Univera HealthСare

Job Description: Summary The Affordability Portfolio Manager is responsible for supporting the operational governance, administration, and portfolio management activities that enable successful execution of the Health Plan's affordability strategy. This role serves as a central coordination and accountability point for affordability initiatives, ensuring opportunities progress efficiently through ideation, evaluation, approval, implementation, measurement, and ongoing monitoring. The role drives organizational effectiveness by facilitating governance processes, maintaining portfolio visibility, supporting executive communications, and promoting accountability across cross-functional teams. Acting as the operational backbone of the affordability function, the Portfolio Manager ensures affordability initiatives are prioritized, tracked, measured, and communicated effectively to stakeholders and leadership. Essential Accountabilities: Level I Establish and lead...

Job Description: This position acts as a quality improvement liaison with physician offices, community agencies, hospitals, and members to promote care management and quality programs. Acts as a member advocate by addressing gaps and barriers to care and educate appropriate use of services through outreach and pilot opportunities. The incumbent promotes programs and services available to Excellus members. Essential Accountabilities: Level I Explores multiple sources of information to identify members who have a gap in care, aligning with HEDIS quality measures and Value Base Payment programs. Assesses member's needs by applying Health Plan approved guidelines and assessment tools. Makes appropriate referrals to clinical programs. Provides outreach and education via telephone and written communication for members on health care quality metrics, assesses barriers to care, and intervenes as appropriate to assure access or facilitate referrals to other services for the...

Job Description: Summary: The Affordability Program Manager serves as a strategic implementation leader responsible for advancing affordability initiatives from intake through implementation, operationalization, and value realization. This role partners across business, analytics, operations, technology, clinical, provider, pharmacy, and vendor teams to ensure affordability opportunities are effectively evaluated, designed, implemented, and measured. The Program Manager translates affordability opportunities into executable plans, identifies implementation risks and dependencies, facilitates decision-making, and drives accountability across stakeholders to achieve intended outcomes. The incumbent uses strong program management, business process, analytical, and stakeholder leadership skills to effectively partner with technical teams on data, reporting, and system integration considerations. Essential Accountabilities: Level I Leads intake and evaluation activities for...

Job Description: Summary: Under the direction of Health Informatics leadership, the Informatics Analyst has the responsibility for the extraction and development of complex reports and/or analysis with summaries and recommendations on findings. Monitors and measures health care trends, outcomes and business processes using data mining techniques, statistical techniques, (i.e., control charting) and additional business intelligence technologies. At the higher levels, the position supplies management with (1) the statistical information needed to make informed decisions, (2) the identification of trends, and (3) the use of data mining techniques and development of advanced predictive models. Essential Accountabilities: Level I: Understands analytic processes and tools such as Excel, Access, COGNOS and SAS. Develops on-going knowledge of Health Plan's varied data sources and structures to independently take in business requirements, design and execute on requests....

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: This position helps support the health plan's comprehensive medication management program through proactive identification of high-impact members who are utilizing high-cost specialty medications. The role plays a critical part in executing pharmacy-driven cost reduction strategies, including support of stop-loss initiatives, while ensuring clinically appropriate and member-centered care in collaboration with providers, members, pharmacies, and internal teams. Under the direction of Pharmacy Care Coordination leadership, this role is responsible for evaluating cost effective treatment regimes, with a focus on optimizing specialty medication use, improving member outcomes, and reducing total cost of care. Essential Accountabilities: Level I Utilizes prescription and medical claim data to generate clinical recommendations and conduct comprehensive medication reviews for members, with a focus on high-cost specialty therapies and complex drug regimens....

Job Description: Summary: The Manager of Operational Performance & Workforce Optimization (OP&WO) is responsible for executing multiple operational performance and workforce management strategic and reporting initiatives. This role provides oversight to any performance and workforce optimization initiatives for the operations functional areas and supports operations functional areas on any corporate workforce management projects. In addition, this position directly supports the operational leadership team with system performance analysis, process improvement development & identification and execution of business plans. Two Positions Available: - Manager of Operational Performance & Workforce Optimization (Capacity Planning & Customer Insights) - Manager of Operational Performance & Workforce Optimization (Metrics & Reporting Solutions) Essential Responsibilities/Accountabilities: • Provides leadership to an internal team of operational...

