• Atlanta, GA, Latham, NY, Costa Mesa, CA, Tampa, FL, Indianapolis, IN, Richmond, VA, Denver, CO, Houston, TX, Norfolk, VA

Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.

• Richmond, VA, Saint Louis, MO, Indianapolis, IN, Mason, OH

Coordinate with key stakeholders to manage inquiries and incidents related to anti-trust, establish tracking of firewall inquiries and incidents, organize audits and risk assessments, adopt best practices for firewall management.

• Woodland Hills, CA, Atlanta, GA, Waukesha, WI, Indianapolis, IN, Norfolk, VA

Analyze, develop, and validate statistical data to determine rates. Update actuarial models and collect data for analysis. Minimum requirements: BA/BS degree and passing one SOA or CAS actuarial exam.

• AZ, CA, CO, IN, MA, MN, NY, OR, PA, TX, UT, WA

Perform ongoing analysis and monitoring of actual performance to forecasted plan, identify significant variances, take corrective actions, and detail assumptions.

• VA

Conduct assessments to identify individual needs, develop comprehensive care plans, coordinate with internal and external resources for integrated care, and evaluate health needs and identify applicable services.

• Topeka, KS, Wichita, KS, Overland Park, KS, Kansas City, KS

Responsible for Medicaid operations functions, including member and provider issue resolution, process improvement, and regulatory compliance. Liaison with internal departments and state regulatory agencies. Minimum 10 years of experience required.

• Miami, FL, TX, SC, OH, FL, GA, CA

Provides detailed analysis that identifies and promotes the value of the existing plan, discuss options, provides alternative plan options when appropriate and makes recommendations.

• Mendota Heights, MN, Austin, TX, Atlanta, GA, Cincinnati, OH, Mason, OH, Columbus, OH, Richmond, VA, Roanoke, VA, Houston, TX, Norfolk, VA, Chicago, IL

Perform complete clinical assessments and case management for members with behavioral health and substance abuse needs. Develop care plans, monitor effectiveness, and coordinate resources. Serve as a resource to other case managers and participate...

• Atlanta, GA, Woodland Hills, CA, Richmond, VA, Indianapolis, IN, New York, NY, Columbus, GA, Denver, CO, Norfolk, VA

Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control. Review and conducts analysis of claims and medical records prior to payment.

• Metairie, LA

Works collaboratively with health plans to improve provider collaboration and quality member outcomes. Evaluates quality opportunities for implementation by establishing a project plan that identifies goals and objectives for improvement in partnership...

• Woodland Hills, CA

Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear...

• Columbus, GA, Atlanta, GA, Indianapolis, IN

Consults and solves learning solutions including: identifies client training needs, successfully uses performance consulting to analyze data and identify root cause to determine appropriate learning solutions.

• Cerritos, CA

Conducts assessments to identify individual needs and develops care plan to address objectives and goals as identified during assessment. Monitors and evaluates effectiveness of care plan and modifies plan.

• New York, NY, Atlanta, GA, Columbus, OH, Cary, NC, Richmond, VA, Wallingford, CT, Indianapolis, IN, Mason, OH, Columbus, GA, Denver, CO

Responsible for providing comprehensive administrative support to a Senior Executive and their leadership team. Duties include scheduling and preparing meetings, maintaining calendars, coordinating travel arrangements, and overseeing other administra..

• Indianapolis, IN, Atlanta, GA, Mason, OH, Chicago, IL

Create and implement human capital strategy, partner with cross-functional teams, provide data-driven solutions, influence leadership, design and execute programs, analyze trends, and manage stakeholders.

• Indianapolis, IN, Woodland Hills, CA, Denver, CO, Seattle, WA, Grand Prairie, TX, Chicago, IL

Building relationships with internal partners for growth and compliance. Monitoring legislation, researching revenue expansion opportunities, assisting in strategic planning, and traveling as necessary.

• Nashville, TN

Identify and implement projects, programs, and plans that support business goals. Develop processes and systems, integrate functions and processes, and build support for business change. Provide project management support and coordinate executive pre..

• Denver, CO, Atlanta, GA, Waukesha, WI, Saint Louis, MO, Norfolk, VA

Calculates renewal rates for complex group cases based on thorough analysis of the group's experience, industry, location, size, and demographic nature.

• Indianapolis, IN, Atlanta, GA, Waukesha, WI, Tampa, FL, Louisville, KY, Chicago, IL

Lead the development and execution of high quality assessments of the Companys complex processes and controls (including statistical data) for accuracy, completeness, effectiveness and compliance.

• Norfolk, VA, Atlanta, GA, Richmond, VA, Indianapolis, IN, Tampa, FL, Mason, OH, Chicago, IL

Provide analytic and consultative support on cost of care issues and medical cost trends. Collaborate across multiple business groups to ensure that financial analyses reflect appropriate business considerations and assumptions...

• Las Vegas, NV

Supports business development and maintenance of the contract through request for proposal support. Supports health plan leaders with business operational reviews with senior Medicaid leadership.

• Las Vegas, NV

Provide exceptional customer service to healthcare members and providers by proactively resolving inquiries, explaining benefits, and finding creative solutions. Opportunity for growth, tuition reimbursement, and benefits package offered.

• Indianapolis, IN, Atlanta, GA, Cincinnati, OH, Roanoke, VA

Managing incoming calls or incoming post services claims work. Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.

• Richmond, VA, Atlanta, GA, Saint Louis, MO, Indianapolis, IN, Mason, OH

Provide health education to program members, conduct behavioral assessments, and coordinate with the clinical team. Diffuse situations with members resistant to interventions and provide consultation to associates. Minimum of 2 years related experien..

• Waukesha, WI, Indianapolis, IN, Mason, OH, Louisville, KY

The Financial Accounting Operations Specialistis responsible for performing diverse operational financial and policy activities of a non-routine nature. Interprets and communicates departmental and organizational policies and procedures.

• Woodland Hills, CA, Rancho Cordova, CA, Los Angeles, CA, Costa Mesa, CA, Walnut Creek, CA

Consults with and provides management with solutions and recommended actions. Provides guidance and training to less experienced team members. Leads projects and focuses on business...

• Indianapolis, IN

Review and interpret financial data, projections, and results. Perform consulting services for business development studies. Prepare financial planning and reports. Train and review the work of lower-level Financial Analysts.

• Mason, OH, Waukesha, WI, Saint Louis, MO, Wallingford, CT, Cary, NC, Hanover, MD, Indianapolis, IN, Miami, FL, Charleston, WV, Cincinnati, OH, Richmond, VA, Louisville, KY, New York, NY, Denver, CO, Manchester, NH, Grand Prairie, TX, Chicago, IL, South Portland, ME, Winston-Salem, NC, Des Moines, IA, Mendota Heights, MN, Norfolk, VA

Manage projects across business units, regions, or the enterprise. Influence at all levels within the organization, often setting strategy and direction. Coach and mentor project team members. Develop resource, risk, quality, cost, and scope manageme..