Job Summary: The Community Based Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports and the population through culturally competent delivery of care and coordination of services and supports. Facilitates communication, coordinates care and service of the member through assessments, identificati...
Job Summary: The Community Marketing Representative II is responsible to support the enrollment and retention strategy in collaboration with management to ensure all membership goals are successfully achieved. Essential Functions: Utilize an educational approach to community organizations to promote any available lines of business in assigned regions Serve as a subject matter expert on all lines of business available in the assigned territory Con...
Job Summary: The Actuarial Analyst I is responsible for providing timely, accurate, and actionable data and analysis supporting the department, area, and corporate key initiatives. Essential Functions: Develops actionable recommendations to management relative to all analysis Calculates profitability reports on appropriate business segments Performs regular and ad-hoc analysis to identify opportunities to improve efficiency and affordability Perf...
Job Summary: The Vice President, Market Chief Medical Officer is responsible for ensuring the successful implementation and management of local health plan initiatives, with a focus on clinical excellence and quality improvement, ensuring effective inpatient and outpatient utilization, affordability, and health system transformation, including provider network optimization, compliance with regulatory requirements, growth strategies, and other key...
Job Summary: The Manager, Market Quality Improvement manages the day-to-day prioritization of staff activities in collaboration with Director, Quality Improvement. The Manager will be responsible for developing quality documents in compliance with state and federal requirements and work with departments outside of quality to obtain information for reports. Essential Functions: Responsible for Corporate oversight of the HEDIS Medical Record Review...
Job Summary: The Provider Engagement Communications Analyst II executes small project plans and provides support for new market implementations along with existing markets and products. This role is responsible for aiding in the oversight of all network Provider Engagement communication materials including updating, tracking, cataloging, and socializing materials & templates. Essential Functions: Work collaboratively with team and other business ...
Job Summary: The Pharmacy Resident interacts professionally as a pharmacist resident within an interdisciplinary team of health care professionals to provide support and leadership within the managed care environment and an academic setting. Essential Functions: Assist operations team in processing prior authorization requests and improving operational processes Develop innovative programs and contribute to ongoing projects by performing a variet...
Job Summary: The Provider Contract Manager supports the Director, Provider Contracting & Strategic Growth with the development, implementation, and management of provider contracting operations processes. Essential Functions: Ensure operational effectiveness by assisting in strategic and business planning, including strategic initiative identification and resource planning and allocation Partner with leadership to determine and prioritize opportu...
Job Summary: The Market Administrative Assistant III is responsible for assisting with special projects, conduct research, compile data and maintain records. They will manage the Market President's calendar and provide administrative support. Work 3 days per week in the Downtown Crossing (MA) office and 2 days per week remote. Essential Functions: Compose and prepare advanced business presentation documents and spreadsheets Compose correspondence...
Job Summary: The Special Investigations Unit (SIU) Investigator I is responsible for comprehensive review, examination, and analysis of assigned allegations of healthcare fraud, waste and abuse (FWA) by medical professionals, facilities, and members. Specific responsibilities may fluctuate to align with department priorities and may include any of the following essential functions. Essential Functions: Support other departments to obtain informat...
Job Summary: The Intelligent Automation Developer III is responsible for creating, designing, developing, and implementing Intelligent Process Automation solutions based on client requirements and in accordance with standard automation tool design principles and conventions. This position leverages robotic process automation (RPA) tools such as Microsoft Power Automate and UiPath, or both, to streamline business processes, reduce manual workload,...
Job Summary: The Team Lead, Customer Care is responsible for leading and directing their team to ensure goals, regulatory, compliance, and department standards are met. Essential Functions: Conduct regularly scheduled coaching conversations. listening and providing feedback for improved performance, and when applicable, create performance improvement plans Properly document coaching and development conversations in HR system Complete performance ...
