To plan, organize, manage, and implement projects.

Under direction from the Director of Care Coordination, manages and provides direction to the Care Coordination (CC) Department Managers and Supervisors for all services. Responsible for establishing and maintaining reports that will support the efficacy of department activity and producing a summary at least annually, or upon request, of CC program activities with documentation of department services, member outcomes, return on investment, and quality improvement activities. A key component of this position is the enhancement and refinement of existing programs, and enthusiastic innovation in the development, management, integration, and refinement of new and existing programs....

The Senior IT Project Manager is responsible for the successful delivery of large-scale, complex projects often involving multiple internal and external stakeholders through all phases of the SDLC. The Senior IT Project Manager helps set and follow clear project management standards including project plans, change controls, risk management, and other project management documents on given strategic initiatives. The Senior IT Project Manager assists in developing standards, managing the enterprise IT project priority list with IT Directors, and assists in IT Steering Committee meetings if needed. This position reports to the Director of IT Strategic...

Train examiner and customer service level I staff on all related claim types for all Partnership lines of business using AMISYS Advance system and Claims Operating Instruction Memorandums.

To research and resolve complex claims issues which cross interdepartmental lines and communicate the outcome to providers and affected Partnership managers. D

To support the Claims Department in maintaining pended claims and claim adjustments within established guidelines. Reviews and processes complex claims, and supports claims examining.

To provide daily supervision of utilization management staff. Provide departmental leadership, support, resources and direction to staff. Assists in developing and maintaining a cohesive team with a high level of productivity, accuracy and quality to achieve departmental goals and objectives.

Under the direction of the Provider Payment Strategy Manager, this position will support the development, evaluation, and advancement of provider reimbursement methodologies to align with organizational strategies and objectives, including performance and alternative payment approaches, and advise executive-level leadership regarding the feasibility of various strategies.

Under the direction of the CIO, the Director of IT Business Systems will be responsible for overseeing the end-to-end intake, evaluation, and formalization of new technology initiatives, including software requests, solution proposals, IT evaluation of licensing agreements, and software-related contracts. This position will serve as the critical liaison between business units

In collaboration with Care Coordination team members, this position provides support and guidance to HealthPlan members referred to the Care Coordination Department for Case Management services and programs. The Health Care Guide I works closely with members, families, providers, community agencies, and the interdisciplinary care team to assist in coordination of benefits in a timely and cost-effective manner, while connecting members to available internal and external resources.

Responsible for the development of all processes necessary to complete all phases of the Enterprise Data Warehouse (EDW). This includes source identification, data collection, data transformation, normalization, rule administration, error detection and correction, data consolidation, data storage, data distribution, schema mapping, data enrichment, and data

To develop, implement, improve, and manage assigned programs. In addition to the Program Manager II duties, the Senior Program Manager is a leadership role, has a higher level of education/experience, more autonomy, exercises independent judgment, and provides coaching and guidance to less experienced program managers. 

Responsible for the delivery of business intelligence solutions across the enterprise. Manages deployment, maintenance, and support of data access tools and reports.