HCSC jobs - 1,142 jobs

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job SummaryThe Staff Actuary uses statistics, financial theory, mathematics, and basic financial and actuarial principles to assess the impact of company decisions or situations. They have an in-depth knowledge of at least one market or business segment and operate with a high level of autonomy for daily purposes of pricing, underwriting, statistics, reserving, forecasting and other actuarial functions. This position can communicate complicated concepts, information, and recommendations regarding process, data, analysis, and results, while catering information to different audiences as needed. As necessary, position manages small projects with limited interaction outside Actuarial department. Required Job Qualifications: * Bachelor degree in Actuarial Science, Mathematics, Statistics or Economics. Other Bachelor (or higher) Degrees may be considered. * Associate of the Society of Actuaries (ASA) and Membership in the American Academy of Actuaries (MAAA). * At least 3 years of actuarial experience. * Verbal and written communications skills to prepare effective documentation, facilitate training and development, and participate in presentations. * PC proficiency to include Word and Excel. Preferred Job Qualifications: * Access, SQL, Visual Basic or other programming skills. * Actuarial experience in the health insurance or related field * Pharmacy or Medicare experience is a plus Please note that this role is HYBRID with an in-office requirement of 3 days a week. #LI-LK1 #LI-Hybrid #INJLF Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting ************************************** The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range$82,700.00 - $149,300.00 Exact compensation may vary based on skills, experience, and location.

Principal Network Mgmt Cons page is loaded## Principal Network Mgmt Conslocations: IL - Chicagotime type: Full timeposted on: Posted Yesterdayjob requisition id: R0047015At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.Join HCSC and be part of a purpose-driven company that will invest in your professional development.# # **Job Summary**### This position is responsible for provider recruitment and contracting of Physicians, Physician Groups both large and small (IPA's, PHO's, large independent hospital systems, Integrated & non-Integrated systems, Value Based Contracting, Etc). Develop and negotiate contracts. Develop and maintain relationships with assigned providers. Ensure strategic coverage for all LOBs and maintain required adequacy for each LOB. The person in this position it is expected to be a SME in the department for multiple assigned areas.### **Job Requirements:*** Bachelor's degree and 4 years provider contracting experience OR Master's degree and 3 years contracting experience OR 8 years business experience including 4 years provider contracting experience. Contracting experience involves negotiating reimbursements, financial arrangements and rates.* Extensive knowledge of provider and facility contracting, products, and claims/processing systems.* Negotiation skills.* Relationship building skills.* Knowledge of marketplace.* Meet deadlines and work well under pressure.* Verbal and written communication skills to interact with all levels of corporate personnel and providers.* PC proficiency to include Microsoft Office.* Analytical skills and business acumen to analyze financial data to determine financial impact of negotiations.* Ability and willingness to travel within assigned areas of responsibility, including overnight stays.**This is a Flex (Hybrid) role: 3 days in office; 2 days remote.**#LI-MW2 #LI-Hybrid### ### **Pay Transparency Statement:**At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting .The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.## HCSC Employment Statement:We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.# # **Base Pay Range**$90,900.00 - $164,200.00Exact compensation may vary based on skills, experience, and location.locations: IL - Chicagoposted on: Posted 13 Days AgoFor more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment. #J-18808-Ljbffr

A leading healthcare organization is seeking an Associate Director, Finance Data Management based in Honolulu, Hawaii. This role involves supporting all aspects of finance data management and implementing vital policies. Candidates must have a Bachelor's degree and extensive experience in ERP systems and finance functions. Additionally, proficiency in managing large datasets and SQL is required. Join a dynamic team to help enhance data architecture and improve operational efficiencies. #J-18808-Ljbffr

A national healthcare organization is seeking a Risk Management Lead to oversee risk adjustment operations and compliance. This role requires a minimum of three years of project leadership experience and expertise in audit and compliance. The ideal candidate will have strong relationship-building skills and the ability to manage multiple projects effectively. This remote position offers a salary range of $104,000 to $143,000 annually, along with competitive benefits including health insurance and a 401(k) plan. #J-18808-Ljbffr

