respond to behavioral health calls, texts, and chats by triaging needs, conducting clinical and risk screenings, providing crisis intervention, and connecting people with appropriate care. Document interactions, process after-hours treatment pre-authorizations, maintain safety and compliance, and support operational and performance requirements.
The Care Coordinator serves as the primary manager for a panel of members with chronic health needs, conducting comprehensive assessments and developing person-centered care plans. They collaborate with internal teams and community providers to remove barriers to care and support successful transitions for members.
Design, build, and optimize scalable Azure data and AI platforms, including batch and streaming pipelines, feature stores, and production workflows for machine learning models. Ensure data quality, governance, security, and reliability while developing reusable engineering frameworks, supporting production systems, and deploying responsible AI solutions.
Provide real-time clinical guidance, education, and support to members, resolve health-related concerns, and connect members with appropriate internal specialists and programs. Document interactions, advocate for members in complex situations, and help develop and improve program processes and service performance.
Support UMR CARE members and their families in navigating the health care system through education, outreach, care coordination, referrals, and assistance with adverse determinations and appeals. Conduct pre-admission counseling and discharge-planning outreach, participate in treatment-plan discussions, and maintain complete documentation and activity tracking.
The Senior Clinical Admin Nurse provides individualized support to members by helping them navigate the health care system and managing their health concerns. They also coordinate care, facilitate discharge planning, and ensure accurate documentation of all clinical activities.
Handle 60–80 incoming calls per day from customers and pharmacies about home-delivery pharmacy services and pharmacy benefits, asking relevant questions, listening actively, and documenting information in computer systems. Make occasional outbound follow-up calls to customers.
The Territory Leader is responsible for managing and growing a provider market client territory to achieve above-market growth and profitability. They will lead account management teams, drive strategic initiatives, and foster executive-level relationships with C-Suite stakeholders.
The Strategic Account Executive manages ongoing client relationships, service delivery, and contract renewals for an assigned book of business. They act as a client-facing advocate, coordinating with internal functional areas to implement benefits and address service needs.
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 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.
The Clinical Care Coordinator manages a caseload of complex members by conducting comprehensive needs assessments and developing individualized, person-centered care plans. They collaborate with internal teams and community partners to provide support for medical, behavioral, and socioeconomic needs.
The Production Operations Specialist coordinates end-to-end print production for provider and member notification programs, including data preparation and vendor management. This role ensures timely, accurate, and compliant execution of regulatory and contractual communications while maintaining production documentation.
The Principal System Db2 Software Engineer is responsible for the installation, configuration, and lifecycle management of Db2 components within a large z/OS mainframe environment. The role involves optimizing system performance, managing disaster recovery processes, and providing technical support during critical incident responses.
The Director of Pharmacy Value Economics leads the national measurement, forecasting, and realization of pharmacy value, focusing on manufacturer-funded programs and rebate economics. This role collaborates with cross-functional teams to translate financial and market data into enterprise-level recommendations that balance affordability, access, and quality.
The Director owns the enterprise operating model, governance, and execution strategy for manufacturer-funded medical benefit rebate programs. This role is accountable for end-to-end rebate value capture, including eligibility determination, reconciliation, compliance, and financial performance reporting.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatments. They are also responsible for maintaining accurate electronic medical records and tracking patient treatment responses.
The Junior Solutions Architect supports business recompetes and modernization programs by developing technical approaches and writing winning proposal responses. They partner with senior architects and business leaders to define technology roadmaps and ensure solutions align with customer needs and cost requirements.
The Senior Investigator gathers and analyzes data to identify and document fraud, waste, and abuse (FWA) schemes within healthcare claims. They collaborate with clinical consultants, law enforcement, and legal partners to articulate findings and ensure compliance with regulatory standards.
The Senior Investigator gathers and analyzes data to identify and document fraud, waste, and abuse within healthcare claims. They collaborate with clinical consultants, legal teams, and law enforcement to conduct interviews and ensure compliance with regulatory standards.
The Solutions Architect leads the development of technical solutions for business opportunities, engaging with stakeholders to define architecture and strategy. They are responsible for writing technical responses for RFPs and providing leadership throughout the pursuit lifecycle to ensure successful project delivery.
The Field Account Manager serves as the primary client relationship manager and service owner for self-funded and TPA clients, ensuring proactive service delivery and strategic partnership. This role involves managing service escalations, conducting customer training, and facilitating engagement events to drive satisfaction and retention.
The Community Health Worker will conduct field-based outreach to engage health plan members, provide education, and coordinate clinical service visits. They are responsible for identifying barriers to care, documenting engagement in medical records, and optimizing health plan utilization.
The RN Clinical Care Coordinator manages a panel of members with complex medical and behavioral needs by conducting comprehensive assessments and developing person-centered care plans. They collaborate with internal teams and community providers to facilitate care transitions, provide health coaching, and advocate for member needs.
Provide accurate inpatient coding services by identifying appropriate ICD-10-CM and PCS codes while adhering to official guidelines. Maintain high standards for documentation, perform chart reviews, and provide feedback to providers to ensure optimal health system outcomes.
Manage contracting efforts for network expansion projects and guide unit cost management activities through financial modeling and analysis. Collaborate with ancillary providers to collect and analyze data while ensuring network adequacy and compliance with company standards.
The analyst will identify and document fraudulent or erroneous pharmacy claims, prepare audit reports, and determine overpayments. They will also collaborate with Claims Administration to manage re-billing and ensure compliance with regulatory requirements.
The RN Clinical Care Coordinator manages a panel of members with complex medical and behavioral needs by conducting assessments and developing person-centered care plans. They collaborate with internal teams and community resources to provide education, support care transitions, and advocate for member needs.
The Clinical Pharmacist will lead prospective clinical review activities for specialty medications and infusions to optimize utilization, affordability, and patient outcomes. They will partner with cross-functional teams to implement medication management strategies and ensure compliance with regulatory and clinical standards.
