This position is accountable for the development and execution of on going risk adjustment educational communications for the enterprise. The Program Communication Specialist will participate in drafting and producing materials, scheduling, attending and hosting project meetings in support of risk adjustment education and communication. This position will work to broaden

This position is responsible for leading execution and implementation activities for specific projects within HNS. This role will facilitate the development, coordination, communication, and accomplishment of short and long term business and clinical initiatives. The incumbent will act as a liaison between the department and other constituencies, will communicate and lead

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. Serves as mentor/trainer to new RN's and other staff as needed. Subject matter expert for the various projects and com

Responsible for the daily management of staff and inventory to ensure delivery of exceptional customer service. Evaluate strengths and weaknesses of staff in order to foster a positive working environment which includes Daily evaluations, coaching and mentoring the business team in order to enhance staff performance levels for quality, production, and attendance while ens

The Medical Economics Consultant provides support and consultation to the Medical Economics team through analyzing key business issues related to cost, utilization and revenue for all products at Horizon BCBS. This role will be responsible for the design and development of reports to monitor product performance and identify the root causes of medical cost trends. Responsi

The role is a technical lead that requires deep knowledge, skills, and experience in designing and carrying out clinical analytics. The position is a key team member collaborating in a multi disciplinary business environment with colleagues across the enterprise to lead clinical performance analytics, development, and reporting that deliver actionable clinical insights to

Responsible for conducting research and root cause analysis for customers with the goal of recommending and implementing new processes and solutions to operational deficiencies. Resolves issues and improves operational performance on a cross functional/departmental basis. This is a senior level position working independently with guidance only in the most complex situatio

Lead and drive the innovative transformation of Horizon's payment landscape to enable better affordability and quality of care while also contributing to improved member and provider experience. This team will be focused on strategic work aimed at better aligning financial incentives and key network partnerships with behaviors that result in high provider network performa

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 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

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 Medical Economics Consultant provides support and consultation to the Medical Economics team through analyzing key business issues related to cost, utilization and revenue for all products at Horizon BCBS. This role will be responsible for the design and development of reports to monitor product performance and identify the root causes of medical cost trends. Responsi

This position provides Rating & Underwriting services and support to the Sales team and is responsible for the production of rates for the 51+ markets. This position will support Rating & Underwriting services for Stop Loss products. Develops and issues proposal rates for group size 51+ and experience rated proposals. Develops and issues experience rated renewals for grou

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