Job Summary: The Claims Management Analyst III is responsible for leading eBusiness initiatives and coordination of activities across multiple functional areas. Essential Functions: Manage the EDI (Electronic Data Interchange) trading partners and network of clearinghouses to
Job Summary: The Information Security GRC Analyst III managed day to day, short and long term information security risks and ensures activities are within risk tolerance and in compliance with approved risk management policies, procedures and
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs. This position focuses on
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs. This position focuses on
Job Summary: Reporting to the Chief Medical Officer of instED, the Virtual Medical Control (VMC) Nurse Practitioner provides medical decision making, including all elements of diagnostics, treatment, and disposition, to patients seen by instEDs Mobile Integrated
Job Summary: The Health Plan Network Adequacy Analyst III reviews and analyzes the effectiveness and efficiency of existing market operation processes and systems, ensures compliance of State and Federal Network Adequacy Standards, and participates in development
Job Summary: The Behavioral Health Medical Director is responsible for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing. Essential Functions: Assume responsibility for the overall safety of patients
Job Summary: The Associate Vice President, Provider Contracting, Network and Relations informs decision-making around payer and provider best practices related to innovating, supporting and empowering providers in the pursuit of delivering person-centered and high-quality care to
Job Summary: The Vendor Medical Coding Analyst is responsible for guiding the overall efficiency and accuracy of the vendor payment process through analyzing medical records and supplemental data to ensure diagnostic and procedural codes accurately reflect
Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members,
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs. This position focuses on
Job Summary: Payment Cycle Analyst III is responsible for conducting both systemic and targeted analysis to identify reimbursement errors and to determine root cause. As well as collaborating with Configuration, Configuration UAT, Enterprise UAT, IT Claims,
Job Summary: Payment Cycle Analyst IV is responsible for conducting both systemic and targeted analysis to identify reimbursement errors and to determine root cause. As well as collaborating with Configuration, Configuration UAT, Enterprise UAT, IT Claims,
Job Summary: The AVP, Finance is responsible for providing financial oversight, leadership and support to the market/corporate and ensures the department proactively collaborates with and provides support for analyses being conducted by areas outside the Finance
Job Summary: The Human Resources Business Partner III serves as a strategic partner to senior leaders, aligning HR strategies and initiatives with business objectives and organizational culture. Essential Functions: Serve as a trusted advisor to senior
Job Summary: The Director, Strategic Sourcing is responsible for the enterprise Strategic Sourcing function across all categories of vendor spend, including direct spend (supplemental benefits, care management, utilization management, etc.), indirect spend (operations, marketing, facilities, etc.)
Job Summary: The Claims Specialist III is responsible for capturing, resolving/facilitating resolution, and reporting on claim adjustment requests. Essential Functions: Resolve complex COB issues through member information updates and adjustment of claims Maintain accountability for daily
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs. This position focuses on
Job Summary: The Assistant Clinical Director is responsible for managing the day-to-day activities of care coordination. It ensures delivery of quality service and performance of the staff and team. The Director provides support to the team
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs. This position focuses on