The Chair provides clinical leadership for the Behavioral Health Division, focusing on aligning clinical activities with access, service, and quality standards. They are responsible for executing organizational goals, managing departmental budgets, and supervising clinical staff to ensure high-quality, patient-centric care.
The role involves accurately determining CPT and ICD-10 edits for professional coding services while ensuring compliance with coding policies. Additionally, the coder will provide documentation feedback to physicians and manage medical necessity and denial accounts.
The Regional Account Manager will develop and execute territory sales plans to achieve targets while coordinating with strategic manufacturing partners. They are responsible for managing medical practice accounts, solving client issues, and maintaining business through consultative sales processes.
The Director of Client Services oversees and develops a high-quality contracted provider network while driving strategic vision and performance goals. They manage a team of account managers and collaborate with cross-functional departments to ensure effective healthcare delivery and financial success.
The role involves managing unit cost budgets, financial modeling, and performance reporting to ensure stable and competitive provider networks. You will also lead complex contract negotiations and oversee the development of provider specialties while ensuring compliance with company standards.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and social determinants of health.
You will lead the design, development, and deployment of enterprise-scale data engineering solutions and AI-powered data pipelines. You will also collaborate with cross-functional teams to optimize ETL/ELT architectures and drive data governance across healthcare data sources.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams, medication reconciliation, and point-of-care testing. Collaborate with primary care providers to address care gaps and educate patients on disease processes and social determinants of health.
The role involves analyzing clinical quality, utilization, and population health data to support regulatory reporting and quality improvement initiatives. You will develop reports, dashboards, and actionable recommendations to guide operational and clinical leadership.
Architect, build, and maintain scalable data pipelines and AI-powered analytics solutions on Azure cloud infrastructure. Ensure the security of cloud environments by managing network configurations, access controls, and remediating infrastructure vulnerabilities.
The ECSA serves as the enterprise technical authority for Epic infrastructure, managing client deployment, interoperability services, and API management. This role focuses on ensuring secure, highly available access to Epic applications while driving technical strategy and system optimization.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatment. They are also responsible for maintaining accurate electronic medical records and monitoring patient progress throughout the treatment journey.
Review provider documentation and medical records to assign accurate diagnosis and procedure codes for cardiology services. Manage coding edits, claim denials, and audit findings while maintaining productivity and quality standards.
The Patient Service Representative screens incoming patient inquiries and resolves issues related to patient satisfaction, flow, and administrative needs. They also facilitate updates to patient records and maintain effective communication across the interdisciplinary team.
The Care Coordinator acts as the primary care manager for members with serious mental illness, completing health risk assessments and individualized service plans. They collaborate with physicians, behavioral health providers, and community partners to ensure members receive necessary medical and socioeconomic support.
The Field Care Coordinator manages a panel of members by conducting comprehensive needs assessments and developing person-centered care plans. They collaborate with internal teams and community resources to support member health, facilitate care transitions, and provide ongoing education and coaching.
The Technical Product Manager will design, deliver, and optimize business applications using the Microsoft Power Platform and Dynamics 365. They will facilitate stakeholder sessions to translate business needs into scalable technical solutions while managing backlogs and production support.
The 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 facilitate quality improvement initiatives and provide technical assistance to ensure contractual requirements and positive health outcomes are met.
The Clinical Program Director designs and leads technology-enabled cardiovascular clinical programs to improve affordability, health outcomes, and the member experience. This role provides clinical leadership for heart failure care pathways and collaborates across departments to optimize operational efficiency and clinical performance.
The Care Coordinator applies clinical knowledge to manage care for medically complex members, ensuring access to services and coordinating across the continuum of care. They perform assessments, develop individualized care plans, and collaborate with multidisciplinary teams to improve health outcomes and service efficiency.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
The RN Field Clinical Care Coordinator conducts comprehensive needs assessments and develops individualized care strategies for members. They act as a single point of contact to manage care plans and coordinate with internal teams and community resources.
The Senior Investigator gathers and analyzes data to identify fraud, waste, and abuse (FWA) schemes while maintaining compliance and auditability in case tracking systems. They collaborate with clinical consultants, legal teams, and law enforcement to conduct interviews and articulate investigation findings.
The Sales Account Manager will drive membership growth for the Essential Plan by building strategic relationships with key market influencers and community institutions. Responsibilities include conducting product presentations, managing sales pipelines, and enrolling eligible members within the assigned territory.
The Account Liaison is responsible for creating and tracking patient escalation reports, monitoring prior authorization expirations, and managing clinical tasks. They work closely with sales and operational partners to ensure timely communication and support for the Account Managers in the field.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address gaps in care and educate members on disease processes and health management.
Manage performance target setting, reporting, and financial models while negotiating provider contracts to ensure broad network access. Facilitate cross-functional issue resolution and influence network growth planning activities.
The Senior Associate General Counsel will act as internal antitrust counsel, providing legal guidance on M&A, litigation, and complex business transactions. They will also develop legal strategies, conduct antitrust training, and advise on competition issues across the enterprise.
The Senior Investigator is responsible for identifying, investigating, and preventing healthcare fraud, waste, and abuse by analyzing claims data and conducting field interviews. They must manage a high volume of cases, maintain accurate documentation, and participate in legal proceedings as required.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatment. They are also responsible for maintaining accurate electronic medical records and participating in regular team consultations.
The lead investigator is responsible for triaging, investigating, and resolving potential instances of healthcare fraud and abusive conduct by medical providers. They also perform root-cause analysis, mentor junior investigators, and present case findings to leadership and legal entities.
The clinical reviewer analyzes hospital facility bills and conducts forensic reviews to identify payment adjustments. They also research clinical standards and maintain documentation in compliance with departmental and HIPAA guidelines.
The Associate Director will guide the development of competitive provider networks and manage unit cost performance through financial modeling and pricing analysis. They are responsible for developing market-level strategies and resolving complex operational or technical problems within the network contracting function.