The Optum family of businesses, is seeking a Behavioral Health Case Manager to join our team in Missouri. As a member of the Optum Behavioral Care team, you'll be an integral part of our vision to make healthcare better for everyone. The Behavioral Health Case Manager will provide telephonic and in-person support for both direct referrals and data identified referrals. This requires clinical expertise and the ability to negotiate the complexities involved with special needs conditions such as substance use, suicidality/homicide, major depression, ADHD, eating disorders, and severe mental illness. This position may require minimal field work to meet with members at local facilities in the future. Primary Responsibilities: Facilitate member education and involvement of caregiver in the delivery of interventions Provide advocacy and support to member and family members, including caregiver support & appropriate referral to applicable / needed resources Ensure that members understand treatment options and are effectively linked to treatment resources Promote health, wellness and optimal psychosocial functioning for member (identify caregiver gaps, facilitate education and respite support) Consider the member's needs holistically to identify gaps in care requiring intervention Exhibit excellent customer service in engaging providers in collaborative planning Create and maintain appropriate clinical records Participate as directed in clinical rounds with other members of the team and other external health care management organizations / vendors, as applicable. Also participate in advancing the Quality Improvement Program Conduct condition specific research to meet member needs Maintain success stories which can be utilized to promote program Provide case management support for individuals who meet diagnostic requirements including engagement of member and/ or family making available support throughout the entire continuum of treatment Explanation of authorization process Complete discharge follow-up & if needed, discharge planning / support You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Master's degree in Psychology, Social Work, Counseling, or Marriage and Family Counseling or Licensed Ph.D. Active, unrestricted clinical license to practice independently without supervision in the state of Missouri 2+ years of post-licensure experience in a related mental health environment 1+ years of case management experience Proven intermediate level computer skills including proficiency with MS Office Suite Access to high-speed internet (Broadband Cable, DSL, Fiber) and a dedicated workspace at home Reside in Missouri Preferred Qualifications: Hospital experience including intakes, assessments, discharge planning, and/or case management Community mental health experience including case management Experience doing chart reviews Experience consulting with facility and/or hospital staff to coordinate treatment plans Dual diagnosis experience with mental health and substance abuse Experience working in an environment that required coordination of benefits and utilization of multiple groups and resources for patients Experience with government funded programs Explore opportunities at Optum Behavioral Care. We're revolutionizing behavioral health care delivery for individuals, clinicians and the entire health care system. Together, we are bringing high-end medical service, compassionate care and industry leading solutions to our most vulnerable patient populations. Our holistic approach addresses the physical, mental and social needs of our patients wherever they may be - helping patients access and navigate care anytime and anywhere. We're connecting care to create a seamless health journey for patients across care settings. Join our team, it's your chance to improve the lives of millions while Caring. Connecting. Growing together. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

A leading health care service organization in Chicago is seeking a Principal Network Management Consultant. The role involves provider recruitment, contracting, and negotiation, ensuring strategic coverage for various lines of business. Requires a Bachelor's or Master's degree combined with extensive experience in provider contracting. This hybrid role allows for 3 days in-office and 2 days remote, offering competitive compensation and a comprehensive benefits package. #J-18808-Ljbffr

