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The Manager of UM Operations Strategy & Implementation oversees compliance, regulatory functions, audits, and process improvements in utilization management, leading a team to ensure alignment with business goals.

Lead provider relations and contracting strategies in Ohio, ensuring compliance and optimal performance while collaborating with stakeholders to enhance healthcare delivery.

The Director of Network Development oversees provider contracting and network adequacy, facilitating member access while ensuring compliance and optimal financial performance across various markets.

The role involves developing and managing complex data sets, creating dashboards, and analyzing data for operational efficiency in healthcare. Collaboration with clinical and IT teams is essential to optimize patient outcomes and processes.

The Customer Account Manager oversees customer account management, driving revenue growth and enhancing service utilization while collaborating with multiple teams and managing training and implementations.

The Payment Cycle Analyst II provides analytical support for claims-related projects, ensuring accuracy in claim payments, conducting data analysis, and documenting clinical and payment policies.

The Program Integrity Clinical Reviewer II evaluates medical records for accuracy, audits claims, provides training, and collaborates across departments to enhance clinical documentation compliance.

The AVP, Network and Contracting oversees provider contracting and network strategy, ensuring compliance and optimizing member access while leading a high-performing team.

The Compliance Analyst II supports the Compliance Program through analysis, training, and collaboration, ensuring effective implementation of compliance requirements and managing corrective actions.

The Revenue Cycle Coordinator III ensures timely resolution of member complaints related to eligibility and billing, leads teams, and develops training for compliance with regulatory standards.