Candidates must possess a Juris Doctorate degree with licensing in at least one state, along with a minimum of three years of experience in health law within a law firm or healthcare organization. Strong legal research, writing, and analytical skills are required, as well as the ability to clearly communicate complex legal issues and work independently or within a team.
Candidates must possess an MD or DO degree and have at least 5 years of direct clinical patient care experience post residency or fellowship, preferably including inpatient or Medicare population care. A current and unrestricted medical license in at least one jurisdiction, ongoing Board Certification in an approved ABMS Medical Specialty, and no current sanctions from governmental organizations are required. Strong analytical and interpretation skills, along with excellent verbal and written co…
Candidates must possess a Bachelor's degree and an ASA or FSA designation, along with membership in the American Academy of Actuaries. They should meet basic education requirements for issuing statements of actuarial opinion and have at least 3 years of actuarial work experience. Strong communication skills and the ability to translate technical issues for non-actuarial audiences are also required. Preferred qualifications include 3 or more years of relevant health-related actuarial work experie…
Candidates must possess a Bachelor's degree and at least 5 years of technical experience, with strong hands-on Kubernetes engineering skills. Excellent problem-solving and communication skills are also required. Preferred qualifications include AKS or GKE certification, cloud platform experience with Azure, GCP, or AWS, and prior experience with OpenShift.
Candidates must have at least 3 years of experience researching state Medicaid hospital reimbursement methodologies that utilize MS-DRG, APR-DRG, APC, or EAPG. A minimum of 2 years of experience researching MS-DRG, APR-DRG, and/or EAPG grouper logic is required, along with experience processing or reviewing facility claims. Prior professional experience utilizing Microsoft Excel, including performing basic data analysis, using pivot tables, and functions like VLOOKUP, is also necessary.
Candidates must be fully bilingual in English and Spanish, with the ability to speak, read, and write both languages without limitations. A minimum of 1 year of recent call center experience and 2 years of customer service experience are required. Applicants must reside in the Eastern or Central Time Zone and possess strong customer service orientation, attention to detail, and proficient computer navigation skills, including Microsoft Office applications. A separate, private home office with ha…
Candidates must be licensed as a Registered Nurse in Wisconsin, possess at least two years of clinical care experience, and have a minimum of three years of experience in prior authorization or utilization management. Proficiency in Microsoft Office applications, including Word, Excel, and Outlook, is also required. Preferred qualifications include a Bachelor of Science in Nursing, previous leadership experience, knowledge of Milliman (MCG) or InterQual, familiarity with TruCare, and managed car…
Candidates must possess a Bachelor's degree and have over 8 years of experience in provider relationship management, provider education, and provider engagement. A deep understanding of organizational capabilities across teams and markets, strong leadership experience, critical thinking, problem-solving skills, and a strategic mindset are essential. The role requires residency in or willingness to relocate to North Carolina and familiarity with North Carolina Medicaid.
Candidates must have 5-8+ years of product management experience, with at least 3 years in consumer-facing digital products. Experience building or optimizing search and discovery tools is required, along with strong systems thinking, product discovery skills, hypothesis testing, and MVP definition. Excellent collaboration and communication skills are essential. Familiarity with healthcare or regulated industries is preferred.
Candidates must have experience in healthcare operations, preferably with exposure to MRA or risk adjustment, and a strong understanding of financial concepts such as budgeting, ROI, and cost management. Proficiency in Excel and familiarity with business intelligence tools like Tableau or Power BI are required, along with demonstrated project leadership experience spanning two or more years. Exceptional communication, relationship-building, and analytical skills are essential, as is a detail-ori…
Candidates must be fully bilingual in English and Spanish, passing a speaking, reading, and writing test. A Bachelor's Degree in Nursing (BSN) and an active, unrestricted RN license in Puerto Rico are required. An active RN license in Florida or having passed the NCLEX exam is also necessary, along with affiliation with the CPEPR. Prior clinical experience in adult acute care, skilled nursing, rehabilitation, or discharge planning is essential. The ability to work independently and as part of a …
Candidates must have four or more years of vendor management experience, including writing process improvement documents like Statements of Work (SOWs), Policies & Procedures (P&Ps), and Standard Operating Procedures (SOPs). Three years of experience managing corrective action plans, including root cause analysis and vendor implementation oversight, is required. Additionally, three years of experience in the healthcare, health insurance industry, or DOD contracting is necessary, along with famil…
Candidates must possess an AHIMA or AAPC CPC certification, have 4 or more years of medical coding experience, and demonstrate knowledge of Risk Adjustment and coding guidelines. A Bachelor's degree, CRC certification, experience interacting with healthcare providers, strong Microsoft Office skills, attention to detail, follow-up skills, a valid driver's license, and public speaking experience are preferred. Occasional travel up to 5% is also required.
Candidates must possess an MD or DO degree and have at least 5 years of direct clinical patient care experience post-residency or fellowship, preferably including inpatient or Medicare-eligible population care. Board certification in an approved ABMS Medical Specialty is required, along with a current, unrestricted medical license and the ability to obtain additional licenses. Applicants must have no current sanctions from federal or state governmental organizations and must pass credentialing r…
Candidates must possess an unrestricted RN license in Ohio and have previous experience in Care Management (CM), Utilization Management (UM), or training and learning development. Proficiency in Microsoft Office Suite (Outlook, PowerPoint, Word, Excel), strong virtual and in-person presentation skills, and experience collaborating with multiple levels of leadership are essential. A valid state driver's license and proof of personal vehicle liability insurance with specific limits are also requir…