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
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
Overview Versiti is a fusion of donors, scientific curiosity, and precision medicine that recognize the gifts of blood and life are precious. We are home to the world-renowned Blood Research Institute, we enable life saving gifts
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
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,
Xometry (NASDAQ: XMTR) powers the industries of today and tomorrow by connecting the people with big ideas to the manufacturers who can bring them to life. Xometry’s digital marketplace gives manufacturers the critical resources they need
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
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.
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
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