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 Senior Software Engineer will design and develop scalable microservices-based applications and RESTful APIs using .NET and Azure cloud environments. They will also contribute to CI/CD pipelines, perform performance tuning, and mentor junior developers while implementing AI-powered solutions.
The Senior Software Engineer will design, develop, and integrate AI tools and services, including intelligent assistants and semantic search, while focusing on Oracle 26 AI DB. They will also collaborate with cross-functional teams to advance DevOps practices and maintain scalable, high-throughput applications across the full engineering stack.
The Clinical Care Team Manager leads a team of care managers to oversee day-to-day clinical operations and program initiatives for Home and Community Based Services. They are responsible for performance management, ensuring standardized execution of clinical processes, and maintaining compliance with contractual requirements.
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 Referral Navigator Representative manages care coordination and referral completion within the Medical Management Department. They perform clinical documentation triage and facilitate communication between providers, patients, and internal departments to ensure continuity of care.
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.
Lead complex client onboarding, data interface programs, and enterprise-wide initiatives while managing multi-team dependencies and vendor integrations. Drive operational excellence through process improvement, risk mitigation, and the implementation of automation and performance metrics.
The Manager leads daily Provider Audit & Education operations, ensuring performance, quality, and service goals are met for assigned clients. This role serves as the primary client contact, driving provider education initiatives and analyzing operational data to identify trends and process improvements.
The Associate Patient Service Specialist is responsible for verifying insurance eligibility, managing patient registration, and coordinating medical appointments. They also handle patient-care related inquiries and ensure accurate documentation within the electronic medical record system.
The Patient Care Coordinator manages patient scheduling, verifies insurance information, and coordinates medical procedures for inpatients and outpatients. They also provide patient education regarding managed care plans and maintain clear communication with providers and patients regarding appointment changes.
The Senior Clinical Appeals RN analyzes DRG appeals and performs complex conceptual analyses to determine if claim adjustments are necessary. They also provide coaching to DRG Validation Specialists and collaborate with auditors to ensure accurate medical record review and documentation.
The Associate Patient Care Coordinator is responsible for verifying patient insurance, managing registration, and coordinating medical appointments. They also provide patient education and maintain clear communication with providers and patients regarding scheduling changes.
The Registered Nurse will assess patient health status, develop and implement care plans, and collaborate with an interdisciplinary team to manage complex medical and social needs. They will conduct in-home visits, provide patient education, and facilitate transitions between care settings to ensure a seamless health journey.
The Senior Clinical Appeals RN analyzes DRG appeals, performs complex conceptual analyses, and prepares written rebuttals to resolve claim disputes. They also provide coaching and guidance to DRG Validation Specialists while collaborating with internal teams to ensure accurate clinical and coding documentation.
The role involves managing behavioral health and substance abuse member cases by coordinating care and collaborating with treatment teams. You will engage members to assess their needs, educate them on available resources, and ensure they receive evidence-based care.
The Credentialing and Enrollment Specialist manages the credentialing and re-credentialing process for physicians and providers, ensuring all applications are processed and tracked accurately. They also maintain compliance with regulatory standards, perform internal audits, and coordinate with medical staff to ensure all credentials remain current.
The nurse will perform telephonic clinical assessments and triage patient health concerns using approved medical protocols. They will also coordinate services, identify provider gaps, and coach consumers on treatment alternatives.
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 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 Occupational Therapist Case Manager is responsible for determining the medical necessity of treatments and implementing clinical policies to ensure quality outcomes. They will monitor utilization trends and collaborate with providers to maintain compliance with regulatory requirements.
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 Coding Supervisor assists in managing a remote team of edit coders, monitoring performance, and ensuring productivity standards are met. They also coordinate workflow, handle onboarding, and serve as a primary point of contact for hospital clients to troubleshoot billing and system issues.
The Medicaid Specialist will manage relationships with members, providers, and internal partners while facilitating cross-functional communication. They are responsible for data analysis, reporting, workflow development, and continuous process improvement to support Medicaid and LTSS initiatives.
You will design and deliver scalable technology architecture solutions while bridging the gap between technical and non-technical stakeholders. Additionally, you will lead architectural planning, mentor engineering teams, and deploy AI-powered solutions to drive process improvements.
The Customer Service Advocate will resolve customer inquiries regarding health benefits, eligibility, and claims while educating members on plan options. They will also coordinate with healthcare providers and assist customers in navigating digital self-service tools.
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 Registered Nurse will manage patient care within the palliative specialty, utilizing the nursing process and evidence-based practice. They are responsible for building therapeutic relationships, conducting telephone triage, and coordinating care transitions with the clinical team.
The Medical Director will perform utilization management determinations, identify utilization trends, and suggest improvements to the utilization management program. They will also participate in case reviews, ensure compliance with CMS regulations, and assist in the development of care management protocols.
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.
The Director of AI/ML Engineering will lead the enterprise vision, strategy, and execution of AI and machine learning solutions across health financial platforms. They will manage high-performing engineering teams while championing ethical AI practices and partnering with business executives to deliver transformative value.
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.
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 analyst will support population health initiatives by analyzing clinical quality and utilization data to develop reports and actionable insights. They will also validate data trends and guide the development of comprehensive care plans to improve patient outcomes.
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.
Deliver remote measurement-informed care using evidence-based treatment models and monitor participant progress. Coordinate care, document session notes, and identify high-risk encounters while maintaining strict HIPAA confidentiality.
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 Sales Account Manager will generate and close leads while managing professional relationships with community organizations and healthcare providers. They are responsible for presenting Medicare products and enrolling eligible members into specific health plans to meet monthly sales goals.
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 Clinical Nurse Liaison is responsible for patient education, strategic oversight of infusion referrals, and managing provider relationships. They also provide leadership and mentorship to the clinical liaison team while collaborating on growth strategies.
The nurse will handle incoming calls from patients and healthcare providers to assess patient needs using nursing protocols and triage guidelines. They will also facilitate referrals to appropriate medical providers, specialists, and community resources.
The Account Manager manages operational performance and service delivery for assigned client accounts, acting as the primary liaison between the client and internal teams. They are responsible for overseeing implementation, benefit design, and resolving escalated concerns to ensure high levels of client satisfaction.
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 Patient Care Coordinator manages patient admissions, transfers, and discharges while ensuring accurate demographic and insurance data entry. They provide essential support to clinical teams by coordinating bed management and communicating effectively with payers and facility staff.
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 quality improvement opportunities and provide education on effective clinical practices.
The clinician will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatments like CBT and DBT. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment responses.
The 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.
The Provider Credentialing Advocate manages provider inquiries and resolves contracting, credentialing, and demographic issues through phone and chat channels. They coordinate with internal and external partners to ensure efficient resolution while providing real-time education on self-service resources.
The Dental Provider Relations Advocate manages provider relationships, conducts recruitment, and ensures network adequacy for dental programs. They also act as a liaison for contracting, claims resolution, and provider education within their assigned territory.
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.
The associate data engineer will transform usage data into actionable insights by building and maintaining robust ETL/ELT pipelines. They will also collaborate with cross-functional teams to automate data processing and deploy AI-powered data solutions.
The role involves maintaining general ledger accounts, preparing journal entries, and performing reconciliations for month-end and quarterly-end closing processes. Additionally, the accountant will analyze financial statements, support internal and external audits, and provide ad hoc reporting and analysis.
The Pharmacy Care Coordinator acts as a liaison between clinicians, pharmacies, and patients to manage medication information and support adherence. They document interventions, perform administrative tasks, and engage with stakeholders to ensure accurate medication therapy.
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.
