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The Quality Improvement Specialist conducts audits of Primary Care Physicians and associated facilities to ensure compliance with regulatory standards. The role involves managing scheduling, documenting findings, developing reports, and providing training and technical assistance to improve accessibility for members, while maintaining confidentiality and adhering to policies.
The Community Relations Specialist leads activities to achieve membership and enrollment goals through marketing, community activities, and outreach. Responsibilities include planning events, developing business relationships, conducting internal and external meetings, and coordinating with sales teams for market execution, all while ensuring compliance with policies and procedures.
The Retention Field Representative is responsible for retaining membership, conducting outreach, and providing product education to new and existing members. They maintain relationships with members, document interactions in systems like Sales Force, and ensure compliance with corporate policies. Fluency in Cantonese and Mandarin is required.
The Community Relations Coordinator is responsible for developing and implementing the community outreach plan for the Health Plan. This role involves engaging with community contacts, attending health events, organizing outreach activities, and supporting health education presentations. A strong focus is placed on member growth goals and complying with regulatory guidelines in healthcare marketing.
The Senior QA Automation Test Engineer designs and develops automated test scripts, conducts code reviews, and enforces quality standards. They also execute manual and automated tests, mentor junior engineers, analyze product quality, and ensure compliance with industry standards while integrating automated suites with CI/CD platforms.
The Manager, Provider Network Operations oversees provider network activities ensuring compliance with health standards and regulatory requirements. Responsibilities include managing operational functions like credentialing and contract processing, monitoring onboarding processes, leading initiatives for process improvement, and ensuring compliance with internal and external standards.
The Senior Solutions Architect creates and integrates architecture guidelines to support testing integration requirements. They provide expertise on testing architecture decisions, develop integration testing architecture blueprints, and collaborate with various teams to assure compliance with standards and enhance business processes. Additionally, they participate in strategic discussions regarding technology trends and new initiatives.
Recruit and develop networks of physician, hospital, and ancillary service providers by negotiating and managing network participation agreements. Ensure compliance with Corporate, health plan, and State guidelines. Coordinate with internal departments and contracted providers for contract compliance. Requires 2+ years of provider contracting experience.
The Senior IT Assurance Analyst gathers and organizes assessment data to support risk reporting, advising on IT controls, and designing corrective actions to address deficiencies. They consult with stakeholders to implement controls, assess risk levels across the enterprise, and develop metrics for reporting to management. They also communicate remediation strategies and manage project-related issues and risks effectively.
The Senior Manager, Procurement will manage vendor relationships, evaluate vendor performance, and oversee contract management. Responsibilities include leading complex procurement projects, developing supplier relationships, and mitigating risks through effective contract negotiation and compliance training.
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