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American multinational healthcare company
Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for…
Position Purpose: Provide sales coverage and develop best possible market penetration for all products to present and prospective accounts in his/her assigned territory in accordance with company's policies and…
Position Purpose: Conduct comprehensive reviews of medical records and documents supporting claims for providers, suppliers, and pharmacies to include but not limited to physicians, inpatient, outpatient, ancillary,…
Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service…
Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care…
Position Purpose: Responsible for building and governing the enterprise knowledge foundation that powers AI-generated insights. This role oversees the capture, curation, structure, and lifecycle management of business…
Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including…
Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved.…
Position Purpose: Leads and directs the long-term care management of members with physical/medical health and/or behavioral/mental health care needs to develop and assess high quality, cost- effective healthcare…
Position Purpose: Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a…
Position Purpose: Oversee provider network and contracting related activities. Lead all aspects of provider network strategy including, access analysis, network operations and support decision makers with analysis…
Position Purpose: Oversees the design and management of an organization's cloud systems, applications, policies, and strategy. Manages the development of scalable architecture to support applications and…
Position Purpose: As part of Carolina Complete Health, the Finance Analyst II will compile and analyze financial information for the company, health plan. Key Details: For this role, while it is remote, we are…
Position Purpose: Manages the team members accountable for designing, developing, and implementing complex enterprise software solutions. Collaborates closely with technical and non-technical roles such as data…
Position Purpose: Authorize, direct and monitor care for behavioral health and/or substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and…
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