Design, develop, and deploy AI-powered solutions and intelligent automation to drive business outcomes and operational efficiency. Collaborate with cross-functional teams to prototype and scale emerging AI technologies while establishing governance and best practices.
The Senior Provider Relations Advocate manages provider network performance by resolving complex operational and claims issues while fostering strong relationships between the health plan and providers. This role also involves delivering provider education, ensuring regulatory compliance, and collaborating across internal teams to drive operational excellence.
Provide compassionate and empathetic support to callers while resolving escalated issues and guiding them through health care benefit decisions. Act as a subject matter expert to assist team members and facilitate connections between customers and care providers.
The resident will participate in a pathway program to gain exposure to primary care and population health models within a team-based environment. They will contribute new practice ideas and initiatives while receiving mentoring and financial support during their final year of training.
The Provider Data Specialist is responsible for maintaining and improving the provider network database through data extraction, reporting, and quality assurance audits. They also coordinate corrective activities to ensure database integrity and act as a representative for the provider network area on IT projects.
The Senior Software Engineer will drive the development and delivery of scalable enterprise software and AI-powered applications within the Clinical AI domain. They will collaborate cross-functionally to integrate intelligent capabilities, automate workflows, and design robust architectures that address complex healthcare challenges.
The Medical Coding Auditor determines the accuracy of health insurance claims by comparing submitted documentation against medical records and coding guidelines. They identify aberrant billing patterns, investigate potential fraud, waste, or abuse, and provide clinical expertise to support payment decisions.
The Senior Software Engineer will design, develop, and deploy scalable REST-based microservices and AI-powered solutions for portal and system integrations. They will also support daily batch processes and collaborate with cross-functional teams to optimize platform capabilities.
The Behavioral Intake Counselor manages incoming calls and chats for the 24/7 Access and Crisis Line, conducting behavioral health screenings and providing crisis intervention. They are responsible for documenting interactions in the EHR, ensuring safety, and linking individuals to appropriate care services.
Lead the strategy, design, and technical delivery of enterprise software platforms and AI-powered solutions to modernize procurement capabilities. Collaborate with cross-functional teams to translate business needs into scalable digital solutions and automated workflows.
The Senior Software Engineer will design, build, and maintain core Java-based applications while optimizing automated build pipelines and workflows. They will also leverage AI-powered solutions to streamline development processes and mentor team members to ensure high-quality software delivery.
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.
Conduct outreach to newly enrolled Medicaid members to perform initial health screenings and identify medical, behavioral, and social needs. Document screening results accurately and connect members to appropriate care, providers, and community resources.
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 teams to implement benefits and drive client satisfaction.
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.
Manage the intake of members and coordinate admission/discharge information with hospitals and clinical teams. Handle service requests, process referrals, and resolve inquiries from members and providers.
The Quality Manager designs and implements quality processes and standards while leading cross-functional teams to drive continuous improvement. This role involves analyzing clinical and administrative data to ensure compliance, mitigate risks, and align organizational objectives with customer expectations.
You will design, develop, and maintain data-intensive applications and ETL/ELT pipelines using cloud technologies like Snowflake, Spark, and Azure. Additionally, you will collaborate with cross-functional teams to deliver scalable data solutions and AI-powered features within an agile environment.
The representative will handle 50-70 daily calls from customers regarding health benefits, eligibility, and claims. They will also educate members on plan options and assist with navigating internal health care websites.
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 Credentialing Representative manages end-to-end provider credentialing, including data entry, file preparation, and system loading. They also conduct audits to ensure compliance with NCQA and CMS standards while identifying process improvements.
The clinician will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatments like CBT and DBT. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment progress.
The Medical Coder is responsible for accurate procedure and diagnostic coding of professional charges using CPT, HCPCS, and ICD-10 standards. They also manage the preparation and transmission of claims while ensuring compliance with government and insurance regulations.
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.
The Support Coordinator will manage a panel of members with intellectual or developmental disabilities by assessing their medical, behavioral, and socioeconomic needs. They are responsible for developing and implementing person-centered care plans while collaborating with internal teams and community providers to ensure quality outcomes.
The Regional Vice President of Business Development provides sales leadership by coaching, directing, and setting strategies for the sales team to achieve admit and census goals. They are responsible for developing high-performing sales consultants and fostering a collaborative partnership with the operations leadership team.
The Care Coordinator serves as the primary manager for members with chronic health needs, conducting comprehensive assessments and developing individualized care plans. They collaborate with internal teams and community resources to implement interventions, remove obstacles, and support successful community living.
The Regulatory Affairs Consultant leads regulatory initiatives, ensures compliance with federal and state healthcare regulations, and manages audits. They also provide expert guidance to stakeholders and drive process improvements across the organization.
The specialist performs DRG validation reviews and provides clinical coding expertise to ensure accurate claim adjudication and medical necessity. They also identify trends in provider coding practices and develop strategies to prevent future overpayments.
Design, develop, and deploy AI-powered solutions and platform automations to streamline infrastructure workflows. Collaborate with security and engineering teams to modernize applications and ensure compliance across cloud and on-premises environments.
The Strategic Account Executive serves as the primary relationship leader for assigned clients, focusing on pharmacy trend management, member experience, and long-term business retention. This role coordinates cross-functional teams to execute strategic roadmaps and ensure operational excellence and financial performance for national employer accounts.
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.
Respond to 60-80 incoming calls daily from customers or pharmacies regarding pharmacy benefits and home delivery services. Document all interactions accurately in computer systems and perform outbound follow-up calls as needed.
Respond to 60-80 incoming calls daily from customers or pharmacies regarding pharmacy benefits and home delivery. Document information accurately in computer systems and perform outbound follow-up calls as needed.
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.
You will design, develop, and maintain scalable web applications and intelligent AI-powered solutions using modern frameworks. You will also collaborate with cross-functional teams to integrate backend services and automate workflows using GenAI tools.
The role involves managing and optimizing cloud infrastructure, including architectural modifications and server maintenance. You will also be responsible for ensuring security compliance, troubleshooting complex performance issues, and supporting disaster recovery plans.
The associate performs pre-audit and post-audit analysis of claims and client contracts to determine eligibility for hospital bill audits and overpayment calculations. They are responsible for documenting outcomes in payer systems and responding to operational inquiries while maintaining compliance with privacy regulations.
The clinician will screen and assess patients for mental health and substance abuse disorders while providing evidence-based treatments like CBT and DBT. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment progress.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based psychotherapy. They are also responsible for maintaining accurate electronic medical records and participating in regular team consultations.
The therapist will screen and assess patients for mental health and substance abuse disorders while providing evidence-based psychotherapy. They are also responsible for maintaining accurate electronic medical records and participating in regular team consultations.
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.
You will own end-to-end design projects, from problem framing and stakeholder collaboration to high-fidelity design and developer handoff. Additionally, you will contribute to the design system and collaborate with cross-functional teams to ensure solutions meet user and business needs.
The Senior Account Manager manages ongoing contract relationships and service delivery for assigned accounts, serving as the primary point of contact for day-to-day operations. They coordinate with internal teams to implement systems, address service needs, and lead project activities such as open enrollment and product implementations.
The Program Manager coordinates and executes provider communications initiatives across Optum Health Networks by managing workflows, timelines, and stakeholder dependencies. This role ensures efficient delivery of high-volume communications while maintaining visibility into project milestones and operational readiness.
The Data Architect / Data Engineering Lead will own the end-to-end architecture and engineering standards for modern data platforms. This role involves designing scalable data solutions, leading data modeling efforts, and driving hands-on engineering execution for pipelines and orchestration.
