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Position Purpose: Oversees the design and management of an organization's cloud systems, applications, policies, and strategy. Manages the development of scalable architecture to support applications and infrastructure on IaaS and PaaS platforms. Leads the evaluation process to s
Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized car
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Posi
Position Purpose: Serves as a vital link between members and the healthcare system, focusing on improving health outcomes by identifying and closing care gaps. This role emphasizes community engagement, member education, and collaboration with providers and internal teams to ensu
Position Purpose: Work with the Pharmacists to accurately prepare prescription orders in a timely manner Key Details: Remote (TX, FL, MO, or CA only) Pharmacy Technician II, Specialty Outreach position supporting specialty pharmacy operations through customer service, phone outr
Position Purpose: Oversee provider network and contracting related activities. Lead all aspects of provider network strategy including, access analysis, network operations and support decision makers with analysis related to reimbursement and unit cost management. - Oversee the
Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educa
Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient s
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Posi
Position Purpose: Leads and directs the long-term care management of members with physical/medical health and/or behavioral/mental health care needs to develop and assess high quality, cost- effective healthcare outcomes. Leads and develops strategies and objectives within care m
Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Key Details: This fully remote role supports
Position Purpose: Manages the team members accountable for designing, developing, and implementing complex enterprise software solutions. Collaborates closely with technical and non-technical roles such as data modelers, architects, business analysts, data stewards, and subject m
Position Purpose: Strategizes, plans, conceptualizes, configures, and builds complex solutions that solve common challenges within the business, by using technological tools or programs. Conducts extensive research and gathers requirements to determine customer needs and lead and
Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Key Details:
Position Purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Key Details: This
Position Purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Key Details: This
Position Purpose: Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and
Position Purpose: Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends/schemes Education/Experience: Bachelor’s degree in Business, Healthcare, Criminal Justice, related field, or equivalent
Position Purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Education/Experie
Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. KEY DETAILS: This fully remote role with “Pa