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 is a senior level manager position within the Actuarial department. Supporting Level Funded product and additionally supporting Stop Loss products, including all areas of actuarial work pricing, reserving, forecasting, etc Lead internal meetings providing transparency and understanding of the actuarial analyses and results Collect and analyze data to use for actuaria

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 supports the Clinical Operations functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators Responsibilities Performs review of service requests for completeness of information, collection and transfer of non clinical data, and acquisition of structured clinical data from physicians/pa

This position supports the Clinical Operations functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators Responsibilities Performs review of service requests for completeness of information, collection and transfer of non clinical data, and acquisition of structured clinical data from physicians/pa

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 helping to identify, secure, and maintain community based housing for MLTSS/SNP/Medicaid Members and for developing, articulating, and implementing a broader housing strategy within the Contractor to expand housing availability/options. The Housing Specialist(s) shall act as the Contractors central housing expert(s)/resource(s), providing

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

This position ensures excellent customer service by responding in a timely, accurate and thorough manner to general requests. In addition this position is accountable for assisting in the preparation and analysis of data and for maintenance and initial reconciliation of accounts. Coordinate with Service and Billing to address customer inquiries related to Account Receivab

This position is responsible for performing behavioral health 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 behavioral health clinical need against established guidelines and/

Responsible for all workforce functions including budgeting, capacity planning, forecasting, scheduling and real time monitoring. Own and manage creation of leveryday tactical workload forecasting while continuously improving forecasting accuracy taking into consideration new hire classes, meetings, coaching product releases and key disruptions. Provide strategic insight

Responsible for conducting file audits for all areas of clinical operations. These audits review daily business practice compliance to regulatory compliance relative to NCQA, URAC and CMS. Responsibilities Conduct quarterly file audits for all lines of business against business Process Flows to determine compliance with regulatory standards according to NCQA, URAC and CMS

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

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 role is responsible for working collaboratively with members of the Quality & Health Equity Team and HNS to implement, monitor and evaluate Horizon clinical opportunities to develop enterprise and community health initiatives. These initiatives will be aimed at addressing Health Disparities and advancing awareness and education about social determinants of health to