Responsible for accurate and timely implementations of pharmacy benefits and operations configurations Provides project management support for all pharmacy services initiatives across all lines of business Responsible for initiation, planning, tracking, documenting, execution, and monitoring and controlling of program implementations Proactively works with the project tea

Responsible for the coordinated management of multiple large scale, critical or complex projects. The Senior IT Project Manager (PM) is responsible for overseeing all aspects of project work to ensure that goals and objectives are accomplished within the constraints of the budget, schedule, and stakeholder expectations. Monitors progress according to plan, identifying and

At the direction of the Manager of Behavioral Health Operations, the Behavioral Health (BH) Program Manager, New Hampshire (NH) is responsible for leading and resolving high visibility behavioral health (BH) initiatives, issues and priorities through significant interface with the health plan's material subcontractor. Key deliverables include the oversight of New Hampshir

The Manager Clinical Audit provides oversight and leadership of the Clinical Audit Team within the Payment Integrity Department. The Clinical Audit team performs detailed medical record and chart audit review of the health plan's claims to ensure that all reimbursement to the provider is paid accurately. The Clinical Auditors are a liaison and resource between the health

Investigate, document, track and assist with claims resolution Interact with various operational departments to assure accurate and timely payment of claims in accordance with WellSense policies and procedures Identify system changes impacting claims processing and work internally on resolution Identify systematic issues and trends and research for potential configuration

Manages a panel of high risk, medically complex members Completes timely initial and on going face to face comprehensive assessments with Member to evaluate Member's medical, behavioral health, functional status, and socioeconomic needs Administers MDS HC assessments and other required assessment tools Facilitates meetings of the PCT and serves as clinical subject matter

Uses SAS and/or SQL coding to pull claims and membership data to support involved healthcare analytics Supports the development of effective medical management programs/initiatives through analyzing, monitoring, and reporting the effectiveness of these programs Develops and implements plans to measure and report on corporate wide health care delivery cost and utilization

Responsible for the daily supervision and operations of the Prior Authorization Specialists. Develops training, trains staff, assigns work, implements policies and procedures, and resolves complex issues to ensure accurate and timely management of prior authorization requests. Maintains compliance with state and federal requirements. Performs quality assurance audits. Imp

Reporting to the Director of BH and LTSS Network Strategy, in this highly visible role, the Manager of Behavioral Health Network is responsible for contracting the entire BH Network for the Medicare, Medicaid and Commercial suite of products across multiple states. The Manager of BH Network will be a central point of contact for the BH Network. Will enable a high performi

The Staff Accountant is a key member of the Accounting team and works closely with all members of the team in meeting close deadlines, working with various general ledger modules, preparing account reconciliations, and supporting internal and external audits. Positive and team oriented work ethic is critical to this role. Our Investment in You Full time remote work Compet

Reporting to the VP, ACA & Commercial Product Management, Public Plans division, the Product Manager serves as the business lead for ACA product operations and project execution as well as end to end management to bring new products and services to market. The Product Manager plays a key role in the development and execution of strategic initiatives to support market comp

The Operations Reporting and Performance Analyst (ORPA) plays an essential role in improving organizational effectiveness by analyzing operational data and identifying opportunities for learning and development. The OPRA collects and analyzes data to assess performance metrics, identifies training needs, and implements strategies to improve employee performance and skill

The WellSense Health Plan Manager of Hospital and Physician Contracts is responsible for the development, implementation and management of a cost effective provider network, maintaining complex and geographically diverse contracts. The Manager leads a team of Hospital and Physician Contract Managers and is responsible for the development of network wide strategies to impr

The Manager of Healthcare Analytics is responsible for financial analysis, measurement, and contract compliance as it relates to WellSense's Clinical Vendors. Working closely with Finance leadership, clinical leadership, and leaders from WellSense's Clinical Vendors, the Manager will ensure the financial integrity of these partnerships by leading the development and commu

The WellSense Plan Manager of Ancillary Contracts is responsible for the development, implementation and management of a cost effective provider network, maintaining complex and geographically diverse contracts. Serves as mentor and manage o Ancillary Contract Managers, leading in the development of network wide ancillary strategies to improve efficiencies and access. Und