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The Manager, Provider Network Operations oversees provider network activities ensuring compliance with health standards and regulatory requirements. Responsibilities include managing operational functions like credentialing and contract processing, monitoring onboarding processes, leading initiatives for process improvement, and ensuring compliance with internal and external standards.

The Senior Solutions Architect creates and integrates architecture guidelines to support testing integration requirements. They provide expertise on testing architecture decisions, develop integration testing architecture blueprints, and collaborate with various teams to assure compliance with standards and enhance business processes. Additionally, they participate in strategic discussions regarding technology trends and new initiatives.

Recruit and develop networks of physician, hospital, and ancillary service providers by negotiating and managing network participation agreements. Ensure compliance with Corporate, health plan, and State guidelines. Coordinate with internal departments and contracted providers for contract compliance. Requires 2+ years of provider contracting experience.

The Senior IT Assurance Analyst gathers and organizes assessment data to support risk reporting, advising on IT controls, and designing corrective actions to address deficiencies. They consult with stakeholders to implement controls, assess risk levels across the enterprise, and develop metrics for reporting to management. They also communicate remediation strategies and manage project-related issues and risks effectively.

The Senior Manager, Procurement will manage vendor relationships, evaluate vendor performance, and oversee contract management. Responsibilities include leading complex procurement projects, developing supplier relationships, and mitigating risks through effective contract negotiation and compliance training.

The Provider Engagement Account Manager is responsible for managing partnerships between the health plan and provider networks. Key duties include resolving provider issues, educating providers on policies, managing network performance, and driving improvement in quality metrics and utilization. Must travel locally four days a week and adhere to company policies.

The Community Resource Coordinator II position supports community connection activities to help members access resources for their care management. Responsibilities include outreach, health assessments, and documentation of community resources while assisting clinical teams and promoting awareness of available services.