The Senior Product Analyst will support the management, monitoring, and optimization of member and provider communications across multiple channels. This role involves coordinating deployment updates, ensuring regulatory compliance, and managing vendor relationships to maintain operational excellence.
The Community Health Worker will conduct field-based outreach to engage members, provide education on health benefits, and coordinate clinical services. They are responsible for documenting engagement in electronic medical records and identifying community resources to help members overcome barriers to care.
Provide telephonic and telehealth clinical direction to patients, caregivers, and facility staff while managing acute and chronic conditions. Coordinate care transitions and document comprehensive assessments in compliance with CMS regulations.
The medical coder will identify appropriate ICD-10, CPT, and modifier assignments for emergency department facility services while adhering to official coding guidelines. They are also responsible for maintaining required levels of coding quality and productivity while participating in department meetings and educational events.
The role involves promoting product portfolios to benefits brokers, negotiating sales, and driving strategies to increase enrollment and case size. The representative will also collaborate with management on market objectives and educate support staff on plan designs.
The role involves managing, optimizing, and maintaining Azure cloud infrastructure while automating deployments using Infrastructure as Code methodologies. Additionally, the engineer will collaborate with security teams to remediate vulnerabilities and develop AI-powered solutions to address complex business challenges.
The Community Health Worker will conduct field-based outreach to engage health plan members, educate them on benefits, and coordinate clinical services. They are responsible for removing barriers to care, documenting engagement in electronic medical records, and optimizing schedules to improve health outcomes.
The role involves managing unit cost budgets, financial modeling, and performance reporting to ensure geographically competitive and stable provider networks. You will also lead complex contract negotiations and provide guidance on reimbursement structures and network development 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.
The role involves obtaining and reviewing post-discharge medical records and navigating electronic medical record systems to support patient care. Responsibilities also include conducting member outreach to update medication lists and coordinating with providers to resolve medication discrepancies.
The clinician provides telephonic and telehealth care, managing acute and chronic conditions for patients across various settings. They coordinate care between caregivers, facilities, and providers while ensuring all clinical encounters are documented in compliance with CMS regulations.
The Account Executive serves as the primary relationship owner for State Government clients, managing portfolios and driving growth across Optum's healthcare and technology solutions. They lead multi-year account planning and act as a trusted advisor to senior state officials to ensure client satisfaction and retention.
The Care Manager assesses, plans, and implements individualized care management interventions while serving as a single point of contact for members. They also identify community-based service referrals and advocate for members to ensure their needs are met within the integrated care model.
The Account Manager serves as the primary liaison for residential and healthcare partner accounts, focusing on relationship management, service continuity, and growth. They are responsible for maintaining a quarterly outreach cadence, resolving operational and billing issues, and collaborating with internal teams to support account onboarding.
The Senior Fraud Investigator is responsible for gathering facts, monitoring investigation status, and collaborating with clinical consultants to identify fraud, waste, and abuse. They also conduct interviews, review medical documentation, and communicate findings to legal and stakeholder teams.
The Plan Pharmacy Director is responsible for setting the strategic direction, operational execution, and financial oversight of pharmacy programs for the UnitedHealthcare Community Plan of Washington. This role serves as the primary subject matter expert and point of contact for internal and external stakeholders regarding pharmacy benefits, compliance, and affordability initiatives.
The analyst determines the accuracy of provider claims by comparing them against medical records and state/government compliance guidelines. They are responsible for identifying aberrant billing patterns, managing caseloads, and providing clinical expertise for pre-payment claim reviews.
Define and drive the strategic vision, feature trade-offs, and execution roadmap for the Enterprise Rewards multi-tenant platform. Partner with cross-functional teams including engineering, science, and legal to deliver multi-year platform initiatives and technical requirements.
The Physician Advisor conducts medical necessity reviews, facilitates peer-to-peer discussions with payor medical directors, and manages appeals. They also ensure clinical care aligns with regulatory standards and evidence-based medicine while collaborating with hospital case managers.
The role involves developing scalable data pipelines, microservices, and ETL/ELT solutions within the Azure cloud environment. You will also mentor other engineers and collaborate with stakeholders to implement AI-based solutions and optimize data reliability.
The Pharmacy Audit Analyst conducts onsite and desktop audits to identify discrepant pharmacy claims and ensure compliance with regulatory requirements. They are responsible for gathering documentation, reporting findings to providers, and performing quality control on completed audits.
The medical coder is responsible for assigning accurate diagnostic and procedure codes for palliative care services based on clinical documentation. They must also monitor work queues to ensure timely coding and generate queries for physician documentation clarification.
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 Community Health Worker assesses, plans, and implements individualized care strategies while managing referrals for social services. They act as a liaison for Medicaid/Medicare members to ensure access to care and address social determinants of health.
The representative will provide excellent customer service by resolving patient billing issues and managing accounts in compliance with departmental policies. They will also participate in team meetings and collaborate with leadership to improve processes and support financial objectives.
The Health Engagement Coach collaborates with consultants to develop and implement health strategies while providing one-on-one coaching for lifestyle interventions. They are responsible for monitoring employee health goals, conducting biometric screenings, and delivering educational presentations to improve health outcomes.
The Senior Data Engineer will ensure the reliability and operational excellence of critical data systems by monitoring pipelines and leading incident resolution. They will also leverage AI tools to automate workflows and drive strategic innovation across the healthcare data ecosystem.
The Nurse Practitioner provides telephonic and telehealth care, managing acute and chronic conditions for patients in various settings. They coordinate care across the interdisciplinary team and ensure all clinical encounters are documented in compliance with CMS regulations.
Perform concurrent and retrospective chart reviews to improve clinical documentation completeness and accuracy. Actively communicate with providers to clarify documentation requirements and ensure appropriate diagnosis coding based on severity of illness.
Provide telephonic and telehealth clinical care to patients, caregivers, and facility staff across various settings. Coordinate care transitions and manage both acute and chronic medical and behavioral conditions in collaboration with the interdisciplinary team.