Design, develop, and deploy scalable AI/ML models and Python-based inference APIs using GenAI and LLM technologies. Integrate semantic search capabilities and maintain robust, containerized pipelines to address complex healthcare business challenges.
Lead the end-to-end technical integration of AI-enabled solutions and collaborate cross-functionally to drive automation and workflow intelligence. Design and deliver scalable, high-quality enterprise software while mentoring engineering teams on best practices.
The Software Engineer will design, develop, and deploy microservices and AI-powered solutions using Java, Python, and ReactJS. They are responsible for automating engineering tasks, maintaining high performance, and ensuring the reliability of cloud-native applications.
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 Community Health Worker assesses, plans, and implements individualized care strategies while acting as a liaison for Medicaid members. They manage care plans, initiate social service referrals, and address social determinants of health to ensure quality coordinated care.
The Patient Access Intake Specialist manages the referral intake process by verifying patient benefits, obtaining prior authorizations, and coordinating care requirements. They also maintain accurate patient records, communicate with families and referral sources, and ensure all start-of-care documentation is completed.
The Intake Specialist is responsible for receiving and processing patient referrals, including verifying insurance benefits and obtaining necessary prior authorizations. They also manage patient documentation, communicate with families and referral sources, and ensure all start-of-care paperwork is completed accurately.
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 systems to provide efficient support while promoting self-service digital tools to enhance provider satisfaction.
The Specialty Operations Manager leads client relationships and manages the day-to-day operations of specialty pharmacy programs. They are responsible for clinical strategy execution, performance reporting, and providing data-driven recommendations to optimize client health outcomes.
The Intake Specialist is responsible for processing patient referrals, verifying insurance benefits, and obtaining necessary prior authorizations. They also manage patient documentation, communicate with referral sources, and ensure all intake paperwork is completed accurately.
The Bleeding Disorder Patient Liaison coordinates services between OptumRx and patients through recruitment, retention, and educational activities. They are responsible for developing consumer relationships, participating in community events, and achieving sales objectives through proactive engagement.
Design, develop, and maintain scalable cloud-native applications using C# and .NET frameworks within Azure environments. Collaborate with cross-functional teams to deploy containerized microservices and integrate AI-powered solutions to optimize operational performance.
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 Senior Analyst produces financial reports, reconciliations, and actionable insights to support the Healthcare Finance management team and business units. They also develop analytical models, automate reporting processes, and provide technical guidance to junior analysts.
The Medical Director conducts acute level of care and length of stay reviews to ensure medical necessity for members across the continuum of care. They collaborate with clinical and operational teams to drive quality initiatives and engage in telephonic outreach with treating providers to optimize health outcomes.
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 Inpatient Care Management Nurse is responsible for performing initial and concurrent reviews of inpatient cases using evidence-based criteria to ensure proper utilization of health services. They collaborate with medical directors and facility staff to facilitate effective discharge planning and ensure patients receive the appropriate level of care.
The Strategic Account Executive serves as the primary relationship leader for assigned national employer clients, managing pharmacy benefit partnerships and ensuring operational excellence. They are responsible for developing multi-year strategic roadmaps, driving business growth, and coordinating cross-functional teams to deliver measurable clinical and financial outcomes.
The Clinical Coordinator assesses, plans, and implements individualized care strategies while serving as a single point of contact for members throughout the continuum of care. They also advocate for patients, collaborate with medical directors, and support quality and population health initiatives.
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.
The clinician will provide mental health services, including individual or group therapy, in both virtual and in-person settings. They are responsible for completing assessments, developing comprehensive treatment plans, and assisting patients in accessing community resources.
The Clinical Quality Consultant provides guidance and support for utilization management related to advanced molecular and genetic testing in oncology. This role ensures evidence-based decision-making and compliance with regulatory standards through expert interpretation of genomic data and multidisciplinary collaboration.
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 executive will lead sales efforts for innovative healthcare solutions, focusing on building relationships with health plan partners to drive business growth. They are responsible for developing opportunity-level sales strategies, managing the full sales cycle, and negotiating contracts to meet performance targets.
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.
Design, develop, and deploy enterprise-scale software applications and AI-powered solutions to address complex business challenges. Collaborate with cross-functional teams to integrate machine learning models and maintain high-performance software systems.
The Cybersecurity Analyst will manage critical security incidents, monitor security intake technologies, and perform analysis on cybersecurity alerts in both on-premises and cloud environments. They will also lead remediation efforts, mentor junior analysts, and collaborate with cross-functional teams to improve security standards and processes.
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 Senior Data Analyst will lead the design and implementation of scalable data solutions and AI-driven workflows to support business intelligence and advanced analytics. They will partner with stakeholders to translate requirements into actionable insights while ensuring data accuracy and compliance within healthcare domains.
The Utilization Management & Clinical Validation RN reviews patient medical records to extract case details and crafts defensible appeal letters. They also recommend coding changes to optimize financial impact while adhering to company policies and regulatory requirements.
Lead multiple software engineering teams in delivering complex PBM technology modernization initiatives, including API-first architectures and microservices. Oversee platform modernization, manage budgets and staffing, and drive the adoption of AI-enabled engineering practices to accelerate delivery.
The role involves developing and validating AI methodologies within a Responsible AI program to ensure ethical and compliant healthcare applications. You will collaborate with cross-functional teams to automate testing, document best practices, and mentor colleagues on AI development.
The Senior Provider Data Specialist maintains and updates the provider network database to ensure data accuracy and quality while conducting data extraction and reporting. They also coordinate corrective activities, manage communication regarding database improvements, and represent the provider network area on IT projects.
The Nurse Practitioner or Physician Associate will provide virtual clinical care and coordinate health services for high-risk patients in facility settings. They are responsible for conducting comprehensive assessments, managing acute and chronic conditions, and collaborating with an interdisciplinary team.
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 Clinical Product Manager serves as the domain expert for Cardiology product solutions, guiding the evolution of CPACS and CVIS workflows. This role collaborates with cross-functional teams to ensure product designs align with clinical standards, improve patient care, and drive operational efficiency.
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 Client Service Executive acts as the primary relationship manager for outsourced revenue cycle clients, ensuring service level agreements are met and client satisfaction is maintained. They are responsible for analyzing operational data, reporting trends to hospital executives, and driving growth and retention strategies.
The Senior Manager of Data Engineering will lead the development of scalable ETL pipelines and cloud-based data platforms to support enterprise analytics and AI/ML initiatives. They will also mentor a team of data engineers while establishing data governance standards and collaborating with stakeholders to deliver reliable data solutions.
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 Customer Service Advocate will resolve customer inquiries regarding benefits, eligibility, and claims while educating members on health plan options. They will also coordinate with care providers and assist customers in navigating digital health platforms.
The Wellness Coordinator provides care coordination and administrative support to members with behavioral health and substance abuse needs. They act as a primary care navigator by identifying gaps in care, addressing social determinants of health, and developing individual care plans.
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 Compliance Analyst will conduct independent, risk-based coding and billing audits to ensure adherence to regulatory requirements and organizational standards. They will also research coding inquiries, perform root cause analysis, and deliver targeted education based on audit findings.
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 Clinical Nurse Liaison is responsible for providing patient education, managing infusion referrals, and overseeing clinical assessments. They also provide leadership to the liaison team and collaborate with sales representatives to ensure successful patient care starts.
The consultant will travel to meet with healthcare providers to discuss tools and programs aimed at improving quality of care and Medicare Advantage performance. They are responsible for managing risk and quality client programs, providing coding training, and ensuring documentation meets CMS standards.
