JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibi...
JOB SUMMARY: The QNXT Project Supervisor provides day-to-day leadership and coordination of business resources supporting the QNXT core system implementation. The Supervisor ensures business workstreams remain aligned with project priorit...
JOB SUMMARY: Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk members, and other mem...
Overview: In collaboration with patients, families (as defined by the patient) and staff across all disciplines and departments is responsible for performing selected clinical duties including administrative/clerical duties, basic patient...
JOB SUMMARY: The Utilization Management Clinical Pharmacist is responsible for playing a critical role in optimizing medication use, improving member outcomes, and ensuring regulatory compliance. This position serves as a clinical expert ...
Overview: The Facilities Maintenance Technician II performs sub-journeyman work in a variety of maintenance, repair, and tasks in one or more craft areas. This role is responsible for make ready duties in offices and clinic areas, mainten...
JOB SUMMARY: The Director of Product is responsible for scaling product management capability across core health plan value streams. This role will oversee product strategy, strengthen Product Owner capability, and ensure product investme...
Overview: Responsible for being the first point of contact for patients, staff, and guests presenting at the clinic, and performing all the administrative tasks associated with patient check in. Responsibilities: DUTIES AND RESPONSIBIL...
JOB SUMMARY: The Risk Adjustment Analyst II supports the organization’s Medicare Advantage (MA) and Affordable Care Act (ACA) risk adjustment programs by managing data submissions, developing reporting, and delivering actionable analytics...
JOB SUMMARY: The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This ...