The Medical Director is responsible for the clinical review and adjudication of appeals and grievances for various health plan products. They also communicate with internal medical directors and regulatory bodies to ensure compliance and quality in medical service determinations.
The Community Health Worker assesses, plans, and implements individualized care strategies while managing referrals for social services. They act as a liaison for Medicaid/Medicare members to ensure access to care and address social determinants of health.
The Senior CICS System Programmer will configure, maintain, and optimize CICS environments on IBM z/OS systems across multi-LPAR and Parallel Sysplex architectures. They will also manage CICS regions, troubleshoot stability issues, and contribute to disaster recovery planning and operational automation.
The Senior Medical Coder performs concurrent reviews of coding rules to ensure accurate CPT and E/M coding for maximum reimbursement. They also manage coding edits, resolve denials, and mentor team members to maintain high coding quality standards.
The Lead Software Engineer will drive operational excellence, platform reliability, and system performance for enterprise-scale applications. Responsibilities include leading incident response, managing release activities, and developing AI-powered solutions to modernize legacy systems.
The Community Health Worker assesses, plans, and implements individualized care strategies while acting as a liaison for Medicaid/Medicare members. They manage care plans, initiate social service referrals, and address social determinants of health through home and social assessments.
The Director will lead the transformation and delivery of a unified AI product portfolio across the Medicare sales and shopping ecosystem. This role involves defining product strategy, managing cross-functional teams, and ensuring seamless integration of AI-enabled experiences for consumers and agents.
The Patient Service Representative screens incoming patient inquiries and resolves issues related to patient satisfaction, flow, and administrative needs. They also maintain accurate patient records and facilitate effective communication between patients, providers, and the interdisciplinary team.
The Associate Director leads Medicare Part D Star Ratings strategy and performance management by collaborating with clinical, analytics, and operations teams. They are responsible for mentoring staff, interpreting CMS regulatory guidance, and delivering actionable insights to improve client quality performance.
The medical coder will be responsible for coding ancillary facility encounters such as lab, therapy, and radiology while ensuring documentation supports code selection. They must also resolve facility edits and maintain established quality and productivity standards in a production environment.
The Account Executive is responsible for the growth, retention, and strategic management of an assigned portfolio of clients within the PBM environment. They act as a liaison between sales, operations, and customers to ensure satisfaction and identify upsell opportunities.
The Behavioral Health Care Advocate manages case coordination and treatment plans for members on SED and Autism waivers. They conduct patient assessments, monitor service plan implementation, and collaborate with providers to ensure effective care delivery.
Design, develop, and maintain scalable data pipelines, backend services, and cloud-native software applications using C# and .NET. Collaborate with cross-functional teams to translate technological advancements into scalable, production-ready healthcare solutions.
The auditor performs outpatient facility coding audits to ensure compliance with ICD-10-CM, CPT, and billing standards while identifying trends and root causes of non-compliance. They also provide quality assurance oversight, conduct independent reviews, and develop educational materials based on audit findings.
The Provider Liaison Pharmacist is responsible for conducting provider education, training, and academic detailing to ensure compliance with TennCare programs. They also provide audit assistance and work closely with the clinical team to manage utilization programs and provider relations.
The Behavioral Health Advocate will conduct home and community-based visits to support Medicaid members with care transitions, medication reviews, and resource connections. They act as an intermediary between providers and members to improve health outcomes and reduce hospitalizations.
The Community Health Worker identifies and initiates referrals for social service programs while managing care strategies for Medicaid members. They conduct field visits to assess patient needs, advocate for families, and document all interactions to ensure quality coordinated care.
The analyst determines the accuracy of medical claims by comparing submitted documentation against coding requirements and clinical policies. They are responsible for identifying billing patterns, managing a caseload, and ensuring compliance with state and federal mandates.
The Oracle AI Agent Studio Engineer is responsible for designing, building, and supporting AI-powered solutions within Oracle Fusion Cloud. This role involves partnering with business and technical teams to translate requirements into scalable, secure, and maintainable AI-enabled workflow automations.
The Support Coordinator manages a panel of members with intellectual or developmental disabilities by conducting comprehensive needs assessments and developing person-centered care plans. They collaborate with internal teams and community providers to implement these plans and ensure members receive appropriate medical, behavioral, and socioeconomic support.
The Medical Director is responsible for the clinical review and adjudication of appeals and grievances for various health insurance products. They also manage regulatory responses and collaborate with regional medical directors to address network and quality issues.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and social determinants of health.
Conduct comprehensive in-home health assessments for Medicare Advantage and other plan members to identify and document diagnoses. Educate members on disease processes and medications while collaborating with primary care providers to address gaps in care.
You will design, build, and optimize next-generation cloud contact center solutions while migrating from legacy systems to AWS Connect. This involves architecting complex call routing strategies and maintaining backend integrations using AWS Lambda and various programming languages.
The DevOps Engineer will design, implement, and maintain cloud infrastructure with a focus on Azure and Kubernetes environments. They will also manage infrastructure as code, establish observability solutions, and collaborate with teams to ensure security and cost optimization.
The Senior Investigator is responsible for identifying, investigating, and preventing healthcare fraud, waste, and abuse by analyzing claims data and conducting interviews. They must manage complex cases, maintain accurate documentation, and collaborate with regulatory partners to ensure compliance.
The Senior Technical Writer will manage complex technical content and information architecture for the company's internal healthcare platform. They will also lead cross-team content reviews, mentor writing staff, and ensure structural consistency across all documentation sets.
The RN Health Coordinator will assess, plan, and implement individualized care strategies while serving as a single point of contact for patients in the community. They will advocate for patient needs and communicate essential health information to stakeholders to ensure quality coordinated care.
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, collaborate with regulatory partners, and participate in legal proceedings as required.
The analyst will maintain and optimize medication records, formularies, and workflows within the Epic Willow system. They will also collaborate with clinical teams to resolve system issues and ensure compliance with regulatory and safety standards.
