Alliance Health

The Utilization Management (UM) Clinical Specialist RN for physical health (PH) independently assesses the medical necessity of inpatient admissions, outpatient services, surgical and diagnostic procedures, and out of network services, monitors consumer treatment through ongoing and continuous revie

The IDD Community Integration CM position provides a critical support to Alliance members with I/DD to successfully integrated from an institutional setting into independent community living settings of their choice. Responsibilities include building relationships and rapport with members and provid

The Care Manager II position leads all communication among care team members and is the primary point of contact for the member served. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of h

The Manager of EDI Development and Support’s primary role is to oversee the development, implementation, and support of our EDI systems, processes and vendor interactions and support. The Manager of EDI Development and Support will collaborate with cross-functional teams, manage EDI projects, and en

The Medical Economics Analyst performs detailed statistical analysis related to the organization’s service delivery. The Analyst will create and manage reports that monitor care utilization, premium, and MLR. The Analyst will support the Director of Medical Economics in identifying potential cost of

The Cloud Data Architect is responsible for design and implementation of scalable enterprise-wide data architecture. These responsibilities include optimizing data performance and accessibility, and ensuring data quality, integrity and security. This position is full-time remote. Selected candidate

The Cloud Architect is responsible for the enterprise cloud governance framework, ensuring all development adheres to architecture, security and compliance standards. These responsibilities include driving the evolution of the cloud platform, defining the roadmap for services and applications built

The Internal Auditor II provides senior level staff advisory, consultative, and audit work to include the preparation of audit programs and independent review of various functions, policies, and programs for soundness, adequacy, and application. The Internal Auditor II ensures resources are efficien

The Care Manager II-Facility Based provides Transitional Care Management and Physical Health Consultation for members with physical and/or behavioral health needs in Acute Care facilities, State Operated Developmental Centers, and Justice System settings. For Care Manager II-Facility Based assigned

The Risk Manager is responsible for leading and continuously maturing the organization’s Enterprise Risk Management (ERM) program for a Medicaid managed care organization. Reporting to the Chief Risk and Compliance Officer, this role provides second line oversight and enterprise wide coordination to

Provider Network Evaluator I (PNE I) is a QP level professional that works as part of the Provider Network Evaluation Department. The department has the responsibility for ensuring that providers are properly delivering services to Alliance members and their families and ensures any out of complianc

The Assistant General Counsel is responsible for performing a full range of legal services in support of Alliance as a member of the Alliance Office of Legal and Public Affairs. The work of the Assistant General Counsel will serve to mitigate legal risk to the organization through practice in a vari

The Sr. Psychologist – I/DD is a licensed professional who brings both clinical and health plan experience in intellectual and developmental disability (I/DD) to the Alliance Medical Management team, primarily performing utilization management (UM) activities (e.g., peer reviews, appeals) for reques

The SharePoint Developer develops and designs SharePoint websites and designs forms. Developers are responsible for ensuring that requirements are met, and the developed solution is technically sound. The SharePoint Developer will employ technologies that adhere to standards established by the organ