The Coding Analyst provides oversight to Optum360 coding services, managing facility-based operations and leading initiatives related to quality metrics and workflow improvement. This role acts as a subject matter expert, driving continuous quality improvements and maintaining strong client relationships to ensure best practices are followed.
The Network Engagement Manager will assist in managing provider networks, enhancing call quality, and implementing training programs for external providers. They will also identify network gaps and nurture positive relationships between the health plan and practice managers.
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.
The Medical Director conducts clinical coverage reviews and renders determinations based on member plan benefits and medical necessity. They collaborate with multidisciplinary teams and providers to ensure the delivery of cost-effective, high-quality medical care.
The RN Case Manager will engage with Medicaid members to conduct comprehensive needs assessments and develop person-centered care plans. They will collaborate with internal teams and community resources to provide education, coaching, and support for members' medical and socioeconomic needs.
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.
The Technical Program Leader orchestrates execution across multiple engineering organizations to ensure the delivery of strategic platform capabilities. This role involves managing dependencies, facilitating Agile release planning, and driving cross-functional alignment across technical and business teams.
Manage unit cost budgets, financial modeling, and network pricing analysis to support government risk contracting goals. Guide the development of competitive provider networks and negotiate contracts in compliance with company standards.
The Regional Sales Director manages a direct-to-consumer sales team across Florida, Alabama, and Mississippi to drive new membership growth for the UnitedHealth Care Nursing Home Plan. Responsibilities include executing annual sales plans, ensuring compliance with Medicare marketing guidelines, and overseeing the implementation of the Optum care model.
Lead the quality engineering strategy and drive end-to-end test automation across web, API, mobile, and AI-powered applications. Design and maintain scalable automation frameworks while mentoring team members and ensuring high engineering standards.
The consultant will coordinate strategic initiatives across business teams to define performance results and manage vendors. They are responsible for investigating non-standard requests, solving complex problems, and ensuring project documentation is accurate and delivered on time.
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.
Participate in all phases of the software development lifecycle, including requirements analysis, system design, development, and deployment. Collaborate with stakeholders to design and implement high-quality, scalable, and secure software solutions.
The Strategic Client Executive manages a book of National Accounts, focusing on maintenance, growth, and profitability. They coordinate strategic initiatives and maintain intercompany relationships to ensure superior customer service delivery.
The 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 associate is responsible for the accurate pre-registration of patients by verifying demographic and insurance information prior to service. They also facilitate financial clearance by providing benefit information and collecting patient liabilities while maintaining excellent customer service standards.
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 RN Field Clinical Care Coordinator conducts comprehensive needs assessments and implements individualized care strategies for members. They act as a single point of contact, collaborating with internal teams and community resources to ensure coordinated, high-quality care.
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 members receive appropriate medical, behavioral, and socioeconomic support.
The Senior Clinical Administrative Coordinator engages high-risk patients to schedule appointments and facilitates the exchange of clinical information between the care team and provider offices. They are responsible for supporting patient engagement through telephonic outreach and maintaining accurate patient records in the workflow management platform.
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 Utilization Review Nurse performs clinical reviews for inpatient admissions and prior authorization requests using evidence-based guidelines to ensure high-quality, cost-effective care. They also collaborate with the medical management team and physician leadership to coordinate patient care and document clinical decisions within the care management system.
Respond to and resolve customer inquiries regarding health benefits, eligibility, and claims while guiding members through plan options. Act as an advocate by coordinating with care providers and assisting customers in navigating digital self-service tools.
The Utilization Management Nurse is responsible for determining the medical appropriateness of care levels for skilled nursing, inpatient rehabilitation, and long-term acute care. This role involves interpreting member needs, identifying solutions for complex issues, and ensuring health services are administered efficiently.
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 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 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 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 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 ECSA serves as the enterprise technical authority for Epic infrastructure, managing client deployment, interoperability services, and API management. This role involves proactive monitoring of system health, troubleshooting complex performance issues, and implementing AI-powered solutions to optimize infrastructure.
The Network Contract Manager is responsible for building, sustaining, and improving provider networks to ensure access, affordability, and quality care. This role involves managing unit cost budgets, negotiating provider contracts, and maintaining strong relationships with cross-functional stakeholders.
The Coding Quality Analyst reviews patient medical records to extract case details and crafts defensible appeal letters based on medical literature and coding guidelines. They also educate clients on coding compliance and represent them during Administrative Law Judge hearings.
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 Senior Medical Director will provide clinical leadership and strategic guidance for transplant programs while driving evidence-based improvements in quality and performance. This role involves managing client and provider relationships, supporting business growth, and serving as a subject matter expert on industry trends.
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 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 are responsible for conducting clinical reviews, managing provider appeals, and serving as a liaison between the organization and medical service providers.
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.
Lead large-scale technology, data, and AI-enabled transformation initiatives to drive measurable business outcomes in healthcare. Define strategy, manage cross-functional execution, and ensure successful delivery of complex programs from concept through implementation.
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.
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 NICU RN Case Manager acts as a liaison for Medicaid families to ensure appropriate care access and provides comprehensive needs assessments. They develop person-centered care plans and coordinate medical, behavioral, and socioeconomic support to improve member health outcomes.
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 Information Security Engineer is responsible for triaging security alerts, supporting end users with security issues, and escalating incidents as needed. They will also identify process gaps and leverage security tools to improve detections and streamline workflows.
The Strategic Account Executive acts as the primary liaison between OptumRx and clients, managing relationships, contract renewals, and revenue growth. They are responsible for coordinating internal departments to ensure service delivery, monitoring performance guarantees, and presenting performance reviews to clients.
The Strategic Account Executive manages ongoing client relationships, service delivery, and contract renewals for an assigned book of business. They act as a client-centric advocate, coordinating with internal functional areas to implement benefits and address service needs.
The Academic Detailer Pharmacist engages community-based physicians to drive adherence to evidence-based medicine guidelines and support cost-effective prescribing. They serve as a clinical liaison, managing provider relationships and utilizing performance reports to improve clinical outcomes.
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.
The Clinical Consultant Account Pharmacist manages client relationships and provides clinical pharmacy expertise to optimize pharmacy benefits and health outcomes. They collaborate with internal teams to implement clinical programs, analyze pharmacy trends, and deliver proactive recommendations to assigned accounts.
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 supporting clients by resolving deliverable issues, managing job scheduling via Robot Schedule, and ensuring accuracy through quality assurance processes. Additionally, the specialist will maintain MFT processes, document procedures, and assist in training workshops to improve team 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 effective communication between patients, providers, and the interdisciplinary team.
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 Provider Engagement Representative manages business relationships with Skilled Nursing Facilities to support integrated care models and network growth. They are responsible for conducting business review meetings, providing provider education, and identifying network gaps to ensure quality and affordability.
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 Associate Pharmacy Care Technician provides integrated support to clinicians and patients by managing refill requests, prior authorizations, and therapeutic drug conversions. They also assist with pharmacy wellness programs and maintain accurate documentation within the Epic EMR system.
The engineer is responsible for the design, implementation, and administration of Imprivata solutions, including OneSign and Enterprise Access Management. They will lead authentication workflow configurations, manage system upgrades, and provide Tier 2 support for clinical and enterprise identity issues.
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.
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 CIO is responsible for the leadership, operations management, and transformation of the Market Performance Partnership IT pillar. This role drives operational excellence, financial management, and innovation while fostering collaboration across various internal and external functions.
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 Care Coordinator serves as the primary manager for members with chronic health needs, conducting comprehensive assessments and developing individualized care plans. They collaborate with internal teams and community resources to implement interventions, remove obstacles, and support member health outcomes.