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: Summary: The Senior Medical Director is a strategic clinical and business leader responsible for advancing the health plan's line of business focus through value-based care, population health, medical management, quality improvement, risk adjustment, product design, and clinical transformation. This role partners closely with line of business leadership, network and provider contracting, actuarial, finance, quality, pharmacy, analytics, care management, and operations to improve clinical outcomes, member experience, provider performance, and total cost of care while ensuring compliance with CMS requirements. Essential Accountabilities: Serve a senior clinical advisor to line of business leadership on strategy, population health, medical cost, quality, and regulatory priorities, develop and execute clinical strategy in alignment with organizational growth, quality, and financial objectives. Identify clinical and market opportunities to improve member...

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: Summary: The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical documentation, and/or inpatient coding and has a high level of understanding of the current MS-DRG, and APR-DRG payment systems. This position is responsible for reviewing medical records for appropriate provider documentation to support the principal diagnosis, co-morbidities, complications, secondary diagnosis, surgical procedures, POA indicators to validate coding and DRG assignment accuracy, insuring the physician documentation supports the hospital coded data. Essential Accountabilities: Level I • Analyzes and audits acute inpatient claims. Integrates medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise. Clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently....

Job Description: Thank you for your interest in our Customer Care team. Due to the volume of applications we receive, we review all applications in the order in which they were received. If you are chosen to move to the next step in the process, you will receive a Video Assessment from recruiting@jobalerts.univerahealthcare.com Summary: The Customer Care (CC) Advocate resolves customer inquiries via telephone, walk in, mail, fax, web chat, off-phone work, and email concerning, but not limited to, contract benefits, claim payments, and enrollment in accordance with MTM, Corporate Service strategy, NCQA, and legislative requirements. The Customer Care Advocate provides service for customers and business partners while responding in a professional, efficient, and timely manner to resolve issues and enhance member & provider satisfaction/retention. The B version of this role requires the individual to speak Spanish fluently. Essential...

Job Description: Summary: This position assists the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. This role supports the HARP line of business. Essential Accountabilities: Level I Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Supports effective implementation of performance improvement initiatives for capitated providers. Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate,...

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: Summary: The Document Solutions team focuses on the design and creation of correspondence and transactional statements using various software programs. The Publishing Systems Engineer operates in a business analyst/document-generation specialist role as part of the Document Solutions team. This role focuses on programming within the various systems utilized by our Solutions Team. Essential Primary Responsibilities/Accountabilities: Level I: Develops code; analyzes, researches, and resolves system issues for electronic publishing-related problems. Creates, maintains, and follows all documented processes and standards. Builds new and updates existing workflows and documents using xml and text data in variable data composition systems based on the requirements and functional specifications. Documents functional specifications and solutions for work to be performed. Develops or assists in the development of systems testing and implementation plans. Reviews...

Job Description: Summary: Under the direction of assigned management, the Electronic Data Interface (EDI) Administrator is responsible for quality assurance during the onboarding process for all electronic submissions, including testing as well as ongoing production support. This position provides analysis and feedback for continuous process improvement to maximize customer electronic transaction submissions. At the higher levels, the EDI Administrator is responsible for quality assurance of more complex interfaces including Secure File Transfer Protocol (SFTP) facilitation and testing. Essential Accountabilities: Level I • Supports the Business and IT teams with various tasks related to movement of files and automation. Loads files manually through SFTP methods for the Business when automation is not available. • Under guidance, conducts basic testing of electronic submissions. • Monitors daily electronic transaction processing and takes appropriate action to reduce or...

Job Description: Summary: Under the direction of assigned management, the Legal Counsel functions as a strong legal generalist on a collaborative, business aligned team. The Legal Counsel exercises sound judgment and excellent communication skills and balances risk while operating with a solutions-oriented approach. The focus of this role is to engage as a trusted business partner providing practical, timely, and context-driven legal advice to enable informed decision-making and advance enterprise objectives. Essential Accountabilities: Supports Business-Aligned Decision-Making & Serve as a Trusted Business Partner Builds strong, collaborative relationships with internal clients, legal department colleagues, and cross functional partners, grounded in trust, transparency, and shared accountability. Communicate legal advice clearly, concisely, and professionally, tailoring messages for non-legal audiences to support timely, informed decision making. Anticipates...

Job Description: Job Description Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours...