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Position Purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Key Details: This is a remote position

Position Purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Key Details: This is a remote position

Position Purpose: Promote increased program efficiency, service levels, and value by capturing and monitoring performance, and then identifying opportunities for improvement and strategies to realize those opportunities. Plan, organize, monitor, oversee and lead multiple, concurrent resultant projec

Position Purpose: Promote increased program efficiency, service levels, and value by capturing and monitoring performance, and then identifying opportunities for improvement and strategies to realize those opportunities. Plan, organize, monitor, oversee and lead multiple, concurrent resultant projec

Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. KEY DETAILS: This fully remote role with “Partnerships In Care” s

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: Responsible for evaluating and interpreting Payment Integrity (PI) policies, Federal and State Regulatory, Contract changes to support compliant and accurate claims adjudication. Analyzes state and federal regulations, payer contractual requirements, and internal Payment Integrity

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: Designs, develops and implements enterprise software solutions. Collaborates closely with technical and non-technical roles such as data modelers, architects, business analysts, data stewards, and subject matter experts (SMEs). Strong application development and data engineering ex

Position Purpose: Contributes to the design of data integration, processing, reporting, and analytics. Executes strategies for warehouse implementation, data acquisition and access, and data archiving and recovery. Develops data platform specific capabilities and roadmaps, works closely with the Dat

Position Purpose: Oversee the development and implementation of hospital provider contracting activities in network development and enhancement. 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 spo

Position Purpose: The Coding Quality Coordinator II is the journey level position within a job series that performs complex reviews of clinical documentation on inpatient and outpatient medical records. Validates accuracy of diagnostic and procedural coding, payment methodology, and reimbursement am

Position Purpose: Deploys data center related end-to-end technologies. Tracks assets and cabling using standard documentation. Monitors and responds to alarms for data center equipment. Monitors and responds to alarms for the mechanical/electric plant (MEP). Completes change requests and associated

Position Purpose: Performs care management duties to assess, plan and coordinate aspects of medical and supporting services across the continuum of care for post-discharge members, promoting quality and cost effective care. Completes medication review for pre-admission and post-discharge reconciliat

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:Ensure timely processing of complex pending medical claims. Verify and update information on the submitted claims. Review work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company practices and procedures. Process first

The Care Coordinator II provides non-clinical administrative support to the care management team. Handles inbound and outbound calls to support care management services. Manages call queues, tasks, and referrals in a timely manner. Gathers information by phone to determine eligibility for care manag

The candidate will ideally reside in Austin or El Paso or surrounding areas. Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage wit

Position Purpose: Learn about various processes and functions within the Managed Care industry and develop professionally by contributing to projects that support the business. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsor

Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. Responsible for ensuring that all appeal letters generated comply with both State and NCQA requirements. Key Details: This is a fully remote, work-from-home position