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.
This role is responsible for the design, configuration, implementation, and maintenance of complex clinical information systems. The analyst will provide technical guidance, lead projects, and ensure system optimization to support clinical enterprise operations.
This position is responsible for the design, configuration, implementation, and maintenance of clinical applications of basic to medium complexity. The analyst will also provide business analysis, develop testing scripts, and partner with customers to meet their clinical operational needs.
The role involves reviewing medical records to ensure accurate coding and sequencing of diagnoses and procedures for optimal DRG assignment. Additionally, the coder manages charge reviews and claim edits to ensure timely and accurate billing in compliance with federal regulations.
Develop and track key performance indicators to ensure accurate revenue capture and reimbursement while managing denial processes. Collaborate with department stakeholders and IS teams to analyze reporting, resolve technical issues, and implement workflow improvements.
The coder is responsible for accurately assigning ICD-10-CM, PCS, and CPT codes to professional and hospital services to ensure optimal reimbursement. They also manage claim edits, perform charge reconciliation, and provide feedback to providers regarding documentation clarification.
The manager oversees professional and outpatient hospital coding operations to ensure accurate billing and regulatory compliance. They are responsible for supervising coding staff, analyzing performance metrics, and implementing process improvements to optimize revenue cycle outcomes.
The analyst will define, develop, and implement enterprise-level business processes to support information systems and technology. They are responsible for designing complex reports, conducting data modeling, and facilitating process improvements to meet institutional requirements.
Provide telephonic and telehealth clinical direction to patients, caregivers, and facility staff in a 24/7 integrated care environment. Coordinate care transitions, manage acute and chronic conditions, and document comprehensive assessments in compliance with CMS regulations.
The Health Engagement Coordinator plans, implements, and monitors worksite wellness programs while collaborating with consultants to develop data-driven engagement strategies. They are responsible for conducting employee surveys, managing vendor services, and facilitating health education activities to improve overall employee health outcomes.
The Medical Director will lead the development of clinical decision support content by translating clinical guidelines into structured logic for EHR-embedded applications. They will also collaborate with cross-functional teams to integrate AI and optimize clinical workflows.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams, medication reconciliation, and evidence-based screenings. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health compliance.
The Associate Director will lead the development and oversight of strategic network initiatives while analyzing provider network performance to improve operational efficiency. They will collaborate with cross-functional teams to execute client-specific network strategies and provide leadership to program staff.
The 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 clinician provides telephonic and telehealth care to patients, coordinating with caregivers and facility staff to manage acute and chronic conditions. They are responsible for comprehensive clinical assessments, documentation in the EMR, and facilitating care transitions across various settings.
The RN Field Clinical Care Coordinator conducts comprehensive needs assessments and implements individualized care strategies for members. They act as a single point of contact to manage care plans and coordinate with internal teams and community resources.
Design, develop, and maintain enterprise-grade applications and microservices across the AI software development lifecycle. Collaborate with cross-functional teams to build scalable, AI-powered solutions and data pipelines using modern cloud-native technologies.
The 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 role involves managing and manipulating structured data to build business intelligence tools and conduct trend analysis. You will create models, develop actionable insights, and present recommendations to support health optimization initiatives.
The Quality Clinical Analyst supports quality improvement initiatives, including maternal/child health, behavioral health, and value-based programs. This role manages KPI dashboards, analyzes clinical data, and coordinates provider performance tracking to ensure compliance with state and contractual goals.
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.
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 Group Service Associate provides support to members, brokers, and business associates by resolving inquiries regarding eligibility, enrollment, and benefits. They also manage small group renewals by conducting outbound calls, explaining processes, and assisting with plan design changes.
The Medical Director conducts clinical coverage reviews and medical necessity determinations to ensure cost-effective, quality care for members. They collaborate with multidisciplinary teams and providers to manage medical benefits and educate stakeholders on coverage policies.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
Drive the definition, design, and delivery of AI-powered technology solutions including conversational virtual assistants and proactive engagement strategies. Collaborate with cross-functional teams to manage product backlogs and translate business capabilities into technical requirements.
The role involves monitoring system health, developing performance reporting, and delivering recommendations for system optimization. The analyst will also troubleshoot complex incidents and participate in a 24/7 on-call rotation to ensure system stability.
Perform deep dive performance forensics and code reviews to optimize application CPU usage and runtime. Provide technical support, mentorship, and technology proof of concept support while leveraging AI tools to enhance analysis efficiency.
The Physician Associate is responsible for the clinical review and adjudication of appeals and grievances in collaboration with a Medical Director. They will perform individual case reviews, interpret benefit coverage, and participate in organizational committees to improve clinical processes.
The Integrated Care Coordinator serves as the primary care manager for older adults with complex medical and behavioral health needs. They conduct comprehensive needs assessments and develop individualized care plans while collaborating with internal teams and community resources.
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 Observability Engineer will lead the design, automation, and operational excellence of enterprise observability platforms using Dynatrace. This role involves developing Python-based automation, managing CI/CD pipelines, and implementing Observability-as-Code practices across hybrid and multi-cloud environments.
The Sales Account Manager will prospect and enroll new members into health plans while building strategic relationships with community influencers and business partners. They are responsible for meeting enrollment goals, conducting product presentations, and managing a sales pipeline within their assigned territory.
The medical coder will identify and assign appropriate CPT and ICD-10 codes for outpatient ambulatory observation services while ensuring compliance with coding guidelines. They will also analyze and correct coding edits, abstract data during chart reviews, and provide documentation feedback to providers.
Develop and execute a territory business plan to grow specialty prescription referral volume and achieve revenue goals. Build and maintain trusted relationships with healthcare providers to identify and resolve barriers to therapy access.
Provide accurate inpatient coding services by identifying appropriate ICD-10-CM and PCS codes while adhering to official guidelines. Maintain high standards of documentation, perform chart reviews, and provide feedback to providers to ensure optimal health system performance.
The Senior Software Engineer will design, develop, and maintain scalable, high-throughput distributed applications across the full engineering stack. They will collaborate with architects to drive system design, implement DevOps practices, and utilize AI tools to streamline engineering workflows.
The Senior Software Engineer will design, build, and maintain high-performance, scalable distributed systems for the UHC Rewards platform. Responsibilities include developing backend microservices, optimizing SQL databases, and leveraging AWS to ensure platform reliability and operational efficiency.
Design, build, and maintain scalable full-stack AEM solutions using Java, OSGi, and modern frontend frameworks. Collaborate with cross-functional teams to integrate web applications with enterprise services and leverage AI tools to streamline development workflows.
The Senior Software Engineer will design, develop, and modernize scalable enterprise applications and cloud-native microservices within an Agile environment. They will also leverage AI-powered tools to enhance engineering productivity and ensure the high availability of mission-critical healthcare systems.
The Lead Generation Representative will identify, target, and qualify prospective business opportunities within the Middle Market employer segment. They will execute outbound prospecting campaigns and manage the sales pipeline within Salesforce to support strategic growth.
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 Strategic Client Executive manages a book of National Accounts, focusing on maintenance, growth, and profitability. They coordinate strategic initiatives and maintain intercompany relationships to ensure superior service delivery.
The role involves identifying and assigning accurate ICD-10-CM and ICD-10-PCS codes for inpatient hospital services while ensuring compliance with coding guidelines. Additionally, the coder will perform chart reviews, provide documentation feedback to providers, and maintain high standards of coding quality and productivity.
