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Manages and coordinates the development of new business as needed to grow revenue for the company within identified markets and solutions. Identifies, pursues, and wins new business. Develops and recommends account plan and marketing approaches, and related changes as needed to reach sales goals and objectives. Prospects and develops leads leading to requests for proposals (RFP's) and sole source
Posted 1 day ago
Responsible for the supervision and maintenance of the daily functions of the following areas Utilization Review/Review Nurses, Case Management, Medical Review, Health/Disease Management, Quality Management, and/or Appeals, to include departmental staff and specialty programs. Responsible for all data collection for specialty programs and ensures appropriate levels of healthcare services are provi
Posted 1 day ago
Negotiates Pharmacy Benefit Management (PBM) contract terms with Commercial Business self funded groups for retail/mail order/specialty pharmacy service and specialty drug medical management rebate sharing services. Monitors contract performance including performance guarantees, financial guarantees, and compliance with state and federal regulatory requirements specific to self funded groups. Nego
Posted 1 day ago
Responsible for directing all contract activities to ensure that contractual obligations are met and compliance is maintained with mandatory government regulations, applicable laws and Corporate policies/procedures. In addition, this position is responsible for interacting with contracting partners to ensure compliance with their respective contractual obligations. Serves as the liaison between th
Posted 1 day ago
Intern position utilized for training an active college student towards a professional level role. Responsibilities vary and are based upon the needs of the area and the experience of the incumbent at the time of employment. This incumbent works under direct supervision and has responsibilities for performing entry level tasks and for learning professional level tasks relating to area operations.
Posted 1 day ago
Responsible for evaluating loss potential for each member. Calculates and assigns risk score via a comprehensive risk analysis approach. Ensures action requests and internal/external issues are addressed in a timely manner. Description Job Duties Utilize statistical tools to extract and analyze data to identify and evaluate loss potential. Required Education Master's degree in Management, Fi
Posted 1 day ago
Acting as an internal consultant, advocate, mentor, and change agent, plan, design, and develop the most complex and business critical software solutions, utilizing appropriate software development methodologies either individually or as part of a project team. Responsible for ensuring that browser based systems and applications meet client requirements and operate properly, using software develop
Posted 1 day ago
Plan, design, and develop complex and business critical software solutions, utilizing appropriate software development methodologies either individually or as part of a project team. Responsible for ensuring that browser based systems and applications meet client requirements and operate properly, using software development methodologies. Description Multiple positions available. Job Duties Plan
Posted 1 day ago
Manages the daily activities of a multi functional area. Responsible for monitoring productivity, attendance and quality of work produced. Responsible for motivating associates to meet individual and departmental goals. Description 35% Direct and supervise claims/documents processing and support team associates to ensure claims/documents are processed in a timely and efficient manner to maintain
Posted 1 day ago
Develops difficult statistical analysis using standard reporting, AD HOC reporting, and data mining tools in order to identify patterns and trends. Prepares charts, illustrations, and other graphics and narrative reports to identify and explain data findings. Description 30% Develops, maintains, and executes complex database programs for the extraction and presentation of data for standard and a
Posted 1 day ago
Under general supervision, analyzes proposed policies, procedures, forms, and reports. Recommends operational improvement through standardization, simplification, discontinuance and other methods. Recommends installations of new systems/procedures. Reviews organizational functions and structure to avoid overlapping or duplication. May provide security administration to application supported by are
Posted 1 day ago
Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Description 70% Performs medical claim reviews for one or more of the following claims for medi
Posted 1 day ago
Coordinates the quality control program for the medical review area. Researches the Center for Medicare and Medicaid services (CMS) changes. Trains new staff and provides continuing education to clinical staff. Description 30% Reviews medical review decisions for accuracy and to ensure CMS instructions have been applied correctly. 25% Develops/implements the quality control program used as an in
Posted 1 day ago
Responsible for moderately complex accounting activities relating to the maintenance of a complete and accurate general ledger and/or the resultant managerial reports and/or financial statements. Description 30% Reconciles assigned general ledger accounts of routine to moderate complexity. Initiates and/or processes journal entries into various accounts. Performs reviews of various systems activ
Posted 1 day ago
Acting as an internal consultant, advocate, mentor, and change agent, plan, design, and develop the most complex and business critical software solutions, utilizing appropriate software development methodologies either individually or as part of a project team. Responsible for ensuring that browser based systems and applications meet client requirements and operate properly, using software develop
Posted 1 day ago
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