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Perform various analysis and interpretation to link business needs and objectives for assigned function Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems Identify and analyze user requirements, procedures, and problems to improve existing processes Perform detailed analysis on assigned projects, recommend potent
Posted 1 day ago
Provide health education and coaching to members tailored to issues identified within treatment and service plans Coordinate with various healthcare providers for diagnostics, ambulatory care, and hospital services Assist members with social determinants of health including access to exercise and healthy food Promote activities focused on the health of a patient and their community, including with
Posted 4 days ago
Perform various analysis and interpretation of member enrollment data. Identify opportunities and recommend actions to improve the efficiency and accuracy of processes. Review regular and periodic processing reports to ensure all transactions associated with enrollments and disenrollments are accepted Perform detailed analysis on assigned projects, recommend potential business solutions and assist
Posted 6 days ago
Respond to customer inquiries via telephone and written correspondence in a timely and appropriate manner. Respond to telephone or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources Provide assistance to members and/or providers regarding website registration and navigation Document all activiti
Posted 6 days ago
Senior Business Process Improvement Manager Senior Business Process Improvement Manager (1099970) Position Purpose Identify, develop, and execute process improvement opportunities utilizing continuous improvement principles and LEAN/Six Sigma methodologies Prioritize and lead process improvement activities across the enterprise in support of all departments and functional areas Monitor process imp
Posted 13 days ago
Manage the portfolio of cross functional process improvement projects across the enterprise in support of all departments and functional areas Train, coach and develop project facilitators to effectively utilize continuous improvement principles and LEAN/Six Sigma methodologies Establish team goals and priorities and assist project facilitators to overcome escalated obstacles Evaluate project perf
Posted 13 days ago
Responsible for analytic data needs of the business unit. Handle complex data projects and acts as a lead for other Data Analysts. Provide advanced analytical support for business operations in all or some of the following areas claims, provider data, member data, clinical data, HEDIS, pharmacy, external reporting Extract, load, model, and reconcile large amounts of data across multiple system pla
Posted 27 days ago
Compile and analyze financial information for the company. Lead various financial projects. Develop integrated revenue/expense analyses, projections, reports, and presentations Create and analyze monthly, quarterly, and annual reports and ensures financial information has been recorded accurately Identify trends and developments in competitive environments and presents findings to senior managemen
Posted 1 month ago
Design and implement programs, policies, and practices to ensure State and Federal program contract compliance, as well as compliance with federal and state legal and regulatory requirements. Manage the compliance/reporting staff. Oversee the day to day health plan policies and procedures to ensure federal and state regulatory compliance. Validate state and federal deliverable reports for accuracy
Posted 1 month ago
Audit systems entry, performance metrics and work processes for assigned functions Audit accuracy of new group set ups, existing contract changes, group terminations Design, implement, and manage data review processes to ensure accuracy and integrity of PDM/Credentialing data reports to meet regulatory and operational requirements Execute risk based audits evaluating controls and processes for sca
Posted 2 months ago
The Counselor is a licensed mental health professional who exercises discretion and independent judgment to provide appropriate information, coaching, training, and education to Service Members and their families. The Counselor provides face to face direct, non medical, brief, solution focused counseling services to individuals, couples, families and groups for situations resulting from commonly o
Posted 2 months ago
Oversee the clinical pharmacy services function and develop new quality improvement and revenue enhancement activities Plan, direct and implement pharmacy related activities Assist with the development and implementation of key contracts and ensure that relevant performance standards are met by vendors Ensure successful implementation of prior authorization and drug utilization review program and
Posted 2 months ago
Audit systems entry, performance metrics and work processes for assigned functions Audit accuracy of new group set ups, existing contract changes, group terminations Design, implement, and manage data review processes to ensure accuracy and integrity of PDM/Credentialing data reports to meet regulatory and operational requirements Execute risk based audits evaluating controls and processes for sca
Posted 2 months ago
Provide health education and coaching to members tailored to issues identifiedwithin treatment and service plans Coordinate with various healthcare providers for diagnostics, ambulatory care,and hospital services Assist members with social determinants of health including access to exerciseand healthy food Promote activities focused on the health of a patient and their community,including without
Posted 2 months ago
Vice President, Quality & Process Improvement Vice President, Quality & Process Improvement (1096862) Position Purpose Develop and oversee quality improvement programs and strategies for the business unit. Assist in the development and application of the business unit's strategic mission and vision. Identify and champion the selection of process improvement activities across the enterprise. Respon
Posted 2 months ago
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