The Technical Writer will produce tutorials, how-to guides, and release documentation for internal engineering platforms. They will collaborate with engineering teams to ensure technical accuracy and maintain documentation through product updates and user feedback.
Lead the design, development, and deployment of AI-powered solutions and intelligent automation to drive business outcomes. Partner with cross-functional teams to prototype and scale emerging AI technologies while establishing engineering best practices.
Design, develop, and deploy AI-powered solutions and intelligent automation to drive business outcomes and operational efficiency. Collaborate with cross-functional teams to prototype and scale emerging AI technologies while establishing governance and best practices.
This role provides clinical account management support to National Account customers, focusing on strategic planning, medical performance, and cost reduction. The position involves collaborating with inter-disciplinary teams to analyze clinical data and present recommendations to improve health outcomes and member documentation.
The Senior Director is responsible for developing and executing medical contracting strategies to expand payer access and improve reimbursement across PCS Pharmacies. This role involves leading strategic negotiations, managing relationships with national and regional health plans, and collaborating with cross-functional teams to drive profitability and growth.
The role involves expanding medical payer access for Optum Specialty Pharmacy through the development, negotiation, and management of medical benefit contracts. You will identify access gaps, prioritize payer opportunities, and collaborate with cross-functional teams to drive execution of contracting strategies.
The Outpatient Therapist will screen, assess, and provide evidence-based treatment for patients with various mental health and substance abuse conditions. They are also responsible for maintaining accurate clinical documentation and tracking patient treatment progress within an electronic health record system.
The Senior Software Engineer will design, build, and deploy enterprise-scale AI-powered data solutions and automated ETL workflows. They will collaborate with cross-functional teams to optimize cloud database performance and maintain big data infrastructure.
The Associate Director will lead the development and management of provider networks, focusing on unit cost performance and competitive pricing. They are responsible for negotiating contracts, maintaining business relationships with providers, and applying financial modeling to ensure network stability.
The Associate Director will lead the development and support of provider networks through financial modeling, contract negotiation, and unit cost management. They are responsible for maintaining a geographically competitive network while ensuring compliance with company standards and business objectives.
The Sr Provider Relations Advocate manages the Florida SMMC provider network by evaluating and negotiating contracts while ensuring network adequacy and compliance. They also provide education, support credentialing, and maintain strong business relationships with ancillary and home-based service providers.
The clinician will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatments like CBT and DBT. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment progress.
Design, develop, and maintain advanced Power BI dashboards while integrating data from Azure and Databricks. Collaborate with stakeholders to translate business requirements into technical solutions and optimize data models for performance.
Provide evidence-based behavioral health treatment for primary care patients with co-occurring medical or substance use conditions. Collaborate with primary care teams and specialists to create and implement comprehensive treatment plans.
Provide behavioral health treatment for primary care patients with co-occurring medical conditions and mild substance use disorders. Collaborate with the behavioral medicine team and primary care providers to create and implement effective treatment plans.
The Lead AI/ML Engineer will define and execute the AI/ML engineering roadmap while providing technical leadership for initiatives including Generative AI, NLP, and Predictive Analytics. They will design, build, and deploy production-ready AI systems and establish end-to-end MLOps pipelines to drive scalable healthcare solutions.
The clinician will screen and assess patients for mental health and substance abuse disorders while providing evidence-based psychotherapy treatments. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment progress.
Develop and maintain complex Quadient Workflow Designer solutions including automation, business rules, and metadata-driven processing. Integrate Quadient solutions with enterprise systems, cloud platforms, and high-volume document production environments.
The Senior Manager will lead the design, implementation, and management of Identity & Access Management (IAM) systems while ensuring compliance with security and privacy regulations. They will also provide technical leadership, mentorship, and guidance to engineering teams to drive organizational efficiency and best practices.
The Medical Director provides leadership and oversight for the claims review program, ensuring the quality and effectiveness of medical services. They act as a liaison between the organization and providers, conducting clinical reviews and participating in appeals and policy development.
The 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 collaborate with state and federal partners to address misconduct.
The M&R Coding Clinical Investigator determines the accuracy of provider claims by comparing them against medical records and established coding guidelines. They are responsible for identifying aberrant billing patterns, ensuring compliance with state and federal mandates, and providing clinical expertise for pre-payment claim reviews.
Participate in a primary care pathway program while completing residency training to gain experience in value-based care models. Engage in mentorship and virtual or in-person training sessions to prepare for a post-residency career at Atrius Health.
The Community Health Worker acts as a liaison for Medicaid members, providing home assessments, social support, and health education. They spend 50-75% of their time in the field engaging with members to ensure access to appropriate care and community resources.
The 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 cloud-native solutions while managing team deliverables and collaborating with product owners.
The Provider Relations Advocate manages relationships with HCBS providers to resolve claims, authorization, and contract-related issues. They also conduct provider education and outreach to ensure network adequacy and operational efficiency.
The Care Manager will assess, plan, and implement individualized care interventions while serving as a single point of contact for members. They will advocate for member needs and coordinate healthcare and community-based services to ensure quality care delivery.
The radiologist will perform general radiology duties including radiography, fluoroscopy, and procedures. They will also be responsible for the interpretation of ultrasound and general body CT scans within a multi-specialty clinic environment.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams, medication reconciliation, and vital signs. Identify health gaps, educate patients on disease processes, and collaborate with primary care providers to improve health outcomes.
The role involves accurately determining CPT and ICD-10 codes for various outpatient procedures and ensuring coding assignments meet quality and productivity standards. Additionally, the coder will provide documentation feedback to physicians and analyze medical necessity accounts.
The radiologist will perform general radiology duties including radiography, fluoroscopy, and procedures. They are expected to provide high-quality interpretations of ultrasound and body CT scans within a multi-specialty clinic environment.
The radiologist will perform general radiology duties including radiography, fluoroscopy, and procedures. They are also expected to provide expert interpretation of ultrasound and general body CT scans.
