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 responsible for receiving verbal and written request for prior authorization from pharmacists, physicians and/or patients and is responsible for supporting and assisting in the coordination of Pharmacy Services activities including claim utilization analysis, prescription plan design, ad hoc reporting, correspondence and special projects. Must maintain pe

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

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

This position has oversight for the analysis and translation of business needs into business/technical requirements. Leads teams and other resources to ensure alignment of technical solutions with business requirements for complex issues (quantity and magnitude). Acts as a representative of IT to the Enterprise regarding Enterprise Initiatives. Leads and owns the analysis

This field based position is accountable for the assessment and case management of members to ensure facilitation of health care services. Responsibilities Assist with implementation and facilitation of services to members in the program. Collaborates with member/family, physician and all members of the healthcare team, internal and external to this organization. Coordina

This position is responsible for focusing stop loss risk management activities on the centralized stop loss team and coordinating risk oversight with care delivery related areas of the company. Assures care is coordinated across the company and throughout the care delivery system for high risk members of groups with stop loss coverage underwritten by the company. Uses est

Job Description Summary The Application Security Analyst II will partner with developers to conduct application security assessments. The individual will work closely with technical teams and analyze potential security impacts and pitfalls associated with threats and vulnerabilities to applications and systems. Candidate will advise developers, business owners and technic

This position is responsible for performing LPN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care under the direction/supervision of an RN. Performs duties and types of care management as assigned by management. Responsibilities Performs the following job responsibilities under the direc

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 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 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

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

This field based position is responsible for performing assessments of members using established guidelines to ensure appropriate level of care and develop a member centric plan of care. Responsibilities Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members' needs. Evaluate

This senior analyst position within the Treasury Department will be responsible for conducting one or more major cash management activities. Responsibilities include cash management, liquidity projections, treasury operations, bank relationship management, cash accounting, account reconciliations, short term investing, short term borrowing and payments. The Treasury Analy