Manage the internal training function, including supervision of the staff responsible for developing training materials and conducting training. Develop and implement a process to evaluate and improve training outcomes.
This position performs market research to understand trends in Medicare product design, benefit enhancements and administration of Medicare Part D, Medicare Advantage and Medicare Employer Group Waiver Products (EGWP).
Manages day-to-day quality activities in assigned area ensuring program and procedures support company goals for service, quality, and cost effectiveness as well as compliance with contract, federal and state requirements.
This position would be responsible for the overall management of a Care Management Centers or Health Plan, including oversight of clinical and administrative operations; includes the areas of care management, quality, medical, customer service, network, compliance, claims, information technology, reporting and human resources.
This position drives product strategy, solution development and implementation, and ongoing product maintenance, enhancements and optimization; creates tangible business strategies, facilitates planning activities, executes activities, and measures results to maximize product performance, growth and profitability.
This position is responsible for assisting with the implementation and administration of the company Medicare Advantage Compliance Program, and ensuring regulatory compliance with applicable CMS regulatory requirements.
Responsible for developing and fostering alliances and partnerships with pharmaceutical manufacturers within the Managed Markets segment; negotiate profitable customer contracts, direct customer initiatives and special projects.
Analyze and review monthly results for risk against annual plan and forecast projections and provide variance explanations/recommendations; provide financial support in the completion of monthly Corporate reports.
Responsible for development of long term profitable relationships based on provision of consultation and effective business solutions; develop and implements effective, creative account retention & growth plans that protects and generates revenue and EBITDA.
Provides prior-authorization services for formulary drugs, develops programs to provide optimal pharmacy care to patients, participates in drug utilization review programs, reviews assessment and documentation of patient care, and retrospective reviews of provider reimbursement.
Develops, implements and monitors the CG&A programs to align with clinical programs and meet contractual requirements; communicates across various departments, and drives understanding of the strategic impact of the CG&A programs for the SBU and they integrate with other clinical initiatives.
Leads and monitors a pro-active, clinically and operationally-driven quality and process improvement program for assigned units; collaboration with management in developing process and system improvements.
Directly oversees all fiscal and administrative operations, including the areas of clinical operations, quality, compliance, network, regulatory, finance, human resources, customer service, claims payment and billing, information technology and reporting.
This position provides technology leadership by first understanding line of business and IT strategy and providing the leadership required for driving a specific Architecture domain(s) within a SBU IT organization.
The Software Engineer works effectively across the entire software development life cycle as a full stack developer; includes requirements definition, architecting, prototyping, detailed design, coding, testing, deployment, and support of the day-to-day operation of production systems.