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 Medical Director provides clinical oversight for utilization management, medical necessity reviews, and quality improvement initiatives. They collaborate with clinical staff and external providers to ensure consistent medical decision-making and compliance with regulatory standards.
The Medical Director will conduct clinical case reviews, medical necessity determinations, and oversee utilization management activities to ensure compliance with federal and state requirements. They will also collaborate with clinical staff and committees to improve population health outcomes and support quality improvement initiatives.
The Manager of Behavioral Health Provider Engagement oversees a team of consultants to manage provider relationships, ensure regulatory compliance, and resolve operational issues. They are responsible for developing training plans, analyzing performance data, and collaborating with internal and external stakeholders to meet network objectives.
The Senior Director will establish and drive the enterprise data strategy, overseeing the transition to cloud-based infrastructure while ensuring data integrity and regulatory compliance. They will lead a team of architects to modernize health data systems and champion the use of advanced analytics to support strategic decision-making.
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 coder manages chart abstraction, vendor auditing, and reporting in accordance with state and federal regulations. They ensure all claims accurately reflect diagnosis information supported by clinical documentation.
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.
The HR Program Manager oversees a portfolio of cross-functional HR initiatives and partnerships to achieve sustainable organizational outcomes. This includes designing HR programs, optimizing processes, and ensuring compliance with Medicaid and Medicare contracts.
