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Position Purpose: Develop and implement business process excellence initiatives throughout the organization to analyze and address process and operational inefficiencies by utilizing Six Sigma/LEAN methodologies. Provide leadership and oversight of the business unit's implementation processes; manag

Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and thei

Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and thei

Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and thei

Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote qu

Position Purpose: Manage and support the development of network performance analytics. Design and build solutions that create, maintain, interface, or transform data in order to support a complete business need around contracting analytics and modeling applications. Key Details: This position is 100

Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Key Details: Applicants for this r

Position Purpose: Responsible for analytic data needs of the business unit. Handle complex data projects and acts as a lead for other Data Analysts. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future

Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Key Details: This is a remote, fie

Position Purpose: Supports administrative care management activities including performing outreach, answering inbound calls, and scheduling services. Serves as a point of contact to members, providers, and staff to resolve issues and documents member records in accordance with current state and regu

Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to ment

Position Purpose: Manage vendor relationships and ensure vendor compliance with established internal and/or regulatory performance metrics. Accumulate, monitor, and report on vendor performance metrics to business unit management Communicate expectations and vendor performance against established pe

Position Purpose: Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care

Position Purpose:Learn about various processes and functions within the Managed Care industry and develop professionally by contributing to projects that support the business. We're seeking curious, collaborative problem-solvers who are passionate about cybersecurity. Interns may support projects ac

HEDIS Operations experience highly preferred Clinical Medical Record Review experience. Position Purpose: The Senior Quality Improvement Specialist is responsible for coordinating assigned regulatory, accreditation, clinical quality and/or service improvement programs. Functions as a leader for assi

Position Purpose: Conduct fraud, waste, and abuse (FWA) investigations by reviewing referrals, claims data, medical records, provider information, and other relevant evidence to identify potential misconduct and support case resolution. Document investigative activities, prepare reports and referral

Position Purpose: Manage the specialty pharmacy call center customer service function, including technology needs and implementation. Coordinate with various operational departments to research and resolve complaints and inquiries. Key Details: Manager, Patient Services (Call Center - Pharmacy). Thi

Position Purpose: Develops, assesses and coordinates holistic care management activities, with primary focus and support towards populations with significant mental/behavioral health needs, to enable quality, cost-effective healthcare outcomes. Evaluates member service needs and develops or contribu

Position Purpose: Plans, organizes, monitors, and oversees projects utilizing cross functional teams to deliver defined requirements and meet company strategic objectives. Key Details: Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States. Ma

Position Purpose: Develops, assesses and coordinates holistic care management activities, with primary focus and support towards populations with significant mental/behavioral health needs, to enable quality, cost-effective healthcare outcomes. Evaluates member service needs and develops or contribu