UnitedHealth Group is a health care and well-being company that's dedicated to improving the health outcomes of millions around the world. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a team that shares your passion for helping others. Join us to start Caring. Connecting. Growing together. Join a dynamic and forwardthinking legal team at the forefront of artificial intelligence and technology in healthcare. As Associate General Counsel, you will help shape the legal framework for emerging AI solutions and advanced technologies, supporting enterprise initiatives that are transforming how care is delivered and experienced. No prior experience in AI or healthcare is required-we will provide the training and resources you need to succeed. What matters most is exceptional analytical judgment and strategic legal thinking. The ideal candidate quickly synthesizes complex facts, frames issues crisply, and crafts practical, businesssavvy strategies. You know when to escalate, when to influence, and when to pivot-embracing diverse perspectives and driving toward thoughtful, durable outcomes. You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: AI Legal Guidance: Provide legal support to the AI Review Board (AIRB) and the Responsible AI program, advising on new AI use cases and solutions Offer legal guidance throughout the development and lifecycle of AI solutions and products Ensure AI initiatives meet legal and enterprise standards by partnering with technical and business stakeholders to address novel legal questions in a rapidly evolving space AI Legislative & Regulatory Support: Monitor, interpret, and advise on proposed and enacted AI legislation and regulation and otherwise collaborate on policy related matters Support implementation of new laws across a complex, highly matrixed organization Technology: Advise on technology-related legal matters Support texting campaigns including compliance with the Telephone Consumer Protection Act (TCPA) Advise and partner with the business in managing risk and implementing best practices for communications and technology solutions Otherwise provide legal support for technology initiatives and team projects You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Juris Doctorate degree Licensed to practice law in the United States 5+ years of legal experience, including time in private practice Proven ability to build and maintain solid working relationships across functions Comfortable operating in a fast-paced, results-oriented environment Demonstrated ability to identify issues, offer timely and proactive advice, and follow through to resolution Expertise, judgment, and presence to advise leadership on complex legal matters Preferred Qualifications: Litigation experience Exceptional legal analysis, written and verbal communication skills Results-driven with intellectual curiosity and a solid work ethic Ownership mindset with accountability for deliverables Poise and confidence to engage with senior legal and business leaders Organizational agility to advocate for key decisions while remaining open to other ideas and collaborative pivots *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $134,600 to $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Executive Director, Actuarial page is loaded## Executive Director, Actuariallocations: IL - Chicago: TX - Richardsontime type: Full timeposted on: Posted 2 Days Agotime left to apply: End Date: February 27, 2026 (30+ days left to apply)job requisition id: R0047720At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.Join HCSC and be part of a purpose-driven company that will invest in your professional development.# # **Job Summary**### The Executive Director, Medicare Part D Actuarial will lead the actuarial function for Medicare Part D products, including Individual MAPD and PDP, with end-to-end accountability for product strategy, pricing, and financial performance. The Executive Director provides actuarial leadership across product strategy, benefit design, formulary and pharmacy network strategies, and is responsible for Medicare Part D bid development and submission, quarterly forecasting, monthly close support, and bid audits. This position reports to the DSVP, Pharmacy Finance and Actuarial and serves as a key strategic partner to senior leaders across Pharmacy, Product, Finance, Compliance, and Operations. The role also acts as the primary actuarial point of contact for external vendors and consultants.### **Key Responsibilities:** ***Medicare Part D Product & Pricing Leadership*** • Lead actuarial strategy for Individual MAPD and PDP products, ensuring financial sustainability, regulatory compliance, and competitive market positioning. • Provide actuarial leadership on product strategy and component strategies, including benefits, formulary, rebate, network, and mail, balancing affordability, growth, and margin objectives. • Partner cross-functionally with Pharmacy, Product, Finance, Compliance, and Operations to align actuarial assumptions with enterprise strategy. ***Bid Development & Financial Management*** • Oversee end-to-end Medicare Part D bid development and submission, including pricing, assumptions, documentation, and internal governance approvals. • Lead quarterly forecast updates and support monthly close activities, ensuring accuracy, transparency, and alignment between actuarial projections and financial results. • Provide actuarial support for annual PBM market checks and negotiations. • Identify key financial risks and opportunities, proactively communicating insights and recommendations to executive leadership. ***Market Intelligence & Strategic Insights*** • Lead Medicare Part D market intelligence, including competitor analysis, CMS policy changes, regulatory guidance, and industry trends. • Translate market insights into actionable recommendations for product design, pricing strategy, and long-term Medicare positioning. Audit, Governance & Compliance • Serve as actuarial lead for CMS bid audits, internal audits, and financial audits, ensuring defensibility of assumptions, data integrity, and timely responses. • Establish and maintain strong actuarial governance, controls, and documentation standards to support regulatory and audit requirements. ***Vendor & External Partner Management*** • Act as the primary actuarial point of contact for external actuarial vendors and consultants. • Oversee vendor scope, deliverables, timelines, and quality, ensuring alignment with business objectives and regulatory expectations. • Leverage external partnerships to enhance modeling sophistication, analytics, and strategic decision-making. ***Leadership & Talent Development*** • Lead, mentor, and develop a high-performing actuarial team supporting Medicare Part D. • Foster a culture of accountability, collaboration, and continuous improvement, with a focus on developing future actuarial leaders. • Set clear priorities, performance expectations, and development plans aligned with organizational goals.**JOB REQUIREMENTS:** \* Bachelor's degree in business, Finance, Actuarial Science, Mathematics, Economics, Computer Science or Management Information Systems. \* 10 years of data, transactional application-based knowledge or group health underwriting experience \* 10 years of management experience, including overseeing two or more departments led by managers. \* Experience in leading one or more major (multi year) group insurance implementation projects \* Experience in leading one of the following: Actuarial Systems or Applications and systems related teams including testing, building, and writing requirements. \* Experience in quality and auditing and system testing (including creating test scripts) \* Experience planning skills including: Setting goals at a position appropriate level, long term planning (one year or longer), budget and expense management, creating staffing models for up to 2 years, establishing department vision \* Problem solving, negotiation skills, and organizational alignment \* Clear and concise verbal and written communication skills. Experience presenting to all levels of management including audiences with diverse communications preferences\*Overseeing the annual budget and allocating resources for various projects and operational needs.\*Translating needs and initiatives into compelling business cases.\*Conducting cost-benefit analyses to justify investments and ensure ROI.**PREFERRED JOB REQUIREMENTS:** • Bachelor's degree in Actuarial Science, Mathematics, Statistics, Economics, or a related field; advanced degree preferred. • FSA designation. • 10+ years of progressive actuarial experience, including significant leadership responsibility in Medicare Part D. • Deep expertise in Medicare Part D pricing, bid development, forecasting, and regulatory requirements. • Strong strategic influence, executive presence, and financial acumen. • Strong understanding of pharmacy benefit economics, including formulary and network strategy impacts. • Proven experience leading CMS bid audits and financial audits, and partnering with external actuarial firms. • Demonstrated ability to communicate complex actuarial and financial concepts clearly to senior leaders and non-technical stakeholders.#LI-TR1#LI-HybridINJLF### ### **Pay Transparency Statement:**At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting .The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.## HCSC Employment Statement:We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.# # **Base Pay Range**$161,500.00 - $299,700.00Exact compensation may vary based on skills, experience, and location.For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC #J-18808-Ljbffr

