This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care, as well as, planning for the transition to the continuum of care and developing a member centric plan of care. Primary Nurses will outreach to high risk members and will work to engage members in preventative care opportu

This position is accountable for examining, coding and inputting all cash receipts into UPS and NASCO. This position is also accountable for various accounting clerical tasks associated with processing cash receipts, off system payments, daily systemic disbursements, 1099 reporting, imaging cash receipts and sorting mail. Analyze daily systemic cash disbursements to ensur

This position is an extended member of the departments leadership team and is responsible for the supervision and the execution of assigned audits and strategic initiatives. These responsibilities include ensuring the appropriateness of the scope, quality and execution of testing and reporting, and the identification as well as tracking of issues to closure. Responsibilit

This field based position is accountable for the assessment and case management of Dual Special Needs members using established guidelines to ensure appropriate level of care as well as developing a member centric plan of care. Responsibilities Assesses patient's clinical needs against established guidelines and/or standards to ensure that the services provided are medica

Job Profile Summary This position is accountable for providing support to the field based Care Managers (RN II and Care Specialist III). In addition, Clinical Care Associates serve as the first point of contact for our members looking for service and/or provider information as well as members or providers requesting authorizations and denials of services. This position co

This position supports HR leadership and is accountable for contributing to the efficiency of departmental operations through the performance of various administrative functions. Responsibilities Screen inquiries and memos for referral to appropriate areas within the division or company or organize such material for the director to expedite resolution. Provide the directo

The Financial/Accounting Data Analyst Reporting will be assigned to the Finance department and will be responsible for Financial, Planning and Analysis and/or accounting responsibilities. The position will be accountable to support the management leadership team on multiples areas of the budgeting, forecasting and accounting areas. This includes working directly with larg

This position is responsible for managing, monitoring, supporting, and participating in the development/enhancements of distributive system management platforms. Job Description Resolve issues through level 3 in server, operating systems or other software under the control of the Distributed Systems management team Provide guidance to junior infrastructure analysts and fo

The Care Transformation Specialist will support Horizons Value Based programs by working with multidisciplinary frontline clinical personnel, including physicians and nurses, within multiple care delivery settings for the entire spectrum of patient population. This person will mentor the frontline staff on promoting patient centered care, on maintaining frequent contact w

Provide excellent service to customers through the resolution of basic customer inquiries received by phone or though written correspondence. Responsibilities Receive customer inquiries via phone, fax, mail, e mail, etc. If necessary, probe for additional helpful information (i.e. member ID, claim number, name, etc.) in order to effectively handle inquiry. Review computer

This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management. Responsibilities Assesses patient's clinical need against established guidelines and/or standards to ensure that the l

This position will perform care management duties specifically targeting high risk members within commercially risk adjusted populations to enhance the deployment of commercial risk adjustment tactics. This position will work closely with the Risk Adjustment Management (RAM) function, including the RAM Manager & RAM Business Analysts to assess the health status of high ri

This position will perform care management duties specifically targeting high risk members within Medicare Advantage/Commercial risk adjusted populations to enhance the deployment of risk adjustment tactics. This position will work closely with the Care Management and Risk Adjustment Management (RAM) teams, including the RAM Manager & RAM Business Analysts to assess the h

The Manager of Clinical Analytics is a managerial position requiring excellent leadership, communication, and data analytics technical skills. The position is a key team member collaborating in a multi disciplinary business environment with colleagues across the enterprise to support clinical performance analytics, development, and reporting that deliver actionable clinic

This position supports the Clinical Operations functions and acts as a liaison between members, physicians, delegates, operational business members and member service coordinators. Responsible for providing leadership and guidance to non clinical team and handle escalated issues/problems. Responsibilities Performs review of service requests for completeness of information