The consultant is responsible for the delivery, maintenance, and support of PACS and cloud-based healthcare products. They will perform system installations, upgrades, and troubleshooting while maintaining daily communication with customers to ensure satisfaction.
The role involves designing, coding, and maintaining scalable Big Data and cloud solutions while developing analytics rules engines. You will also collaborate with cross-functional teams to build AI/ML models and provide production support for analytic applications.
The Psychiatric Nurse Practitioner will formulate comprehensive treatment plans using evidence-based tools and deliver individual or group psychotherapy. They are also responsible for prescribing and managing psychotropic medications while maintaining accurate electronic medical records.
Design, develop, and maintain scalable Big Data and cloud-based analytics solutions to support payment integrity and health optimization. Collaborate with cross-functional teams to implement AI/ML models and ensure high-quality technical documentation and production support.
The role involves configuring, maintaining, and optimizing CICS environments on IBM z/OS systems within a multi-LPAR, Parallel Sysplex infrastructure. You will also diagnose system incidents, support application teams, and contribute to disaster recovery planning and operational resilience.
The pharmacist will review prescription prior authorization requests and oversee the activities of pharmacy technicians and support staff. They will also ensure all pharmacy operations comply with state and federal regulations while providing clinical consultation in a call center environment.
The ED RN Case Manager monitors real-time ADT notifications to provide proactive patient outreach and discharge coordination. They collaborate with hospital teams and outpatient resources to ensure optimal transitions of care and continuity for members.
The role involves identifying and assigning accurate ICD-10 and CPT codes for inpatient and outpatient services while ensuring compliance with coding policies. Additionally, the coder will provide documentation feedback to physicians and maintain high standards of coding quality and productivity.
The role involves performing all phases of software engineering, including requirements analysis, design, development, and testing of applications. You will also collaborate with cross-functional teams to design APIs and microservices while ensuring high-quality releases through Agile/Scrum methodologies.
The Account Executive will identify potential healthcare business customers and develop relationships with brokers to drive sales for small and medium-sized businesses. They are responsible for educating brokers on products and pricing while navigating a complex, matrixed business environment.
The Sales Account Manager is responsible for enrolling Medicare beneficiaries into the UnitedHealthcare Institutional Special Needs Plan by generating leads and managing account strategies. They must educate facility personnel and document all sales activities to ensure compliance with Medicare Marketing Guidelines.
The Strategic Account Executive serves as the primary relationship manager for a portfolio of Labor & Trust clients, ensuring client satisfaction, retention, and growth. They provide strategic consultation on pharmacy benefits, industry trends, and cost management while collaborating with internal teams to deliver exceptional service.
The Senior Regulatory Adherence Analyst will develop and maintain a comprehensive pharmacy licensing implementation program to support pharmacy openings, acquisitions, and operational changes. This role involves leading cross-functional teams to ensure regulatory compliance and integrating licensing requirements into business workflows.
The Senior Network Pricing Consultant analyzes and re-prices pharmacy claims to ensure accurate cost management and financial modeling. This role involves manipulating data using SQL to support analytic solutions and collaborating with internal teams to ensure efficient claim processing.
The Medical Director conducts clinical coverage reviews and medical necessity determinations to ensure cost-effective, quality care for members. They collaborate with multidisciplinary teams and providers to manage medical benefits and facilitate accurate, timely coverage decisions.
Design, develop, and deploy AI-powered healthcare solutions using Java microservices and interoperability standards. Manage event-driven backend components and integrate with cloud infrastructure to drive operational excellence.
The Associate Finance Director will serve as a primary finance business partner to leadership, overseeing financial planning, analysis, and strategic modeling. This role is responsible for managing revenue and profit budgets, driving cost efficiencies, and providing leadership to both domestic and offshore teams.
The Coding Quality Analyst will maintain expert knowledge of coding operations and conduct internal audits to ensure compliance with federal and state regulations. They will also collaborate with stakeholders to identify root causes of compliance issues and provide quality performance feedback to coding staff.
The Subject Matter Expert oversees Optum360 coding services and facility-based operations to ensure quality metrics, workflow efficiency, and standardization are met. They act as a liaison between clinical stakeholders and coding teams to drive continuous quality improvement and maintain strong client relationships.
Deliver remote measurement-informed care using evidence-based treatment models while monitoring participant progress and documenting session notes. Collaborate with a care team to assist participants in accessing resources and ensure compliance with HIPAA privacy and security standards.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
The Senior Inpatient Medical Coder will assign ICD-10-CDM and CPT-4 codes for observation services while ensuring documentation meets high quality and productivity standards. They will also provide feedback to providers and maintain up-to-date coding knowledge through departmental meetings and educational events.
The Associate Director will lead complex negotiations with pharmacy chains and specialty providers to ensure favorable financial and operational outcomes. They are responsible for monitoring provider performance and maintaining strong business relationships while aligning with market trends and internal strategies.
Manage inbound and outbound communications for patient case management, including monthly refills and benefit verification. Collaborate with pharmacists, sales, and nursing teams to ensure coordinated patient care and accurate order processing.
The RN Clinical Care Coordinator manages a panel of members with complex medical and behavioral needs by conducting comprehensive assessments and developing person-centered care plans. They collaborate with internal teams and community partners to support member health, facilitate care transitions, and provide ongoing education.
The Sr. Strategic Account Executive manages assigned client accounts by developing trend management strategies, overseeing contract renewals, and cultivating multi-level relationships. They are responsible for presenting performance reviews, ensuring contract compliance, and providing leadership to client services team members.
The auditor is responsible for planning and executing financial, operational, and compliance audits across the healthcare revenue cycle. They will also identify risks, prepare objective audit reports, and collaborate with leadership to implement corrective actions.
The Clinical Manager provides oversight and direction to service coordination staff while identifying process improvements to ensure accurate delivery of waiver and non-waiver services. They are responsible for managing staff productivity, facilitating training, and ensuring compliance with regulatory standards.
