The Care Coordinator performs telephonic outreach and screenings to coordinate behavioral health and community resources for members. They collaborate with clinical staff to triage cases and ensure members receive appropriate care management.
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 Clinical Pharmacist is responsible for pharmacy utilization management, including reviewing prior authorization requests and overseeing support staff. They also coordinate with the pharmacy benefits manager and support clinical committees to ensure quality and cost-effective care.
The Senior Actuarial Analyst provides technical support for rating, pricing, reserving, and financial forecasting within the health insurance sector. They are responsible for analyzing complex financial data, managing regulatory rate filings, and developing actuarial models to support corporate initiatives.
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.
