The Project Analyst manages clinical trial coverage analysis and budgets while supporting the financial and operational management of oncology research studies. They are responsible for developing workflow dashboards, monitoring performance metrics, and coordinating with internal and external stakeholders to ensure compliance.
The Manager will provide operational leadership and oversight for a team of Telephonic Care Managers to ensure high-quality, patient-centered care coordination across the healthcare continuum. They are responsible for developing staffing strategies, monitoring performance metrics, and partnering with stakeholders to improve patient outcomes and reduce avoidable utilization.
The Actuary will lead the development of financial tools to drive medical cost improvement strategies and analyze healthcare utilization trends. They are also responsible for presenting findings to leadership and supervising less experienced actuarial staff.
The Lead Business Intelligence Developer manages and develops BI assets while partnering with clinical and business leaders to address reporting needs. They are responsible for designing semantic models, creating data visualizations, and providing training and support to other staff members.
The Coder II is responsible for accurately assigning ICD-10-CM and CPT codes for outpatient records while ensuring compliance with coding guidelines and CCI edits. They must also manage physician queries for incomplete documentation and maintain productivity and accuracy standards.
The coder is responsible for assigning and verifying accurate ICD-10-CM and PCS codes for inpatient accounts by reviewing medical records in the electronic health record. They must also identify incomplete documentation to initiate physician queries and maintain productivity standards while adhering to official coding guidelines.
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 Clinical Documentation Specialist facilitates modifications to clinical documentation through concurrent interaction with physicians to ensure accurate severity of illness and service level capture. They are responsible for daily clinical evaluation of medical records and participating in organizational documentation improvement initiatives.
The Actuary Specialist will lead complex actuarial analyses to identify medical cost drivers and affordability opportunities while presenting findings to leadership. They will also develop financial tools, forecast results, and provide supervision to less experienced staff.
The Coder II is responsible for reviewing medical documentation to assign accurate ICD and CPT codes while ensuring compliance with coding guidelines. They must also resolve coding edits and denials, formulate physician queries for missing information, and maintain productivity standards.
The Lead Neurodiagnostic Tech oversees daily operations, staff scheduling, and equipment maintenance for EEG and EMG labs. They also provide clinical leadership, ensure patient safety, and coordinate care flow while working closely with physicians.
The Medical Director provides leadership for utilization management and quality improvement programs to ensure high-quality healthcare delivery. They are responsible for conducting clinical reviews, managing provider relations, and ensuring adherence to established medical policies and standards.
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 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.
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.