The Support Coordinator will manage a panel of members with intellectual or developmental disabilities by conducting comprehensive needs assessments and developing person-centered care plans. They will collaborate with internal teams and community providers to implement these plans and ensure improved quality of care and service utilization.
The Medical Coder is responsible for assigning accurate diagnostic and procedural codes to patient health records to ensure data accuracy and claims processing. They also provide coding auditing services and generate queries to clarify physician documentation.
The Claims Provider Service Advocate investigates and resolves complex LTSS claim issues while ensuring compliance with contractual and reimbursement standards. They also facilitate provider clinics and analyze claim trends to provide actionable insights to leadership.
The resident will participate in a primary care pathways program involving 1-3 hours of commitment per month to learn value-based care models. They will receive mentorship from experienced physicians while preparing for a post-residency employment agreement.
The Senior Solution Sales Executive will own business development for the Crimson AI platform across a Southeastern territory, managing the full sales lifecycle from prospecting to agreement. They will build relationships with healthcare decision-makers and coordinate internal teams to deliver measurable business value through clinical analytics solutions.
The 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 communicate clinical findings in accordance with regulatory requirements.
The role involves performing code reviews on professional and facility claims while maintaining high accuracy and production standards. You will also abstract and code diagnoses and procedures from electronic medical records to ensure proper compliance.
The Senior Strategic Account Executive manages ongoing contract relationships and service delivery for large, complex client accounts. This role acts as the primary point of contact, driving strategic planning, client retention, and growth initiatives while collaborating across internal teams.
The Market Growth Manager is responsible for building and managing a team of sales agents and strategic partners to achieve assigned sales targets. They will execute outreach and marketing strategies while monitoring market trends to ensure compliance and growth.
The Medical Director provides leadership and oversight for the claims review program, ensuring the quality and effectiveness of medical services. They act as a liaison between the organization and medical providers while participating in clinical reviews, appeals, and policy development.
The Medical Director provides leadership and oversight for the claims review program, ensuring the quality and effectiveness of medical services. They are responsible for conducting surgical claim reviews, participating in provider appeals, and serving as a clinical liaison.
The Medical Director provides leadership and oversight for the claims review program, ensuring the quality and effectiveness of medical services. They are responsible for conducting clinical claim reviews, participating in provider discussions, and supporting regulatory compliance.
The Medical Director provides leadership and oversight for the claims review program, ensuring the quality and effectiveness of medical services. They act as a liaison between the organization and medical providers while participating in clinical reviews, appeals, and policy development.
The Network Contract Manager is responsible for negotiating and managing contracts with hospitals, ancillary entities, and other facilities to ensure a competitive and stable provider network. This role involves synthesizing financial data to develop renewal strategies and maintaining strong business relationships with providers across the Mid-Atlantic region.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatment. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment responses.
The Senior Strategic Account Executive manages assigned client accounts by developing trend management strategies, overseeing contract renewals, and cultivating multi-level client relationships. They are responsible for presenting performance reviews, ensuring contract compliance, and providing leadership to the client services team.
The medical coder will assign ICD-10-CM, CPT, and HCPCS codes for emergency department services while ensuring documentation supports code selection. They are also responsible for resolving facility edits and supporting charge capture reconciliation to meet quality and productivity standards.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
The Account Manager will interface with the New York Health Plan to drive membership growth through strategic business relationships and community outreach. They are responsible for prospecting new business opportunities, conducting product presentations, and managing the enrollment process for eligible members.
The Coding Consultant investigates and resolves healthcare fraud and abuse by reviewing prepay claims and medical records for payment accuracy. They also provide coding guidance to investigators and facilitate communication with internal and external stakeholders.
The coder will identify and assign appropriate CPT, ICD-10, and modifier codes for various professional services while ensuring adherence to official coding guidelines. They will also analyze medical necessity edits, provide documentation feedback to providers, and maintain high standards of coding quality and productivity.
The Senior Software Engineer will design and deliver production-grade Agentic and Generative AI platforms integrated with LLMs and MCP servers. They will collaborate with cross-functional teams to build secure, scalable, and automated cloud-based architectures for healthcare applications.
The UX Engineer will design user flows, hi-fi mockups, and prototypes to simplify complex security data while collaborating with cross-functional teams. They are also responsible for conducting usability testing and maintaining design systems to ensure consistent, user-centric experiences.
The Support Coordinator will manage a panel of members with intellectual or developmental disabilities, focusing on their medical, behavioral, and socioeconomic needs. Responsibilities include conducting comprehensive needs assessments and developing person-centered care plans to improve health outcomes and service utilization.
The 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 role involves the end-to-end administration, reliability, performance, and security of PostgreSQL, Oracle, and MySQL databases across on-premises and multi-cloud environments. You will collaborate with engineering and infrastructure teams to drive cloud modernization, automation, and continuous improvement initiatives.
The Quality Engineer will analyze software requirements to create and execute test cases while driving the resolution of product defects. They will also develop and maintain automated test scripts to ensure efficient testing and process integrity.
The Production Support Engineer ensures the stability and operational health of enterprise contact center platforms like Amazon Connect and NICE CXOne. This role involves managing production incidents, performing root cause analysis, and coordinating with vendors to maintain reliable service.
The 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 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.
The Group Service Associate provides support to members, brokers, and business associates by resolving inquiries regarding eligibility, enrollment, and benefits. They also manage small group renewals by conducting outbound calls, explaining processes, and assisting with plan design changes.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
The role involves monitoring system health, developing performance reporting, and delivering recommendations for system optimization. The analyst will also troubleshoot complex incidents and participate in a 24/7 on-call rotation to ensure system stability.
Perform deep dive performance forensics and code reviews to optimize application CPU usage and runtime. Provide technical support, mentorship, and technology proof of concept support while leveraging AI tools to enhance analysis efficiency.
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 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.
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 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 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 accurate prescription processing.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and social determinants of health.
