This position supports HR leadership and is accountable for contributing to the efficiency of departmental operations through the performance of various administrative functions. Responsibilities Screen inquiries and memos for referral to appropriate areas within the division or company or organize such material for the director to expedite resolution. Provide the directo

This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management. Responsibilities Assesses patient's clinical need against established guidelines and/or standards to ensure that the l

This field based position is responsible for performing assessments of members using established guidelines to ensure appropriate level of care and develop a member centric plan of care. Responsibilities Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members' needs. Evaluate

This position is accountable for providing guidance and support to the Dual Special Needs Program (DSNP) Clinical Care Coordinators who perform outreach, and ongoing member contact as well as the clinical care managers who manage the Level 1 members. This position also ensures facilitation of health care services within a member centric plan of care, care gap closure and

This position is accountable for providing guidance and support to the Dual Special Needs Program (DSNP) Clinical Care Coordinators who perform outreach, and ongoing member contact as well as the clinical care managers who manage the Level 1 members. This position also ensures facilitation of health care services within a member centric plan of care, care gap closure and

The role is a technical lead that requires deep knowledge, skills, and experience in designing and carrying out clinical analytics. The position is a key team member collaborating in a multi disciplinary business environment with colleagues across the enterprise to lead clinical performance analytics, development, and reporting that deliver actionable clinical insights to

This position is responsible for receiving verbal and written requests for prior authorization from pharmacists, physicians and/or members. They are accountable for supporting and assisting in the coordination of Pharmacy Services benefits, including claim utilization analysis, prescription plan design, ad hoc reporting, correspondence and special projects. This position

This position is responsible for being the lead on site audits of hospital billing and coding practices and desk audits; forms development, profiling and tracking institutional audit trends. Designing audit protocols and special projects. Performs and finalizes multiple per diem, bill verification, DRG Validation (utilization review audits) and credit balance. Additionall

This position is accountable for supporting Pharmacy clinical management. The responsibilities include assisting in formulary management, medication therapy management, utilization management, research and collaboration with disease management and medical management. Responsibilities Supports the pharmacy formulary management program, medication therapy management program

This position supports HR Leadership and is accountable for contributing to the efficiency of departmental operations through the performance of various administrative functions. Responsibilities Screen inquiries and memos for referral to appropriate areas within the division or company or organize such material for the director to expedite resolution. Provide the directo

This field based position is accountable for the assessment and case management of members to ensure facilitation of health care services. Responsibilities Assist with implementation and facilitation of services to members in the program. Collaborates with member/family, physician and all members of the healthcare team, internal and external to this organization. Coordina

he Director of Technology Strategy, Architecture & Governance at Horizon BCBS, will play a key role in shaping the technology direction of our organization. This is a strategic leadership position combines technical expertise and innovative problem solving skills and considered as a thought leader within the organization on Technology strategy & architecture. This positio

The role is a technical lead that requires deep knowledge, skills, and experience in designing and carrying out clinical analytics. The position is a key team member collaborating in a multi disciplinary business environment with colleagues across the enterprise to lead clinical performance analytics, development, and reporting that deliver actionable clinical insights to

This field based position is responsible for performing assessments for PCA and MDC services using established guidelines and assessments to ensure appropriate level of care and services are authorized. Responsibilities Assesses patient's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members

Reporting to the Director of Corporate Development & Venture Investment, the Corporate Development and Venture Investment Analyst II will be a key contributor across enterprise investments and initiatives that support the Company's $100 million dollar alternative investment fund and revenue diversification opportunities. The role will work closely with deal leads, cross f