A leading healthcare organization seeks an Executive Director for their Medicare Part D Actuarial function, based in Chicago, IL. In this role, you will lead the actuarial strategy, oversee bid development, and provide financial management for Medicare products. The ideal candidate will possess a strong background in actuarial science, extensive leadership experience, and exceptional communication skills. This position offers a comprehensive benefits package and professional development opportunities. #J-18808-Ljbffr

A leading healthcare company is seeking an experienced Infrastructure Operations leader to drive innovation in AI and cloud technologies. The ideal candidate will have over 10 years in infrastructure, with a strong background in AI/ML, leading cloud operations for Azure and AWS. Key responsibilities include overseeing cloud strategy and governance, enhancing operational performance, and fostering partnerships across teams. This role offers a competitive salary and benefits focused on well-being. #J-18808-Ljbffr

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. This is a field-based position with a home-based office in Eastern Shore, VA Market. The Field Care Coordinator is responsible for facilitating, promoting, and advocating for the enrollees' ongoing self-sufficiency and independence. This position is responsible for assessment and planning for an identified group of patients. Additionally, the care coordinator is responsible for assessing the availability of natural supports such as the enrollee's representative or family members to ensure the ongoing mental and physical health of those natural supports. The Field Care Coordinator collaborates with the Interdisciplinary Team to coordinate the delivery of comprehensive, efficient, cost-effective patient care. The Field Care Coordinator will be traveling into enrollees' homes, nursing facilities, Adult Day Health, and Adult Living Facilities (ALF) to conduct in-depth assessments and develop the plan of care. The Field Care Coordinator actively assists enrollees with care transitions in collaboration with the Interdisciplinary Team and the acute or skilled facility staff, and the enrollees and / or the enrollees' representatives. Field Care Coordinators act as liaison between the Health Plan, the Commonwealth, enrollees, and their families. Field Care Coordinators follow established professional standards of care, Commonwealth guidelines and policy and procedures. If you are located in commutable distance of Eastern Shore, VA Market, you will have the flexibility to work remotely* as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Current and unrestricted Licensed Practical Nurse in the state of Virginia OR Social Work or Human Services (or related field) with a 4-year degree 3+ years of care coordination or behavioral health experience and/or work in a healthcare environment 1+ years of experience with MS Office, including Word, Excel, and Outlook Experience working with members who have medical needs, the elderly, individuals with physical disabilities and / or those who may have communication barriers Driver's license and reliable transportation and the ability to travel within assigned territory to meet with members and providers Preferred Qualifications: CCM certification Experience working with Medicaid / Medicare population Experience working in team-based care Long term care / geriatric experience Background in Managed Care Physical Requirements: Ability to transition from office to field locations multiple times per day Ability to navigate multiple locations/terrains to visit employees, members and/or providers Ability to transport equipment to and from field locations needed for visits (ex. laptop, stethoscope, etc.) Ability to remain stationary for long periods of time to complete computer or tablet work duties *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $23.89 to $42.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable. #UHCPJ At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

