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
We seek to move the world forward through innovative thinking. Woolpert is an award-winning, global leader in architecture, engineering, and geospatial services. We blend design excellence with cutting-edge technology to deliver exceptional client value. Our team
Job Summary: The Director, Pharmacy Clinical Strategy leads the strategic development of formulary management best practices & industry-leading, market-competitive formulary and medical drug strategies across all CareSource lines of business and markets. Essential Functions: Ensures the
Job Summary: The Quality Risk Adjustment Advisor IV is responsible for leading key components of the Quality Risk Adjustment (QRA) programs, including prospective programs, chart retrieval and coding processes, while ensuring compliance with regulatory standards and optimizing quality
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 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
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
Job Summary: The Program Integrity Medical Coding Reviewer II is responsible for review of medical record audit activities, dispute support as needed, medical records work queues as well as claim reviews for provider pre-payment and post-payment functions.
Job Summary: Responsible for providing direction and planning to implement and maintain information security controls, coordinate the evaluation, deployment and management of current and future security technologies, and communicating operating effectiveness to leadership. Essential Functions: Develop
As a Senior Software Engineer, you will work as part of a tightly knit team to design, develop, implement, integrate, test, and demonstrate advanced algorithms and software systems for autonomous platforms. You will provide technical leadership
Job Summary: The Scrum Master II is responsible for guiding and coaching the Scrum Team and organization on how to use Agile/Scrum practices and values. Essential Functions: Guide and coach the Scrum Team and organization on
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,
Requisition Number: 29268 Required Travel: 0 - 10% Employment Type: Full Time/Salaried/Exempt Anticipated Salary Range: $58,877.00 - $85,000.00 Security Clearance: None Level of Experience: Mid This opportunity resides with Warfare Systems (WS), a business group within
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