The coder will identify and assign appropriate CPT and ICD-10 codes for outpatient Acute Interventional Radiology services while maintaining quality and productivity standards. They will also provide documentation feedback to providers and analyze CCI and medical necessity edits.
The Medical Director will lead clinical AI model training, testing, and surveillance, focusing on utilization management and evidence-based clinical criteria. This role serves as the primary clinical authority for guideline interpretation and collaborates with data science and AI teams to modernize clinical programs.
The Nurse Practitioner will conduct comprehensive clinical assessments and provide care to high-risk members in nursing homes and assisted living settings. They will collaborate with interdisciplinary teams to manage chronic conditions and facilitate advanced care planning for patients.
The Senior Account Manager is responsible for the quality and economic performance of physician practices to develop a high-performing provider network. They will analyze data, drive process improvements, and maintain strong relationships with stakeholders to meet quality and cost goals.
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 Clinical Compliance Auditor performs compliance reviews of medical and administrative documentation to identify healthcare fraud, waste, and abuse. The role involves conducting site visits, desk audits, and collaborating with a team to present findings to clients.
The technician manages high-volume inbound and outbound calls to process prior authorization requests for medications while ensuring accuracy and compliance. They research benefit information, identify missing data, and route clinical questions to pharmacists to support timely patient care.
The 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 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.
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 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 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 pharmacist will review, decision, and process prior authorization and appeals requests while ensuring compliance with clinical criteria and regulatory guidelines. They will also collaborate with providers and members to resolve inquiries and maintain accurate documentation of all clinical findings.
The representative provides prompt and courteous customer service to policyowners and agents via phone and email. They are responsible for resolving inquiries, documenting interactions, and recommending products while maintaining compliance with HIPAA guidelines.
The Senior Inpatient Medical Coder will manage acute inpatient hospital claim edits, denials, and coding assignments to ensure data integrity. They will also analyze medical records and provide feedback to providers to improve documentation quality and billing accuracy.
The role involves identifying the appropriate assignment of ICD-10 and DRG codes for facility services while adhering to official coding guidelines. Additionally, the coder will perform chart reviews, abstract data, and query physicians when necessary to ensure coding accuracy and productivity.
The 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.
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.
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 resident physician will participate in a paid mentorship program to gain experience in a value-based care model. They will contribute to population health initiatives and receive guidance from experienced physicians to transition into clinical practice.
Join a large radiologist group to perform general radiology duties including radiography and fluoroscopy. Interpret ultrasound and general body CT scans to provide high-quality patient care.
Join a large radiologist group to perform general radiology duties including radiography and fluoroscopy. Interpret ultrasound and general body CT scans to provide high-quality patient care.
Lead the design, development, and support of industrial automation systems across pharmacy fulfillment centers. Ensure maximum uptime and reliability of robotics and conveyor systems through troubleshooting and continuous improvement.
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.
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 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.
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.
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.
Manage and optimize high-performance compute and zSeries storage environments using IBM Flash Systems and AI tools. Provide 24/7 on-call support, perform capacity planning, and collaborate with platform teams to resolve complex production issues.
Assign appropriate ICD-10, CPT, and modifiers for facility outpatient and same day surgery services. Maintain high levels of coding quality and productivity while adhering to ethical standards and official guidelines.
Deliver remote, measurement-informed behavioral health care using evidence-based treatment models. Monitor participant progress, coordinate care, and maintain strict confidentiality in accordance with HIPAA policies.
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.
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.
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.
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.
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.
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.
Lead production support and incident response for critical customer-facing applications, focusing on reliability and disaster recovery. Coordinate release activities, security remediation, and cloud platform operations using Kubernetes and GCP.
The 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 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.
Assign appropriate medical codes by utilizing reference materials and applying knowledge of anatomy, physiology, and coding guidelines. Manage multiple work demands to maintain productivity standards and provide guidance during quality audits.
The therapist will screen and assess patients for mental health and substance use disorders using evidence-based approaches. They are responsible for tracking treatment response and maintaining accurate clinical documentation in compliance with regulatory requirements.
Perform administrative reviews of short stay inpatient hospital claims based on Federal, State, and client requirements. Responsible for documenting all determinations and maintaining accurate use of screening criteria.
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.
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.
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.
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.
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.
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.
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.
Lead the design and delivery of end-to-end analytics solutions, from Snowflake data modeling to Power BI dashboards. Transform complex healthcare claims and revenue cycle data into actionable business intelligence and decision-support tools.
Design and develop scalable Power BI dashboards and SQL-based data models to provide actionable healthcare insights. Collaborate with stakeholders to define KPIs and transform complex claims and revenue cycle data into decision-support tools.
Responsible for the clinical review and adjudication of appeals and grievances cases across various health plan products. This includes performing regulatory responses for CMS and Department of Insurance and collaborating with medical directors on decision rationales.
Participate in a customized transition program to learn how to operate within a value-based care model. Engage in mentorship and clinical exposure to primary and specialty care with a commitment of a few hours per month.
Participate in a customized program to transition from residency/fellowship into clinical practice within a value-based care model. Engage in mentorship and gain exposure to primary and specialty care settings with a commitment of a few hours per month.
Participate in a customized pathways program to transition from residency/fellowship into professional practice. Engage in a few hours per month of virtual or on-site exposure to primary and specialty care within a value-based care model.
Participate in a customized program to transition from residency/fellowship into clinical practice. Engage in a few hours per month of 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.
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.
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.
Responsible for conducting medical coverage reviews and rendering determinations for musculoskeletal and spine surgery services. The role involves coordinating utilization review activities, ensuring regulatory compliance, and collaborating with healthcare providers.
The Medical Director provides leadership and direction for the claims review program, ensuring the quality and effectiveness of medical services. Responsibilities include reviewing surgical claims for correct coding and conducting telephonic discussions with providers regarding medical necessity.
Oversee performance of end-to-end provider servicing and resolve complex problems. Drive the design and implementation of programs that build positive relationships between the health plan, providers, and practice managers.