The Physician Assistant or Nurse Practitioner provides virtual medical care, including patient triage, assessments, and referrals within a remote clinical setting. They are responsible for maintaining accurate medical records, ensuring HIPAA compliance, and collaborating with the healthcare team to deliver quality care.
The provider is responsible for delivering virtual medical care, including patient triage, assessments, and referrals within Optum Serve operations. They must maintain accurate clinical records and ensure compliance with all regulatory and organizational policies while working in a remote, non-traditional setting.
The resident will participate in a primary care pathways program involving 1-3 hours of commitment per month to learn value-based care models. They will receive mentorship from experienced physicians while contributing to practice initiatives and population health efforts.
The RN Care Coordinator manages high-risk patients by facilitating care transitions, conducting telephonic outreach, and coordinating with primary care providers and specialists. They also perform medication reviews, provide patient education, and ensure appropriate site-of-service utilization to improve health outcomes.
The Sales Executive is responsible for driving business development and meeting revenue targets by selling complex revenue cycle and technology solutions to healthcare providers. This role involves managing the full sales lifecycle, from territory strategy and pipeline development to closing deals and fostering executive-level relationships.
The Sales Account Manager will drive membership growth for the Essential Plan by building strategic relationships with key market influencers and community institutions. They are responsible for prospecting, enrolling new members, and conducting product presentations within their assigned territory.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
Manage a dedicated population of patients through high-touch case management, including refill coordination and clinical assessments. Serve as a central point of contact between patients, pharmacists, and medical teams to ensure coordinated care and resolve patient concerns.
Manage a dedicated population of patients through high-touch case management, including refill coordination and clinical assessments. Serve as a central point of contact between patients, pharmacists, and medical teams to ensure coordinated care and accurate prescription processing.
The Senior Investigator is responsible for identifying, investigating, and preventing healthcare fraud, waste, and abuse by analyzing claims data and conducting field interviews. They must maintain accurate case documentation, ensure regulatory compliance, and participate in legal proceedings as required.
The role involves leading complex PBM network pricing analysis, financial modeling, and unit cost initiatives to support pharmacy network strategy and client performance. Additionally, the consultant will drive cross-functional transformation by improving pricing tools, data products, and operational workflows.
The Senior Data Engineer will define and own the end-to-end enterprise data architecture while leading the design of scalable data models and platforms. They will also implement cloud-native data flows, ensure robust data governance, and provide technical leadership to cross-functional teams.
The Integrated Care Coordinator serves as the primary care manager for older adults with complex medical and behavioral health needs. They conduct comprehensive needs assessments and develop individualized care plans while collaborating with internal teams and community resources.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and social determinants of health.
The coder will identify and assign appropriate CPT and ICD-10 codes for outpatient Acute Interventional Radiology services while maintaining quality and productivity standards. They will also provide documentation feedback to providers and analyze CCI and medical necessity edits.
The 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 role involves driving cross-alignment across the Center of Excellence and Trust Office by establishing security frameworks and operational standards. You will manage executive reporting, risk metrics, and program tracking while leveraging automated tools to optimize operational efficiency.
The Nurse Practitioner will conduct comprehensive clinical assessments and provide care to high-risk members in nursing homes and assisted living settings. They will collaborate with interdisciplinary teams to manage chronic conditions and facilitate advanced care planning for patients.
The Senior Account Manager is responsible for the quality and economic performance of physician practices to develop a high-performing provider network. They will analyze data, drive process improvements, and maintain strong relationships with stakeholders to meet quality and cost goals.
The case manager will conduct intake, assessments, and develop support plans while monitoring the health and welfare of members in their homes or long-term care facilities. They are responsible for maintaining accurate documentation and ensuring services align with the LTSS program requirements.
The Medical Director is responsible for the clinical review and adjudication of appeals and grievances for various health plan products. They also collaborate with internal teams and regulatory bodies to ensure compliance and improve health care quality.
Design, build, and maintain secure, scalable full-stack web applications and AI-enabled platform capabilities for cybersecurity products. Collaborate with cross-functional teams to integrate LLMs, semantic search, and automated workflows into customer-facing solutions.
The Senior Director will lead strategic planning for the transformation of finance and accounting functions into world-class, real-time systems. They will also drive process re-engineering efforts using AI solutions and lead a team of Six Sigma belts to address large-scale organizational challenges.
The Solutions Sales Executive is responsible for identifying, pursuing, and closing new business opportunities with pharmaceutical manufacturers. This role involves managing the full sales cycle, developing executive relationships, and driving revenue growth through strategic account planning.
The Senior Manager will lead enterprise Site Reliability Engineering, DevOps, and operational excellence initiatives to improve service reliability and platform resiliency. This role involves driving automation, implementing AI-enabled operational capabilities, and mentoring high-performing teams to meet business and regulatory standards.
The Clinical Program Consultant improves clinical quality outcomes by engaging with providers, monitoring performance, and closing care gaps. This role also coordinates with clinical teams and community partners to ensure compliance with state and federal Medicaid requirements.
The 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.
Design and build full stack web applications using Go and HTMX while maintaining RESTful services and cloud-native workloads in Azure. Collaborate with cross-functional teams to deliver scalable solutions using agile methodologies and modern CI/CD practices.
The 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 Lead Software Engineer will provide technical leadership for a backend delivery team while remaining hands-on with the design and implementation of Java-based microservices. They will collaborate with stakeholders to shape technical strategy, mentor engineers, and ensure the delivery of high-quality, scalable software solutions.
The 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 Client Service Analyst provides system and operational training while managing inquiry research and resolution for member-level issues. They are responsible for logging and tracking issue progress, providing website assistance, and handling ad-hoc client requests.
The Senior Manager will lead the Digital Identity Operations team to ensure operational excellence, incident management, and service reliability for enterprise identity platforms. This role involves driving process improvements, leveraging AI and automation, and collaborating with cross-functional teams to support high-availability services.
The Senior Investigator gathers and analyzes data to identify and document fraud, waste, and abuse (FWA) within healthcare schemes. They collaborate with clinical consultants, legal teams, and law enforcement to articulate findings and ensure compliance with regulatory standards.
The pharmacist will review, decision, and process prior authorization and appeals requests while ensuring compliance with clinical criteria and regulatory guidelines. They will also collaborate with providers and members to resolve inquiries and maintain accurate documentation of all clinical findings.
The 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 Medical Director provides leadership and direction for the claims review program, including conducting surgical and spinal claim reviews. They also facilitate telephonic discussions with providers regarding clinical coding and support regulatory compliance standards.
The Senior Inpatient Medical Coder will manage acute inpatient hospital claim edits, denials, and coding assignments to ensure data integrity. They will also analyze medical records and provide feedback to providers to improve documentation quality and billing accuracy.
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 role involves analyzing business requirements to develop database solutions for healthcare and reporting systems while ensuring service availability and stability. You will also be responsible for resolving production issues through debugging, log analysis, and performing root cause analysis.
The Case Manager will conduct intake, assessments, and develop support plans for members while monitoring their health and welfare in home or facility settings. They are responsible for maintaining accurate documentation and ensuring services align with the LTSS program requirements.
The psychologist will conduct clinical peer reviews to determine the medical necessity and coverage for outpatient mental health and substance abuse services. They will also evaluate treatment plans, psychological testing requests, and appeals to ensure compliance with federal, state, and local guidelines.
The Care Coordinator applies clinical knowledge to manage care for medically complex members, ensuring access to services and providers. They develop individualized care plans, conduct assessments, and collaborate with multidisciplinary teams to improve health outcomes.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Educate patients on disease processes and collaborate with primary care providers to address care gaps.
