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Under direct supervision, the Risk Adjustment Specialist I supports the routine functions of the development, implementation, and operation of risk adjustment management program(s). The Specialist I carries out processes needed to oversee vendors HealthNow has contracted with to perform services and/or provide software to further enhance risk revenue maximization. Additional duties include, but ar
Posted 1 day ago
This position is responsible for supervising the activities of their respective Corporate Claims department. The incumbent will supervise daily activity of staff, and departmental activities. The supervisor will handle questions and inquiries from the staff as well as from other departments and external constituents. The incumbent will also assist in communicating and educating the front line staf
Posted 7 days ago
Under the supervision of the HCQI HEDIS Coordinator performs medical record collection and abstraction in support of the annual HealthCare Effectiveness Data and Information Set (HEDIS) Project Primary Responsibility Medical record collection and abstraction in support of the annual Healthcare Effectiveness Data and Information Set (HEDIS) with duties including but not limited to On an annual basi
Posted 8 days ago
The Clinical Analyst II provides value added analysis of population healthcare data. The incumbent demonstrates business and data understanding; provides advanced comprehensive reporting of healthcare data, statistical analysis, including predictive analytics, data manipulation, interpretation, presentation, and recommendations on specific courses of action. The analyst is also responsible for res
Posted 8 days ago
Under direct supervision, the Actuarial Analyst I performs individual project tasks as requested, executes basic calculations, and understands basic concepts of actuarial analysis. The incumbent is responsible for utilizing various sources to procure data and then turning that data into meaningful information, as well as fulfilling ad hoc requests. Primary Responsibility Under direct supervision,
Posted 12 days ago
Healthcare Economics Intern Position in EI&A Internship Program Each health care economics intern will be placed within the Enterprise Initiatives and Analytics Department and will perform tasks such as information gathering, data manipulation, and data analysis. The assignments could be related to trend forecasting, pharmacy analysis, predictive modeling, process automation, identification of pot
Posted 13 days ago
Financial Intern Position in EI&A Internship Program Each financial intern will be placed within the Enterprise Initiatives and Analytics Department and will perform tasks such as information gathering, data manipulation, and data analysis. The assignments could be related to various projects such as profitability (claims expense and revenues) analysis, trend and risk analysis, budgeting, forecast
Posted 13 days ago
Advanced Analytics Intern Position in EI&A Internship Program Each advanced analytics intern will be placed within the Enterprise Initiatives and Analytics department and will perform tasks such as information gathering, data manipulation, and data analysis. The assignments could be related to various projects such as predictive modeling, statistical analysis, geospatial analytics, and process aut
Posted 13 days ago
Each actuarial analyst intern will be placed within the Enterprise Initiatives and Analytics Department and will perform tasks such as information gathering, data manipulation, and data analysis. The assignments could be related to premium rate calculations, claim reserve estimation, trend analysis and forecasting, provider arrangement evaluation and analysis, underwriting, government product repo
Posted 13 days ago
The Senior Specialist, Corporate Compliance is responsible for evaluation of policies and procedures to ensure compliance with federal and state regulations and the coordination of education and training materials. The incumbent conducts and provides oversight of compliance and regulatory investigations at the direction of the Manager, Regulatory Compliance. Primary Responsibility Assists business
Posted 14 days ago
Serves as a senior architect within the Solution Architecture function. The role is responsible for mentoring other Architects, along with building relationships with other areas of the company outside of a project setting. Within a project setting, the Architect collaborates with business partners, business analysts, systems analysts, and subject matter experts to fully understand business object
Posted 14 days ago
The Clinical Coordinator facilitates the delivery of behavioral health (mental health and substance use disorder) services to our members in all lines of business. This position is responsible for researching, planning, developing and implementing Behavioral Health case, disease and prevention health management programs and processes. Serves as a liaison to the Business Unit's care management staf
Posted 14 days ago
The Supervisor, Risk Revenue will provide direction and support for retrospective and prospective risk revenue initiatives, medical record retrieval, regulatory audit coordination, provider education opportunities, and encounter reporting for the Risk Revenue department. Duties include monitoring daily productivity, quality, and training of team members, with a focus on compliance with all applica
Posted 21 days ago
In collaboration with other IT functions, ensures that HealthNow software applications are effectively designed, implemented, integrated and maintained in support of business goals and objectives. Additional responsibilities include problem resolution, defect resolution, unit/system testing and implementation of software releases. Performs in a technical project leadership role, as required. Prima
Posted 1 month ago
Develops and implements information security architecture and technology solutions to address the current and emerging information security and compliance requirements of the organization. This includes leading the problem analysis, solutions development, implementation, and decision making that significantly impacts enterprise wide initiatives. Performs project management activities for multiple
Posted 1 month ago
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