• Flower Mound, TX

As a Pharmacist for our Specialty Mail Service Pharmacy, you will provide exceptional customer service to patients and healthcare professionals, deliver pharmaceutical care services, and provide leadership and guidance to supporting staff.

• Cumberland, RI

Lead, mentor, and develop a team of Accounting professionals. Design and implement key controls over Rebate accounting, receipts, and payments. Evaluate reserves and recommend adjustments. Streamline and automate processes.

• US National

Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes.

• FL

Provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. support the Medical Management staff ensuring timely and consistent responses to members and providers.

• Woonsocket, RI

Accountable to formulate / define system scope and objectives to meet project deliverables, ensuring that established timelines and cost estimates are maintained.

• OH

Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes.

• Woonsocket, RI

Collaborates with business and technical partners to develop functional area product strategy and roadmap, including the established list of priorities for Colleague Experience.

• WA

Assist with establishing and implementing results-based programs and innovative initiatives for the network operations area, under general supervision. Collaborate internally and cross-functionally to support initial negotiations and re-negotiations...

• US National

Provides comprehensive support and service to behavioral health clinical teams. Assists members in locating services and educates them about available specialty programs. Collects information on patient progress and adherence to treatment plan.

• US National

Provide telephone-based assessment, counseling, and informational services in a call center. Conduct mental health and substance abuse assessments, develop action plans, and collaborate with professionals. Maintain accurate documentation and confiden..

• Woonsocket, RI

Develop dashboards, tools, and processes to deliver actionable insights to leadership. Gather and analyze data to create executive reports. Communicate key findings to cross-functional teams and senior leadership.

• Scottsdale, AZ

Develop and maintain knowledge of contractual, regulatory, and program policy obligations. Conduct oversight and monitor compliance with Medicaid requirements. Perform business operations walkthroughs and participate in monitoring plan development.

• NY

Account Managers are the main contact for customers, overseeing operations, ensuring timely delivery, building relationships, handling issue tracking, driving solutions, and supporting operations and sales teams.

• TX

Develop user stories, acceptance criteria, and detailed product specifications. Monitor and analyze product performance metrics. Work with customers and stakeholders to evolve the roadmap. Clarify dependencies and support release management.

• TX

Lead process optimization, analysis, and improvement initiatives, utilizing Six Sigma, Agile, and Lean methodologies. Collaborate with cross-functional teams to streamline workflows, implement digital tools, and ensure compliance with organizational ..

• OH, MS, TX, GA, NY, VA, IL, MA, NC, SC, CT, RI, TN, KY

Manage architectural design development and implementation of drawings for facilities, oversee project management of A&E firms and consultants, ensure conformance with standards and requirements, and manage multiple complex projects simultaneously.

• Wellesley, MA

Coordinate clinical data initiatives, lead project efforts for clinical data exchange, manage vendor relationships, and ensure successful implementations for health system connectivity. Required: 5+ years of clinical data exchange experience, 3+ year..

• Hartford, CT

Strategize, implement, and maintain program initiatives that align to team and enterprise objectives. Analyze qualitative and quantitative insights to shape program requirements. Coordinate cross-project activities and collaborate with leadership and..

• US National

Lead end-to-end proposal activities for large, complex Medicaid proposals. Ensure high engagement and collaboration across internal and external teams, adhere to established processes, and produce high-quality, compliant proposal responses.

• CT

Lead research and develop cutting-edge technology with a focus on Observability. Conduct literature reviews, engage with cross-disciplinary teams, disseminate research findings, and optimize/mature existing products. 10+ years of experience in Observ..

• CT

Develop and iterate on ML project prototypes rapidly. Build functional elements of a full-stack application. Prepare and preprocess data sets for use in ML models. Work with cloud and infrastructure teams to provision necessary resources for PoCs and..

• OH

Support sales and account management teams by coordinating training programs, facilitating communication, and ensuring accurate contract installation. Provide administrative support, prepare materials, and assist with client retention.

• US National

Lead and support medical management staff in utilization review and quality assurance, clinical team activities, and liaison with network providers. Provide clinical expertise and business direction in support of medical management programs.

• RI, NY, TX, GA

Manage day-to-day operations for Commercial Accountable Care Act (ACA) Prospective Programs. Ensure timely reconciliation of claims for encounter submission deadlines and deliver advice to the organization regarding current business trends and best p..

• MA, NY, PA, RI, NJ, ME, CT, VT, NH

Manage medical economic projects, develop and implement key business efforts, accountable for financial projections. Requires 5+ years of leadership/project management experience and healthcare experience. Preferred knowledge of managed care and stro..

• AZ

Lead transformational initiatives, set price operations standards, maintain operational KPIs, coordinate solutions with internal partners, and ensure continual improvement in pricing operations for a Fortune 5 company in the healthcare industry.

