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…

Handle PCP, demographic changes and/or new ID cards as requested by members. This position supports the Clinical Operations functions and acts as a liaison…

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…

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…

Distributes new case assignments to the Case Management Clinical Staff. Process PCP, demographic changes and new ID cards as requested by members.

Supports Network Strategy efforts related to maintaining and updating records for Horizon business partners on matters of hospital owned and affiliated…

This position is responsible for the oversight of financial control and analysis within the Mid and Major Accounts group, within the Billing, Enrollment and…

This position is accountable for providing day-to-day guidance, support and medical leadership for utilization management activities and decisions within the…

Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties. Conducts on-site visits to hospitals in the Select Hospital…

This position is responsible for performing behavioral health duties using established guidelines to ensure appropriate level of care as well as planning for…

Develop or supervise the development of pricing models and support pricing requests which may include benefit adjustment factors, fee schedule analysis, new…

Serves as mentor/trainer to new RN's and other staff as needed. Serves as a mentor/trainer to new RN's and other staff as needed.

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…

This field based position is responsible for performing assessments of members using established guidelines to ensure appropriate level of care and develop a…

This position is responsible for resolving escalated member inquiries by phone or through written correspondence. Requires a High School diploma or GED.

Demonstrable ability to quickly understand new concepts and to come up with original solutions to various mathematical issues.

This position will need to work closely with a multitude of departments, being able to rapidly understand and navigate new situations - and to be able to create…

Assists Director in establishing, interpreting and implementing new and existing company policies and procedures.

Provide excellent service to customers through the resolution of basic customer inquiries received by phone or though written correspondence.

This position is responsible for supporting the Medicare Operations department with improvements through project planning, development and implementation, and…

The incumbent will partner with multiple customers across the Enterprise to provide more complex resolutions to analytics/data problems (i.e. descriptive…

The incumbent has clear authority in specialized areas to act for the company. Also develops and maintains internal relationships and provides coordination with…

This field based position is accountable for the assessment and case management of members to ensure facilitation of health care services.

The Business Process Improvement Analyst I reports to a Director or Manager of Enterprise Business Process Improvement and is responsible for supporting process…

Acquires new business (Medicare Advantage Employer Group). Directs the implementation process for new clients and/or employers.