JOB SUMMARY: The Clinical Quality Program RN (STARS) plays a critical role in promoting, protecting, and improving the health of the health plan's members. This role involves developing and implementing initiatives to manage chronic condi...
JOB SUMMARY: The Provider Performance Specialist plays a key role in strengthening relationships between the health plan and its provider network by offering education, support, and guidance on performance improvement initiatives. This po...
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 Employee Engagement Coordinator plays a critical role in fostering a positive and productive workplace culture by planning, implementing, and evaluating employee engagement programs and initiatives to increase employee en...
Overview: The Team Member Relations Partner is a specialized role within the People Department responsible for managing employee relations matters, conducting workplace investigations, and providing expert guidance on complex employee con...
JOB SUMMARY: Responsible for providing technical and customer service support for pharmacy benefits, processing prior authorizations according to CMS and State regulations, and resolving pharmacy related complaints. KEY RESPONSIBILITIES...
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 ...
JOB SUMMARY: Responsible for completing out-bound calls and other member outreach opportunities to select members and documenting efforts. This role spends 100% of time on quality program activities. May require extended, or multiple, pho...
JOB SUMMARY: This position works under the Marketing Department and serves as the primary strategic resource for the Individual & Family Plan line of business. This role is responsible for coordinating growth strategies, training initiati...
JOB SUMMARY: The Analyst provides analytical support for all departments, including analysis, pricing, capitation, network and provider specific reporting. Analytical support includes creating and executing beginner and intermediate level...