• USA, or US National

Telephone-based assessment and counseling in a call center environment. Conducts risk, substance abuse, and mental health assessments. Collaborates with a team of professionals to ensure continuity of care. Maintains accurate documentation and confid..

• MI, IN, KY, TN, GA, FL, OH, NC, SC, WV, VA, PA, DC, CT, NJ, NY, RI, NH, ME, MD, DE, VT, MA, ND, SD, NE, KS, OK, TX, MN, IA, MO, AR, LA, WI, IL, MS, AL

Manage IT hardware assets using ServiceNow platform. Oversee entire asset lifecycle, from procurement to retirement. Collaborate with stakeholders, develop policies, perform audits, and provide guidance on best practices. Lead a team and interact wit..

• US National (Not hiring in HI)

Assess and plan appropriate member physical and behavioral healthcare, coordinate care with providers, and promote effective utilization of resources. Apply clinical judgment and motivational interviewing skills to engage members and empower them to ..

• NJ

Manage care, create care plans, and implement health service strategies for members. Conduct face-to-face visits and collaborate with care team participants. Requires RN licensure and advanced clinical judgment skills.

• San Antonio, TX

Analyze and approve routine claims, apply medical necessity guidelines, verify eligibility, identify discrepancies, and apply cost containment measures. Route complex claims to Senior Claim Benefits Specialist.

• US National

Design, develop, and maintain automated solutions for Mainframe Db2 software. Collaborate with software development teams for process improvement and automation. Troubleshoot and resolve database-related issues.

• USA, or US National

Assess and plan appropriate member physical and behavioral healthcare, coordinate with providers, and promote optimal utilization of resources. Apply clinical judgment and motivational interviewing skills to ensure maximum member engagement and promo..

• Frankfort, KY

Perform intake of calls from members or providers regarding services, screen requests for appropriate referral to medical services staff, approve services that do not require a medical review, and maintain accurate and complete documentation of requi..

• AZ, TX, NY, MN, FL, PA, LA

Acts as a quality champion by measuring and monitoring work processes in claim processing and customer service. Conducts quality audits, provides support, and makes recommendations to senior management.

• CT

Develop and optimize ML models and pipelines, upgrade and maintain ML platform, mentor junior engineers, seek opportunities to lower cloud costs. Required: ML pipeline/platform development, cloud native analytics, ML-centric programming. Pr..

• VA

A Clinical Transformation Specialist is responsible for developing and implementing physical and behavioral health integration programs, providing education and technical support, and interfacing with providers to develop and implement Value Based Co..

• Hartford, CT, Chicago, IL, Atlanta, GA, Blue Bell, PA, Overland Park, KS

Assess risk, analyze market data, develop new product offerings, collaborate with various teams, and oversee actuarial priorities to drive business growth and improve competitive position in the international market.

• US, or US National

Deliver analytics and insights to support operations. Act as internal analytics specialist, utilizing tools such as SSIS, SSRS, Teradata, Alteryx, and Tableau. Support data automation reporting and develop business logic metrics.

• NY

Grow customer relationships and sales attainment in key markets. Direct account management activities to achieve maximum revenue attainment and patient participation for contracted business arrangements. Travel required up to 33% of the time.

• NY

Develop and execute account plans to achieve maximum revenue, compliance, and customer satisfaction with assigned clients. Includes team leadership, mentoring, and training responsibilities. Requires 3 years of work experience and ability to handle i..

• IL

Drive and support care management and care coordination activities. Utilize clinical judgment to facilitate member physical and behavioral healthcare. Coordinate psychosocial wrap-around services for optimal outcomes.

• US, or US National

Lead, direct, and manage vendor relationships and tasks for service level performance, align with stakeholder goals, and improve vendor processes. Requires healthcare/PBM experience, strong communication and computer skills, and ability to work indep..

• IN

Negotiate, execute, review, and analyze contracts. Manage contract performance and contribute to provider compensation and pricing development activities. Recruit providers to ensure network expansion and adequacy targets are met.

• Cumberland, RI

Manage a team to ensure compliance with Business Continuity program policy, develop and lead planning activities, collaborate with business unit leaders to address deficiencies, coordinate exercises and client reviews, and manage emergency...

• Woonsocket, RI, Hartford, CT, Scottsdale, AZ, Chicago, IL, Dallas, TX

Provide advice and guidance on company policies, manage grievances and workplace inquiries, assist with coaching, corrective actions, terminations, and serve as a labor relations expert for business unit leaders.

• OK, Oklahoma City, OK

Manage and oversee compliance with provider engagement responsibilities, manage local team to deploy national engagement model, co-facilitate provider advisory group and JOC meetings to implement changes via coordination Quality Management.

• US National (Not hiring in HI)

Facilitates member healthcare through assessment, care planning, provider coordination, and psychosocial services. Reduces risk factors, consults with supervisors, and monitors care quality through case management and quality processes.

• OK

Demonstrated experience with clinical program components, formulary designs, and prescription benefit trends. Experience working in a high production team environment.

• US National

Serve as senior liaison for strategic clients in Care Management. Lead client expansion through consultative selling, recommend tailored solutions, assist with renewals, build relationships with stakeholders, monitor and track financial projections.

• Woonsocket, RI

Develop, maintain, and deploy enterprise automation for AI, ML, NLP, and cognitive services. Manage cloud-based and other AI platforms. Need 4 years' experience in programming or cognitive service platforms.