The Appeals and Grievances Medical Director is responsible for the clinical review and adjudication of appeals and grievances for various health insurance products. They also communicate with internal medical directors and regulatory bodies to ensure compliance and quality in medical service determinations.
Conduct comprehensive in-home health assessments for Medicare Advantage members, including physical exams and medication reconciliation. Collaborate with primary care providers to address care gaps and educate patients on disease processes and health management.
The Coding Supervisor manages daily operations, productivity, and quality metrics for the coding team while ensuring adherence to regulatory and payer guidelines. They also facilitate staff development, process improvements, and cross-departmental collaboration to support revenue cycle performance.
The Associate Finance Director manages quarterly forecasting models and performs variance analysis to support executive decision-making. They serve as a strategic partner to the VP of FP&A by synthesizing complex financial data into actionable business insights.
The case manager is responsible for conducting intake, assessments, and developing support plans for members receiving long-term services and supports. They must also monitor member health, document activities, and ensure compliance with program requirements and safety protocols.
The 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 medical coder will identify and assign appropriate ICD-10, CPT, and modifier codes for facility outpatient observation services. They are responsible for maintaining high levels of coding quality and productivity while adhering to official and client-specific coding guidelines.
The Strategic Account Executive serves as the primary point of contact for key Provider clients, developing and executing strategic plans to drive growth and profitability. They lead matrixed teams to deliver value, manage client relationships, and ensure the successful deployment of Optum solutions.
The resident physician will participate in a paid mentorship program to gain experience in a value-based care model. They will contribute to population health initiatives and receive guidance from experienced physicians to transition into clinical practice.
The role involves conducting educational outreach to providers regarding coding and documentation guidelines via phone and email. Additionally, the coder will audit outpatient claims to validate services and ensure accurate use of procedure codes and modifiers.
The Network Contract Manager develops and maintains a geographically competitive provider network while managing unit cost budgets and financial performance. They are responsible for negotiating contracts, ensuring network adequacy, and building trusted relationships with providers and internal stakeholders.
Design and develop state-of-the-art NLP and AI solutions for medical applications, focusing on clinical knowledge resources. Maintain production systems and collaborate with engineering teams to enhance NLP modules and functionality.
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.
Design, implement, and manage cloud infrastructure and CI/CD pipelines on Microsoft Azure to automate software delivery. Develop and deploy AI-powered solutions using low-code and advanced platforms to enhance business workflows and decision-making.
The Support Coordinator manages a panel of members with intellectual or developmental disabilities by conducting comprehensive needs assessments and developing person-centered care plans. They collaborate with internal teams and community resources to implement interventions that address medical, behavioral, and socioeconomic needs.
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.
The specialist provides telephonic and digital behavioral health support, conducting risk assessments and developing individualized action plans for members. They coordinate care, evaluate medical necessity for treatments, and guide members toward appropriate employer and community resources.
Design and deploy AI/ML and Generative AI solutions to build intelligent data products and digital experiences. Develop full-stack applications and cloud-native data solutions to enable self-service analytics and operational insights.
The physician will participate in a customized pathways program to transition from training into practice within a value-based care model. They will contribute to population health initiatives and engage in mentorship to improve care for patients.
Serve as the senior liaison for assigned client accounts, focusing on trend management, strategic plan execution, and contract renewals. Manage client performance reviews and lead the client services team to ensure high service standards and profitability.
Responsible for the reliability, scalability, security, and automation of enterprise-scale OpenShift Kubernetes platforms. This includes designing automated deployment solutions and collaborating with developers to improve application performance and observability.
Manage and optimize high-performance compute and zSeries storage environments using IBM Flash Systems and AI tools. Provide 24/7 on-call support, perform capacity planning, and collaborate with platform teams to resolve complex production issues.
Support the prior authorization and appeals process by researching and processing medication requests through various intake channels. Manage high-volume inbound and outbound calls while ensuring compliance with regulatory requirements and service level agreements.
Lead and coach a team of IG Care Specialists and Clinical Liaisons to achieve regional sales goals for infusion services. Collaborate with pharmacy operations, marketing, and pharmaceutical manufacturers to ensure superior customer service and business growth.
The role involves intensive outbound phone outreach to engage members, assess clinical needs, and provide guidance on behavioral health and substance use disorder services. The nurse acts as a clinical liaison to coordinate efficient care between members, providers, and internal clinical teams.
Assign appropriate ICD-10, CPT, and modifiers for facility outpatient and same day surgery services. Maintain high levels of coding quality and productivity while adhering to ethical standards and official guidelines.
Assign appropriate ICD-10, CPT, and modifiers for facility emergency department services while adhering to official coding guidelines. Maintain high quality and productivity standards and query physicians when necessary to ensure accuracy.
Acts as the primary bridge between business and technology teams to improve Advocate Central's capabilities. Responsibilities include owning backlog prioritization, translating business needs into user stories, and driving Agile delivery.
Lead strategic relationships with high-profile Health Plan clients to drive growth, retention, and financial performance. Manage a high-performing team of client management professionals while serving as a trusted advisor to C-suite executives.
Manage unit cost budgets and financial models to guide the development of competitive provider networks. Evaluate and negotiate contracts while ensuring appropriate distribution of provider specialties.
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.
The Market CMO serves as the senior clinical executive responsible for achieving clinical outcomes, affordability goals, and growth targets. They lead provider engagement, manage market relationships with regulatory entities, and ensure clinical compliance and quality improvement.
Lead and manage contract relationships and pharmacy benefit analysis for large, complex health plan clients. Serve as the primary clinical liaison to provide proactive recommendations on pharmacy trends and program optimization.
The Field Care Coordinator facilitates and advocates for enrollees' independence by conducting in-depth assessments and developing person-centered care plans. They collaborate with interdisciplinary teams and community resources to coordinate cost-effective care and manage transitions from acute facilities.
Manage unit cost budgets, financial models, and performance reporting to optimize provider networks. Evaluate and negotiate contracts with hospitals, clinics, and ancillary providers to ensure competitive and stable network access.
Develop analytical frameworks and data models to support Medicaid quality analytics and value-based care programs. Collaborate with cross-functional stakeholders to translate complex requirements into actionable insights and strategic recommendations.
The Market CMO serves as the senior clinical executive responsible for achieving clinical outcomes, affordability goals, and growth targets. They lead provider engagement, manage market relationships with regulatory entities, and ensure compliance with government mandates.
Oversee clinical consulting client relationships and manage resource allocation for OptumRx segments. Develop strategies for proactive consultative services, drive clinical upsell targets, and maintain strategic relationships with stakeholders and brokers.
Develop and execute strategic payor contracting and revenue growth plans for the Washington market. Lead the negotiation process to achieve reimbursement terms while maintaining strong relationships with health plans and insurance brokers.
Responsible for the administration, maintenance, and performance optimization of Oracle Exadata engineered systems across on-premises and cloud environments. The role involves developing automation solutions and ensuring the scalability and security of mission-critical platform environments.
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.
Responsible for selling new fully insured and level-funded Medical and Specialty products to employers with 51-99 employees. Focuses on developing broker relationships and managing the sales process from prospecting to implementation.
Lead the quality engineering strategy and design AI-powered automation frameworks for web, API, and mobile applications. Establish engineering standards and mentor QE engineers to ensure the scalability and reliability of claims processing systems.
Design and maintain scalable data quality frameworks to ensure the accuracy and consistency of enterprise data across multiple domains. Implement automated checks within ETL pipelines and validate Power BI reports using AI-assisted practices and AIOps observability.
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.
The VP of Sales is responsible for driving new business growth and developing regional sales strategies within the National Accounts business. This includes fostering consultant relationships and representing the company as an industry expert to achieve annual membership goals.
