Responsible for documenting and processing appeals, disputes, and reconsiderations to align with regulations, ensuring timely reviews and decisions.

The Quality Improvement Specialist supports quality improvement projects, audits medical records, analyzes reporting results, trains staff, and meets with stakeholders to enhance healthcare quality.

Leads technical decisions for cloud infrastructure, manages cloud deployment, and integrates security measures while overseeing a team of engineers and automating processes.

Supports community connection by linking members to resources, provides health education, and assists clinical teams with outreach and assessments.

Analyze large datasets to extract insights that influence business decisions, identify value areas, and support project executions in healthcare analytics.

The Lead Enterprise Platforms Product Manager defines product strategy and roadmap for technology solutions, guides product governance, and aligns senior stakeholders to improve health outcomes through technology.

Responsible for planning, organizing, and overseeing complex projects in the Population Health and Clinical Operations team, ensuring project success through effective communication and resource management.

The Lead IT Portfolio Management Analyst prioritizes projects, manages Agile/Lean portfolios, develops reporting metrics, and ensures strategic alignment with technology goals.

The Senior Accreditation Specialist coordinates accreditation oversight and survey readiness, develops policy and procedures, and communicates with leadership while ensuring quality improvement related to NCQA and HEDIS.

Oversee staff and manage department budgeting. Ensure IT systems align with business goals, develop new policies, and collaborate with senior leaders and suppliers.

Manage relationships with marketing teams to achieve business objectives through effective, insight-driven marketing strategies and campaigns. Monitor compliance with norms and adapt content for diverse audiences.

The role involves educating and supporting members on health management, coordinating non-medical needs, and advocating for members. Responsibilities include outreach and assessment to connect members with community resources.

Provide executive leadership over finance functions for the business unit, manage financial analysis, forecasting, identify cost trends, and ensure compliance with state requirements.

The Clinical Review Nurse performs concurrent reviews to assess member health, medical necessity, and care settings, collaborating with providers and ensuring quality care standards are met.

The Senior HEDIS Quality & Audit Analyst oversees HEDIS quality, audits, and regulatory compliance, ensuring accurate submissions and documentation. They lead audit workstreams, provide expert guidance on compliance, and implement corrective actions for risks.

Analyze prior authorization requests to determine medical necessity, review clinical cases, and coordinate with medical teams for effective care management.

The VBC Performance Manager develops partnerships with provider networks, manages performance, resolves provider issues, and drives quality and cost performance improvements.

Perform internal audits focusing on IT and operational risks, assist in planning and drafting audit reports, and monitor audit findings.

The Clinical Review Nurse performs concurrent reviews to assess medical necessity and appropriate care levels for members, collaborating with healthcare providers and maintaining records according to policies.

This role develops partnerships with provider networks, ensuring improved network performance, issue resolution, and quality outcomes. It involves strategic management, provider education, and performance tracking through data analytics.