Resp & Qualifications. PURPOSE. Drives enterprise optimization by introducing capabilities (inclusive of all functions) for their domain of responsibility utilizing in-depth knowledge and expert skills to advance domain strategies. Translates business needs for the domain into architectural solutions that meet performance, reliability and security expectations. Applies enterprise roadmaps, principles, standards, and practices to drive their domai...
Resp & Qualifications. PURPOSE. Manages, defines, designs, and develops system requirements. Performs trade-off analyses of performance, life-cycle cost, risk and other system or program requirements. Assesses architecture. sub systems and current hardware limitations, defines and designs system specifications, and evaluates input/output processes and working parameters for hardware/software compatibility. Defines system support requirements. Ana...
Resp & Qualifications. PURPOSE. Assists, defines, and/or oversees database organization, standards, controls, procedures, and documentation. Provides recommendations in the definition, design, and creation of a database environment. Develops applications to help solve database solutions to business problems, data architectures, database management system facilities and capabilities, and the operation and tuning of databases. Designs, implements, ...
Resp & Qualifications. PURPOSE. Leads multiple cross functional teams, or Agile Release train (ART) guiding them on how to use Agile, Scaled Agile Framework (SAFe), Scrum and Lean (e.g. Kanban) values/practices through servant leadership in the Data & Analytics Organization. Creates and nurtures a culture of continuous learning, growth mindset and agile maturity in teams/ART through agile practices, agile mindset, metrics, SAFe guidelines, remove...
Resp & Qualifications. PURPOSE. The On-Site Clinical Navigator (RN) manages the timely and smooth transition from inpatient care to home or other levels of care utilizing experience and skills in. both. case management and utilization management. To include proficiency in established guidelines to determine medical necessity, appropriate level of care, referrals to case management to engage members/enrollees, their families and other support syst...
Purpose. Resp & Qualifications. Provides analysis and reporting for practitioners credentialing and institutional credentialing and ancillary providers by obtaining provider related data. analyzing gaps in provider records. designing solutions. carrying out necessary credentialing activities. This role using expertise in credentialing operations, analysis and reporting skills sets to credential practitioners, institutional providers and ancillary...
Resp & Qualifications. PURPOSE. The main purpose of a data analyst is to find meaning in data so that the derived knowledge can be used to make informed decisions and assist the organization in making better business decisions. Essential Functions. Supports stakeholder in gathering business and technical requirements to deliver data driven solutions. Engages in data exploration using various programming languages (reading and writing code), requi...
Resp & Qualifications. PURPOSE. Manages end-to-end oversight of business initiatives. Drives teams and internal projects to maintain and enhance program performance over time. Guides stakeholders through key decisions, communicates and coordinates activities internally and across departments. Facilitates process improvement and identifies and articulates stakeholder needs to drive strategies and maximize outcomes related to ROI, customer satisfac...
Resp & Qualifications. PURPOSE. Responsible for clinical and provider network management for dental organization. Directs daily departmental activities that generally include care management, interpreting dental/medical policy, quality improvement, disease management, utilization review, and dental/medical claims review, network recruitment, credentialing, provider directory information and provider relations. Provides thought leadership for oral...
Resp & Qualifications. PURPOSE. The Directory, Cybersecurity Strategy is responsible for partnering with the Chief Information Security Officer (CISO) in maintaining a corporate-wide cybersecurity program and organization. Reporting directly to the CISO, the Directory, Cybersecurity Strategy will work with all areas of CareFirsts business to mature and communicate a shared vision for a "best in class" cybersecurity program. This will be done by e...
Resp & Qualifications. PURPOSE. Provides Operations Support by obtaining facts. analyzing problems. designing solutions. developing testing methods. conducting and documenting tests. providing operating information to customers. Essential Functions. Research and improve operations by examining and researching systems problems by obtaining facts, analyzing problems/identifying root cause recommending and facilitating resolution. Supports operation...
Resp & Qualifications. PURPOSE. The Actuarial Analyst II will perform individual project tasks as requested, execute calculations of moderate complexity, and understand concepts of actuarial analysis that are of varying complexity. The incumbent is responsible for utilizing various sources to procure data and then turning that data into meaningful information, as well as fulfilling ad hoc requests. ESSENTIAL FUNCTIONS. Reviews and organizes actua...
