The Telephonic Care Manager provides pediatric case management by coordinating care, identifying health needs, and developing comprehensive care plans for members. They collaborate with caregivers and providers to address gaps in care, manage chronic illnesses, and facilitate necessary medical and social services.
The Interface Analyst Associate will design, develop, test, and support interfaces while building foundational technical and analytical skills. They will also manage project timelines, document outcomes, and participate in an on-call rotation after one year.
The Application Delivery Engineer will support secure system development through automated tools, security process execution, and reporting. They are responsible for evaluating infrastructure designs for compliance, managing disaster recovery requirements, and participating in a 24/7 on-call rotation.
The Physical Therapist will evaluate patients, develop individualized treatment plans, and provide evidence-based therapy interventions to improve mobility and quality of life. They are also responsible for documenting patient care, communicating with the healthcare team, and providing patient and family education.
The Critical Incident Investigator manages, investigates, and documents high-volume critical incidents for Community HealthChoices participants to ensure safety and regulatory compliance. They collaborate with service coordinators and providers to identify trends, mitigate risks, and implement corrective actions.
Perform abstracting and coding of core clinical data in accordance with UPMC and regulatory standards. Maintain accurate registry operations and ensure high-quality follow-up data for cancer cases.
The analyst will manage comprehensive data analysis to identify financial and clinical variances while developing strategic opportunities for the Health Plan. They are responsible for articulating these findings to stakeholders, implementing solutions, and monitoring performance progress.
The Lost Time Claims Specialist II is responsible for the investigation, evaluation, negotiation, and resolution of assigned workers' compensation claims. They will manage litigation activities, establish reserves, and ensure all claims are processed in accordance with company policies and state regulations.
The Actuarial Analyst III will produce detailed financial models to project the performance of value-based programs and analyze healthcare claims data to identify cost improvement opportunities. They will also present findings to leadership and provide analytical support for various strategic initiatives.
The Clinical Pharmacy Specialist manages therapeutic drug interventions and clinical programs to control pharmacy trends and improve quality measures. They also collaborate with interdisciplinary teams to coordinate member care and develop innovative clinical strategies for pharmacy benefit management.
The Medical Director will oversee utilization management and quality improvement programs to ensure high-quality healthcare delivery for CHC members. They will also act as a clinical leader, providing medical determinations and fostering effective relationships between the health plan and network providers.
The Managing Actuary will lead medical cost improvement strategies and develop financial models for value-based provider contracts. They are responsible for supervising a team of analysts and collaborating with cross-functional departments to interpret financial results and drive strategic decision-making.
The Medical Director provides leadership for utilization management and quality improvement programs to ensure high-quality care for health plan members. They act as a primary physician reviewer, manage provider credentialing, and ensure compliance with clinical standards and reporting requirements.
The Grants Specialist manages fiscal operations, monitors budgets, and ensures compliance with university and sponsor regulations for research projects. They also provide financial reporting, account forecasting, and serve as a resource for research investigators regarding award administration.
The Actuary will lead the development of actuarial tools to drive medical cost improvement strategies and analyze healthcare utilization trends. They will also provide analytical support to leadership, manage data validation for HCG Grouper software, and supervise less experienced staff.
The Coder III monitors pre-bill edit reports, performs coding corrections, and ensures timely billing for Interventional Radiology and Cardiology. They are also responsible for training other coders and maintaining high accuracy and productivity standards.
Oversees adherence to quality and utilization standards to ensure high-quality healthcare delivery for health plan members. Provides leadership for provider credentialing, medical reviews, and coordination with state health departments regarding reportable conditions.
Responsible for the investigation, evaluation, and disposition of lost time workers' compensation claims across several US jurisdictions. The role involves managing litigation activities, setting reserves, and coordinating with medical experts and legal counsel.
The Medical Physicist will oversee dosimetrists to ensure accurate treatment plans and collaborate with the Radiation Oncologist for treatment planning and delivery. Key duties include developing quality control programs, ensuring equipment functionality through precise measurements, and maintaining regulatory compliance.
