The Clinical Care Manager provides holistic care management services, including comprehensive assessments, care planning, and coordination across the healthcare continuum. They work collaboratively with multidisciplinary teams to improve health outcomes, address social determinants of health, and promote member self-management.
The coordinator is responsible for the identification, intake, and distribution of member appeals and grievances while maintaining accurate records. They also assist management with audits, reporting, and trend analysis to ensure compliance and operational efficiency.
The supervisor manages Member and Provider Service Center staff to ensure high-quality service delivery and adherence to contractual standards. They are responsible for analyzing call volumes, implementing operational policies, and resolving complex service barriers across various product lines.
The Clinical Care Manager provides holistic care management services, including comprehensive assessments, care planning, and coordination across the healthcare continuum. They work collaboratively with multidisciplinary teams to improve health outcomes, address barriers to care, and support diverse member populations through evidence-based practices.
The Medical Director provides clinical case review, consultation, and oversight for utilization management activities while ensuring compliance with federal, state, and NCQA requirements. They also collaborate with healthcare providers to improve population health outcomes and support quality improvement initiatives.
The Clinical Care Manager provides holistic care management services, including comprehensive assessments, care planning, and coordination across the healthcare continuum. They work collaboratively with multidisciplinary teams to improve health outcomes and address social determinants of health for diverse member populations.
The Clinical Auditor performs retrospective chart reviews to verify billed charges against medical documentation and policy guidelines. They act as a liaison between the health plan and providers to ensure billing accuracy, identify potential fraud, and manage cost savings.
The Lead Data Architect will drive the enterprise data strategy and oversee the transition to a cloud-based data infrastructure. They are responsible for ensuring data quality, security, and compliance with healthcare regulations while fostering actionable insights.
The Director of Provider Analytics leads the analytics team to support provider contracting, network strategy, and performance monitoring. This role ensures regulatory compliance through network adequacy reporting and provides actionable insights to senior leadership to drive business strategy.
The Senior Pharmacy Data Analyst will architect complex data models and develop enterprise-level dashboards to drive pharmacy performance and regulatory compliance. This role also serves as the Pharmacy Data Steward, ensuring data integrity while collaborating with cross-functional teams to deliver actionable insights.
The Manager of Learning and Development leads the strategy, design, and implementation of scalable training programs for healthcare call center operations. This role oversees a team of trainers and instructional designers to ensure staff performance, regulatory compliance, and service quality.