• MN

Build shared internal libraries, tools, and processes for teams to self-service build, test, deploy and operate systems. Develop scalable engineering solutions for cross-team concerns. Advocate for best practices in Android development.

• OH

Review and adjudicate complex claims, apply medical necessity guidelines, complete eligibility verification, and identify discrepancies. Make outbound calls to obtain required information for claim or reconsideration. 2+ years of medical claims proce..

• Houston, TX

Outreach and engage with DSNP members to complete Health Risk Assessments. Support members during enrollment calls and connect them with appropriate care team personnel. Document calls accurately and protect member confidentiality.

• OH

Uses motivational interviewing to gather comprehensive information about members' health needs, connects members to appropriate care teams, documents calls, protects member information, builds relationships with members.

• FL

Outreach to DSNP members via phone to introduce services and complete Health Risk Assessment. Use motivational interviewing to gather comprehensive information and connect members with appropriate care team personnel. Accurately document each call an..

• US National

May perform or assist with integration and system testing, according to detailed test plans to ensure high-quality systems. May assist business partners with User Acceptance Testing.

• US National

Design and support complex voice and contact center solutions, engineering multi-vendor solutions, staying current with technology trends, and collaborating with enterprise technology functions to maximize alignment, efficiency, cost optimization, an..

• Linthicum, MD

Answering inbound calls from Aetna Medicaid members and providers, providing assistance with inquiries regarding benefits, eligibility, services, and ID cards. Requires high-speed internet connectivity with secure service via ethernet cable. Company ..

• ND, SD, NE, KS, OK, TX, MN, IA, MO, AR, LA, WI, IL, KY, MS, AL, MI, IN, TN, GA, FL, OH, NC, SC, WV, VA, PA, DC, CT, NJ, NY, RI, NH, ME, MD, DE, VT, MA

Perform comprehensive coordination of medical services, intake screening, and eligibility verification via telephone, fax, and EDI. Utilize Aetna system to enter member information and communicate with Aetna Case Managers. Adhere to company policies ..

• US National

Effectively communicate prioritized strategies, progress towards expected financial outcomes, and provide meaningful insights regarding shrink results at the Executive level

• TX, AZ, HI, CA

Develop test plans, test cases, and test scripts for projects. Perform testing on various software and reporting systems. Collaborate with PA Admin and Medicare Operations to test and validate utilization management criteria, decision trees, drug lis..

• Woonsocket, RI, Hartford, CT, New York, NY

Manage business processes and data flows, enhance processes and data flows, assess process breaks, foster relationships with stakeholders, support implementation of new ETPRM capabilities, work with confidential and sensitive matters.

• IL

Uses motivational interviewing to assess members' health needs, connects members to appropriate care teams, documents calls accurately, maintains member confidentiality, builds relationships with members, and demonstrates empathy and care over the phone.

• Saint Paul, MN

Develop, enhance, and publish iOS apps using Swift. Partner with other iOS engineering teams. Advocate for engineering best practices, maintain shared code, and participate in peer code reviews. Utilize GitHub and operate in an Agile environment.

• Springfield, IL, or US National

Provide clinical expertise and business direction to promote high-quality medical care. Support appeal process, clinical claim review, pre-certification, and predetermination of covered benefits. Collaborate with diverse teams and identify quality...

• Woonsocket, RI, Scottsdale, AZ

Partner with stakeholders to design and execute strategic recruiting plans, manage full lifecycle recruitment for corporate business areas, provide exceptional hiring experience, use data to solve problems and champion innovative talent acquisition s..

• US National

Responsible for the development, maintenance, and delivery of iOS applications. Collaborate with cross-functional teams to deliver great user experiences and ensure app performance. Interact and collaborate with IT teams and external vendors.

• Austin, TX

Assess, plan, implement, and evaluate nutritional status of members. Provide nutritional coaching and support to empower members to make healthy lifestyle choices. Utilize clinical guidelines to positively impact members' health.

• NY

Develop, validate, and execute AI/ML models to solve complex business problems. Collaborate with senior leadership and subject matter experts to outline requirements and areas for support. Serve as a thought leader, mentor, and developer of advanced ..

• Phoenix, AZ

Support development and delivery of strategic vision for Vulnerability Management. Collaborate with IT to implement technologies, manage adherence to control standards and security policies, and optimize practices for risk reduction.

• NJ

Lead cyber incident response team, manage, monitor, and correlate data, produce actionable information, analyze logs, forensic images, and threat models. Interface with business units, IT leads, and law enforcement. On-call rotation.

• ND, SD, NE, KS, OK, TX, MN, IA, MO, AR, LA, WI, IL, KY, MS, AL, MI, IN, TN, GA, FL, OH, NC, SC, WV, VA, PA, DC, CT, NJ, NY, RI, NH, ME, MD, DE, VT, MA

Monitor internal control systems to ensure information security, establish metrics for critical infrastructure components, provide security engineering training, respond to audits, and stay updated on information security technologies.

• NY

Leverage technical and analytical expertise to drive shrink in front store operations, automate shrink forecast and labor planning, and develop scenario models to answer business questions. Collaborate with business leaders to promote adoption...

• CT

Lead research and innovation in infrastructure observability, collaborating with cross-disciplinary teams to develop groundbreaking ML solutions. Mentor junior researchers and contribute to the optimization and introduction of new products.

• MI, OH, IL, IN, KY

Manage contractual obligations, reporting, workflows, and relationships with internal/external constituents. Travel up to 25% nationally. Requires knowledge of Medicaid programs and managed care industry practices. Bachelor's degree desired. Salary r..