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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.
The Provider Engagement Account Manager is responsible for managing partnerships between the health plan and provider networks. Key duties include resolving provider issues, educating providers on policies, managing network performance, and driving improvement in quality metrics and utilization. Must travel locally four days a week and adhere to company policies.
The Community Resource Coordinator II position supports community connection activities to help members access resources for their care management. Responsibilities include outreach, health assessments, and documentation of community resources while assisting clinical teams and promoting awareness of available services.
The Lead Pega Application Development Engineer designs, develops, and implements complex enterprise software solutions focusing on automating claims processes. This role involves leading projects, collaborating with technical teams, overseeing application support, and managing changes while ensuring the software meets business needs.
Identify, negotiate, and manage high performing provider and vendor partnerships. Lead financial analyses and operational reporting for vendor and provider agreements. Develop and initiate corrective action plans for partnerships. Collaborate with internal teams and lead meetings to review agreement performance data and strategy.
The Senior Site Reliability Engineer will lead projects to enhance platform performance, reliability, and security using SRE methodologies. Responsibilities include troubleshooting complex service issues, automating monitoring, and optimizing systems. The role also involves leading deployments, managing observability tools, and guiding lower-level engineers. The ideal candidate will ensure documentation is up-to-date and facilitate post-incident reviews to improve overall system reliability.
Responsible for providing advanced analytical support for business operations in various areas such as claims, provider data, member data, and clinical data. Extracts, models, and reconciles large amounts of data across multiple platforms. Develops reports, ensures data compliance, and mentors other Data Analysts.
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