Jobs in All Categories (56) Accounting & Finance (3) Healthcare (21) Human Resources & Legal (1) Marketing, Media & Design (2) Operations & General Management (3) Project Management (4) Sales & Business Development (2) Science & Education (1) Technology (19)
Ensures compliance with applicable provider panel and network capacity, adequacy requirements and guidelines. Produces and monitors weekly/monthly reports to track and monitor compliance with network adequacy requirements.
Ability to work with different teams and interact with technical and business folks across the Enterprise.
Develops and implements strategies to reduce member access grievances with contracted providers.
Responsible for oversight of clinical training activities and outcomes.
Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytical findings to senior leadership.
Develop ad-hoc reports using SQL programming, SQL Server Reporting Services (SSRS), Power BI, Medinsight, and other analytic / programming tools as needed.
Ability and desire to lead and the flexibility to also share the duties of the technical team.
Interfaces and maintains positive interactions with Health Plan and Corporate personnel.
Develops eLearning videos with the Captivate software tool that are uploaded and published in the Learning Management System (LMS) for customer access and viewing.
Adheres to design and application development standards, methodology and, framework within Architectural compliance and governance.
Perform comprehensive evaluations including history and physical exams for risk adjustment and other regulatory assessments.
Lead the development of financial budgets, forecasts, performance and trend analysis for the Pharmacy area.
Trains all new Specialist team members and serve as a mentor and resource for existing Specialist team members.
Responsible for the design and implementation of server workload delivery with an emphasis on Dev/Ops alignment.
Develops, implements and uses software and systems to support the department's goals.
Strong interpersonal and communication skills; ability to train users in applications and operating system fundamentals and to write basic documentation
Provides constructive feedback on people, process and technology for continuous improvement.
Collaborating with the national, regional and state analytics and strategic teams to develop, present and evaluate.
Collaborates and works closely with other IT and business teams to develop subject matter expertise to enable the delivery of a complete suite of Quality Assurance services.
Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.
Primary emphasis for the role will be setting the network architectural roadmap and strategy to enhance service delivery, improve network availability, and increase business value for network services.
Perform timely documentation in medical records in an electronic medical record computer system.
Provides a supporting role in an EDI & QNXT Data team in front of customers.
Delivers project customer scope for assigned areas of the MITA Business Processes, on-time and within approved budget utilizing PMM processes and tools, for each implementation project.
Ability to establish and maintain positive, effective work relationships with clients, coworkers, customers and development staff.