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A&G Clinical Specialist

FL Req ID: R016503 Remote
Duties and Responsibilities: Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension of services. The end to end process requires the...
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Actuarial Analyst

NY Req ID: R021131 Hybrid
Construct monthly IBNR models using paid claim and membership data. Run, modify, and create data queries to produce supplemental reports. Initiate, oversee, and verify information exchanges between actuarial models and Data Warehouse. Produce and maintain trend reports. Modify or add models as...
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Application Developer

NY Req ID: R019941 Remote
• Designs, develops, and maintains complex applications• Develops unit tests and provides code coverage to accurately test business logic and functionality• Participates in developing specifications such as user stories and designs• Solves or recommends solutions for complex issues and problems•...
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Application Developer

NY Req ID: R019953 Remote
• Designs, develops, and maintains complex applications• Develops unit tests and provides code coverage to accurately test business logic and functionality• Participates in developing specifications such as user stories and designs• Solves or recommends solutions for complex issues and problems•...
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Assessment Nurse

NY Req ID: R019905 Hybrid
Duties and Responsibilities: Conducts home assessments (and virtual assessments, as needed) for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and...
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Assessment Nurse

NY Req ID: R018751 Hybrid
Duties and Responsibilities: Conducts home assessments for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills.  As...
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Assessment Nurse Spanish Speaking

NY Req ID: R018635 Hybrid
Duties and Responsibilities: ·        Conducts home assessments for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills.  As...
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Avature Test - Manager

NY Req ID: R016450 Remote
Partners with Director of Benefits in support of the company’s employee benefit, recognition, and retirement program strategy and administration, including open enrollment Conducts benefits analyses, researches benefits practices, and operationalizes programs to improve employee health, wellness,...
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AVP, Corporate Compliance

NY Req ID: R020940 Hybrid
Hybrid Work ScheduleThis position requires three days per week in the office at 100 Church Street, NYC (Tues//Wed//Thurs).Duties and ResponsibilitiesLeadership point of contact and subject matter expert on all compliance related matters; provides guidance to leadership and the Compliance team...
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Bilingual Pediatric Care Manager

NY Req ID: R020904 Remote
**This position is 100% RemoteDuties//Responsibilities:The Pediatric Care Manager plans and manages pediatric medical and//or behavioral care with members and their beneficiaries across the continuum of care. The Care Manager is assigned to a specific product line such as PHSP, Child Health Plus,...
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