Career Opportunities

JOB SUMMARY The Intake Specialist will be responsible for entering requested authorization of health care services received via telephone, internet, and fax, sorting, and identifying incoming requests. The Intake Specialist will be responsible for following up with providers to obtain clinical information on UM requests. This role may also work with members on redirecting to in-network…

Job Summary Under the direction of the Director of Care Management, the RN Care Manager is responsible for managing high risk, chronic illness members to promote effective education, self-management support, and timely healthcare delivery to achieve optimal quality and financial outcomes. The RN Care Manager will formulate and implement a care management plan that addresses the members…

JOB SUMMARY The Quality & Post Payment Review Nurse is responsible for reviewing prior authorization requests for medical services including elective procedures, outpatient surgeries, home health, and durable medical equipment. The nurse will prioritize expedited requests for medical necessity and efficiency in accordance with health plan coverage guidelines and CMS coverage determinations…

JOB SUMMARY Under the direction of the Director of Quality and Senior Manager of Quality/Medicare Stars, the HEDIS Abstractor is responsible for year-round HEDIS medical record abstraction/education/strategy support in conjunction with the plans' Quality and Medicare Stars programs/initiatives. ESSENTIAL DUTIES AND RESPONSIBILITIES This position must be able to: Performs the Quality…

JOB SUMMARY The Vice President of Information Technology (VP of IT) will be responsible for leading the IT strategy and operations across the organization. This role requires a hands-on leader who can balance strategic vision with day-to-day IT management, ensuring that our technology infrastructure supports our business goals. The VP of IT will collaborate closely with other executive leaders…

JOB SUMMARY The Executive Business Support Assistant will provide senior executives with comprehensive administrative and business support, ensuring their offices' smooth and efficient operation. This role is vital for facilitating the productivity and effectiveness of the executive team. The ideal candidate will possess exceptional organizational and time-management skills, strong…