Lead production support and incident response for critical customer-facing applications, focusing on reliability and disaster recovery. Coordinate release activities, security remediation, and cloud platform operations using Kubernetes and GCP.
Conduct telephonic clinical reviews with providers to ensure members receive effective outpatient psychotherapy and community-based treatment. Assess member care against coverage guidelines and partner with providers to implement best practices.
The Medical Director conducts clinical coverage reviews and renders determinations based on member plan benefits and medical necessity. They collaborate with multidisciplinary teams and providers to ensure cost-effective, quality medical care.
The 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.
Oversee analytic functions to monitor financial performance and identify medical cost improvement opportunities for health plans and provider risk contracts. Lead a team of analysts to produce data-driven insights on utilization and cost trends for the executive team.
Secure IBMi servers and applications to prevent unauthorized access to client data and system configurations. Manage security reporting, investigate potential breaches, and provide evidence for various regulatory audits.
Assign appropriate medical codes by utilizing reference materials and applying knowledge of anatomy, physiology, and coding guidelines. Manage multiple work demands to maintain productivity standards and provide guidance during quality audits.
The therapist will screen and assess patients for mental health and substance use disorders using evidence-based approaches. They are responsible for tracking treatment response and maintaining accurate clinical documentation in compliance with regulatory requirements.
Lead the definition and management of business and functional requirements for the MedMonitor platform to support clinician network growth and CMR program expansion. Act as the primary liaison between clinical operations, IT, and external healthcare partners to ensure scalable platform capabilities.
Perform administrative reviews of short stay inpatient hospital claims based on Federal, State, and client requirements. Responsible for documenting all determinations and maintaining accurate use of screening criteria.
The therapist will screen and assess patients for mental health and substance use disorders while providing evidence-based treatment to individuals, couples, and families. They are also responsible for maintaining accurate electronic medical records in compliance with regulatory requirements.
Assign appropriate ICD-10-CM and ICD-10-PCS codes for inpatient hospital services while ensuring DRG accuracy. Provide documentation feedback to providers and maintain high quality and productivity standards.
Acts as a liaison between coding teams and providers to ensure accurate documentation and coding compliance. Conducts provider audits and delivers targeted education to improve quality standards and revenue opportunities.
Lead a squad of AI/ML engineers to design and deploy production-grade AI solutions, including Generative AI and multi-agent frameworks. Own the technical roadmap and ensure all deliverables meet high standards of quality, compliance, and Responsible AI governance.
Participate in a mentorship program designed to ease the transition from residency to professional practice. Engage in a few hours of monthly commitment to learn about value-based care and population health initiatives.
Serve as the subject matter expert for Palo Alto Networks firewalls to manage enterprise security policies and ensure compliance. Collaborate with technical leadership to develop secure solutions and lead the response to cybersecurity audits and incidents.
Lead Patient Access operations across the western region, overseeing the design and maintenance of Epic technologies and workflows. Manage regional staffing, lead large-scale technology initiatives, and partner with operational leaders to improve patient outcomes.
Assign accurate diagnostic and procedure codes for outpatient hospital professional accounts based on clinical documentation. Monitor work queues to ensure timely charging and generate queries for physician clarification.
Own the inference and delivery of machine learning insights to customers by managing and scaling ML systems. Partner with cross-functional teams to implement scalable pipelines and process high-volume healthcare datasets.
Design and implement enterprise-scale machine learning systems and production-ready MLOps pipelines to improve behavioral health outcomes. Provide technical leadership and mentorship to engineers while ensuring the ethical and responsible use of AI.
Lead the design and implementation of scalable AI/ML, GenAI, and agentic solutions to improve healthcare outcomes and operational efficiency. Own MLOps practices and develop production-grade APIs to expose AI capabilities at scale.
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.
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.
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.
Responsible for the clinical review and adjudication of appeals and grievances cases across various health plan products. This includes performing regulatory responses for CMS and Department of Insurance and collaborating with medical directors on decision rationales.
Participate in a customized transition program to learn how to operate within a value-based care model. Engage in mentorship and clinical exposure to primary and specialty care with a commitment of a few hours per month.
Participate in a customized program to transition from residency/fellowship into clinical practice within a value-based care model. Engage in mentorship and gain exposure to primary and specialty care settings with a commitment of a few hours per month.
Participate in a customized pathways program to transition from residency/fellowship into professional practice. Engage in a few hours per month of virtual or on-site exposure to primary and specialty care within a value-based care model.
Participate in a customized program to transition from residency/fellowship into clinical practice. Engage in a few hours per month of virtual or on-site activities focusing on value-based care and population health.
Participate in a customized program to transition from residency/fellowship into clinical practice. Engage in a few hours per month of activity focusing on value-based care and population health initiatives.
Participate in a customized pathways program to transition from residency/fellowship into professional practice. Engage with value-based care models and population health initiatives to improve patient outcomes.
Participate in a customized pathways program to transition from residency into professional practice. Engage with primary and specialty care environments to learn value-based care models and population health initiatives.
Assign CPT and ICD-10 codes for outpatient ambulatory observation services while adhering to official and client guidelines. Analyze CCI and Medical Necessity edits and provide documentation feedback to providers through physician queries.
Participate in a customized 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.
The radiologist will perform general radiology duties including radiography, fluoroscopy, and procedures while interpreting ultrasound and body CT scans. The role involves working within a 30+ radiologist group to deliver coordinated and accountable patient care.
The radiologist will perform general radiology interpretations including radiography, fluoroscopy, and procedures. They will also provide expertise in ultrasound, body CT, and potentially MSK or PET imaging within a multi-specialty group.
The Travel Psychologist will conduct thorough mental health evaluations and medical opinions for veterans in accordance with VA guidelines. They will also collaborate with multidisciplinary teams and act as a subject matter expert on mental health disability benefits questionnaires.
The Sales Account Manager is responsible for enrolling Medicare beneficiaries into the UnitedHealthcare Institutional Special Needs Plan by generating leads and managing facility relationships. They must document all sales activities to ensure compliance with Medicare Marketing Guidelines while meeting territory enrollment targets.
The radiologist will join a group to perform general radiology duties including radiography, fluoroscopy, and procedures. They are expected to provide high-quality patient care and may rotate between the main campus and satellite clinics.
The radiologist will join a group to perform general radiology duties including radiography, fluoroscopy, and procedures. They will also be responsible for the interpretation of ultrasound and general body CT scans.
The radiologist will perform general radiology duties including radiography, fluoroscopy, and interpretation of ultrasound and body CT scans. The role involves working within a 30+ radiologist group with potential rotations to satellite clinics.
The radiologist will perform general radiology duties including radiography, fluoroscopy, and interpretation of ultrasound and body CT scans. The role involves working within a 30+ radiologist group with potential rotations to satellite clinics.
The Licensed Clinical Social Worker will screen and assess patients for mental health and substance abuse disorders while providing evidence-based psychotherapy. They are also responsible for maintaining accurate electronic medical records and monitoring patient treatment progress.
The Licensed Clinical Social Worker will screen and assess patients for mental health and substance abuse disorders while providing evidence-based psychotherapy. They are also responsible for maintaining accurate clinical documentation and monitoring patient treatment progress.
Perform general radiology duties including radiography, fluoroscopy, and various procedures. Interpret ultrasound and general body CT scans while contributing to high-quality, coordinated patient care.
The radiologist will perform general radiology duties including radiography, fluoroscopy, and various procedures. They will also be responsible for the interpretation of ultrasound and general body CT scans.
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.