• PA, DE, WV

Provide oversight for medical policy implementation, develop and evaluate clinical programs, and support medical management staff. Focus on utilization review/quality assurance and provide clinical expertise and business direction to support medical ..

• OH

Expands medical management programs, oversees utilization review/quality assurance, and provides clinical expertise and business direction. Collaborates with CMO and acts as a liaison to network providers and facilities.

• FL, NC

Provide oversight for medical policy implementation, participate in the development and evaluation of clinical programs, support medical management staff, and provide clinical expertise and business direction.

• Woonsocket, RI, Northbrook, IL, Scottsdale, AZ, or US National

Build advanced analytic models to simplify large data sets, anticipate client needs and drive understanding of program value, evaluate trends to make predictions about the future of health care services.

• Buffalo Grove, IL

Lead the Business Continuity and Crisis Management programs, including managing teams, developing business continuity plans, measuring progress against industry standards, and ensuring compliance to maintenance requirements.

• US National

Bring your heart to . Every one of us at shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world.

• US National

Lead technical direction, standards, guidelines, and methodology for specified technologies in the department. Develop and improve strategic technical direction for functional areas. Lead matrixed application technical leads in the development...

• AZ, TX, OK, VA, IL, PA, CA

Analyze financial performance, review contract terms, and provide pricing recommendations. Collaborate with various departments to manage short- and long-term projects effectively. Create reporting packages and presentations for management.

• Plantation, FL

Maintain systems to track, monitor, and submit regulatory deliverables. Develop compliant business operations and policies. Support external audit review process. Conduct oversight and monitoring for Medicaid managed care compliance.

• Tampa, FL

Initiate and manage national-level internal corrective action plans (iCAP) for Medicaid business. Track progress against iCAP milestones. Maintain documentation and data in designated governance, risk, and compliance (GRC) tool. Review evidence of re..

• PA

Assist clinical teams in providing optimal care by locating services, facilitating follow-up calls, collecting information on member progress, and providing information to members regarding mental health and substance abuse benefits.

• NY

Bring your heart. Every one of us at shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world.

• PA

Assess, plan, implement, and coordinate case management activities to enhance member wellness. Conduct evaluations, develop proactive care plans, and collaborate with stakeholders to address complex health and social indicators. Minimum 3-5+ years cl..

• High Point, NC

Assess, plan, coordinate, and implement all case management activities with members to evaluate medical needs, develop proactive course of action, reduce risk factors, and address complex health and social indicators.

• VA

Maintain accurate provider data, develop database standards, and provide support for provider data transactions. Conduct audits and research activities to resolve concerns and issues. Requires 6 months of healthcare experience and PC skills.

• TX, AR, ID, CO, IN, NE, IA, NV, WY, MI, LA, TN

Provide holistic, evidenced-based care, including assessment, diagnosis, treatment, and health counseling for patients. Serve as a clinical expert and resource for clinical quality initiatives. Develop programs and provide process improvement insight.

• NC

Lead underwriting and financial analysis activities, develop relationships with sales and account management, acquire and maintain knowledge of PBM plan management strategies, work with internal partners to enhance analytical support, manage tight de..

• Richmond, VA, or US National

Manage communication and issue resolution between Network Ops, Health Plans and MPOS teams. Attend meetings, compile and share reports, maintain state market rules, and act as SME for provider data clean-up. Required: experience with provider data an..

• Southfield, MI

Ensure compliance with regulatory requirements, interpret and advise on regulatory mandates, assist in implementing compliance programs, track and maintain system data, manage regulatory interactions, escalate issues, and collaborate with internal an..

• Tampa, FL

Manage and develop national-level corrective action plans for a Medicaid managed care organization. Track progress, maintain documentation, and collaborate with internal and external stakeholders to ensure compliance with Medicaid contracts.

• Austin, TX

Provide psychiatric leadership and oversight for utilization management team, including high-risk cases and medical necessity decisions. Develop, implement, and evaluate clinical/medical programs. Confer with practitioners regarding patient care and ..

• US National

Manage vendor relationships and coordinate tasks and projects to drive performance. Improve vendor processes and deliver on stakeholder and business performance. Communicate with internal and external teams to ensure operational excellence.

• MA, ME, OH, VT, MD, Washington, DC, KS, FL, NH, RI, DE, KY

Provide evidence-based care, diagnosis, treatment, health counseling, and disposition planning. Act as a clinical expert, resource for quality initiatives, and oversee behavioral health care. Develop programs and provide process improvement insight.

• MN

Lead a team to build internal tools for composing customer-facing pages across business units. Set OKRs, partner with leaders, hire high-performing engineers, and participate in design and architecture processes.