The DSNP Project Manager is responsible for coordinating activities related to the Dual Eligible Special Needs Plan (DSNP) lifecycle. This role ensures compliance with CMS requirements, timely execution of deliverables, and seamless collaboration across internal teams and external partners and will oversee strategic project planning and manage all aspects of AEP operational readiness including all impacted business functions. This position will effectively manage assigned projects, utilizing appropriate project management methodologies to drive the planning, implementation, and tracking of projects through all aspects of the project...

The Housing Services Coordinator is responsible for reviewing, approving, and supporting requests for housing-related services for Community Supports services offered by the health plan. This role ensures that housing related services are appropriate, align with program criteria, and support members stability and health outcomes. The position works closely with departmental clinical teams, care management teams, external

The Data Analytics and Reporting Developer is responsible for designing and developing data reports and dashboards that provide actionable insights to support business decisions. This role involves working closely with cross-functional teams to gather reporting requirements, transform data, and deliver high-quality, interactive visualizations. The position ensures data accuracy and

To process TARs for selected services using specific procedures and protocol and to provide administrative assistance to UM Coordinators and Leadership staff as assigned. Serves as Systems Trainer for all new hires and provides ongoing education for all HS/UM staff.

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 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.

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