Job Summary: The Team Lead, Program Integrity drives and encourages innovative investigative processes and workflows to reduce turnaround time and produce positive investigative outcomes. Essential Functions: Direct the day-to-day activities and leadership of investigative staff to ensure
Job Summary: The LTSS & Dual Eligible Report Engineer IV will play a crucial role in utilizing data analytics to drive informed decision-making and optimize business processes within the healthcare environment. This senior-level position is responsible
Job Summary: The Clinical Appeals Medical Director will perform medical necessity review of appeals, within the organization, ensuring timely, accurate, quality and compliant review of clinical appeals. Administers the decision-making process related to appeals, supports clinical operations,
Manager, Information Technology – Encounters IT (Transformation & Architecture Focus) Job Summary The Manager, Information Technology – Encounters IT is a technology leader and visionary responsible for driving modernization, scalability, and innovation across the Encounter Management
Job Summary: The Market Behavioral Health Medical Director is responsible for the overall safety of patients with a Behavioral Health diagnosis, with a special focus on safe prescribing. Essential Functions: Assume responsibility for the overall safety
Job Summary: Vice President, Actuarial - Product is responsible for driving company strategy and managing actuarial expertise in coordination with other leaders on all aspects of CareSource’s rate levels to ensure actuarial soundness, and to use actuarial
Remote Sensing Software Engineer The Opportunity: At Booz Allen, you’ll join a team using advanced imaging, physics-based modeling, and AI/ML to solve some of the nation’s most compelling Space Domain Awareness (SDA) and remote sensing challenges.
About the Team: STR’s Analytics & C2 Division develops novel technologies to solve challenging national security problems through advanced analytics. Our team consists of passionate and motivated individuals with degrees in engineering, computer science, mathematics, physics,
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 Clinical Psychologist provides Behavioral Health coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting. Essential Functions: Assume responsibility for the overall safety of
Job Summary: The Employee Relations Partner III serves as a strategic advisor on employee relations, partnering with business leaders, HR Business Partners, and CoEs to strengthen organizational practices and advance enterprise initiatives. This role helps shape
Manage all assigned technology components, including setting vision, direction and execution. Develop strategy and high-level implementation plans for the delivery of new technology and validate business proposition of this technology. Evaluate currently deployed services and develop
Job Summary: The Board-Certified Behavior Analyst serves as the clinical lead in developing and implementing evidenced based clinical policies and practices for members with Autism and their families Essential Functions: Oversee coverage determinations for ABA utilization
Job Summary: The Assistant General Counsel provides legal counsel and support on complex and high impact matters within the Legal Department, collaborating with the General Counsel, Deputy General Counsel(s), and/or Senior Assistant General Counsel(s) as appropriate. Serves
Job Summary: The Program Integrity Medical Coding Reviewer III supports most complex medical record audit programs, dispute management, escalation management and generates concise in-depth reporting and analysis to track performance related to the Pre-Pay and Post-Paid Processes. Essential Functions:
Job Summary: The Business Analyst IV is a senior-level position responsible for driving strategic initiatives and leading cross-functional teams to deliver innovative solutions that address complex business challenges. This role bridges the gap between business needs
Job Summary: The Manager, Pharmacy Benefit Management is responsible for managing a team and overseeing the day-to-day operations associated with regulatory activity, PBM oversight, performance and monitoring, pharmacy audit activity, pharmacy compliance business owner tasks as
Job Summary: The Quality Consumer Experience (Cx) Project Manager is responsible for managing variably complex high-priority, cross-functional projects within the Consumer Experience organization, executing within the project management framework. Essential Functions: Ensure project milestone deliverables are