A leading health services company is hiring a Lead Experience Researcher to drive high-impact experiences by blending qualitative and quantitative research expertise. This position is crucial in uncovering unmet needs and informing strategic solutions while partnering with cross-functional teams. An ideal candidate will possess a Bachelor's degree, a minimum of five years in experience research methods, and a passion for human-centered innovation. This remote role offers a competitive salary range of $138,900 - $191,000, along with comprehensive benefits. #J-18808-Ljbffr

The Telephonic Case Manager RN in Medical Oncology provides remote nursing support by coordinating patient care, educating members, and ensuring adherence to treatment plans. This role involves assessing patient health, identifying barriers, and connecting patients with necessary resources to improve health outcomes. Working primarily via telephone, the position requires strong clinical expertise, communication skills, and proficiency in healthcare technology systems. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN with UnitedHealth Group, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today! The Telephonic Case Manager RN Medical/Oncology will identify, coordinate, and provide appropriate levels of care. The Telephonic Case Manager RN Medical/Oncology is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. This is a full-time, Monday - Friday, 8am-5pm position in your time zone. You'll enjoy the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Make outbound calls and receive inbound calls to assess members current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self-management Make referrals to outside sources Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. Solid computer and software navigation skills are critical. You should also be solidly patient-focused and adaptable to changes. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Current, unrestricted RN license in state of residence Active Compact RN License or ability to obtain upon hire 3+ years of experience in a hospital, acute care or direct care setting Proven ability to type and have the ability to navigate a Windows based environment Have access to high-speed internet (DSL or Cable) Dedicated work area established that is separated from other living areas and provides information privacy Preferred Qualifications BSN Certified Case Manager (CCM) 1+ years of experience within Medical/Oncology Case management experience Experience or exposure to discharge planning Experience in a telephonic role Background in managed care *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: telephonic case management, oncology nurse, patient education, care coordination, medical management, healthcare advocacy, remote nursing, chronic disease management, UnitedHealth Group, RN license

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job SummaryThis position will be responsible for the analysis and pricing of renewal and RFP business in the ASO Pharmacy space. Required Job Qualifications: * Bachelor Degree OR 4 years experience in managed care or network management involving independent work and judgment. * Plus 3 years project management experience including leading and planning projects. * Managed care/network management database experience including knowledge of information flow. * PC proficiency to include Word, Excel and PowerPoint. * Clear and concise verbal and written communication skills including interpersonal and presentation skills. * Self- starter, meet deadlines, manage multiple tasks/projects, work in a team environment Preferred Job Qualifications: * Pharmacy or Medical underwriting experience * Knowledge of state and federal network management legislation and regulations Please note that this role is HYBRID with an in-office requirement of 3 days a week #LI-LK1 #LI-Hybrid Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting ************************************** The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range$45,000.00 - $100,100.00 Exact compensation may vary based on skills, experience, and location.

A leading healthcare company is seeking a Director - Automations & Efficiencies to lead innovative projects aimed at enhancing operational effectiveness. This role involves overseeing automation initiatives in a healthcare environment, managing strategic partnerships, and improving processes through advanced technologies. The ideal candidate has significant experience in healthcare payer operations, RPA technologies, and cross-functional leadership. This position offers flexibility to work remotely from anywhere within the U.S. #J-18808-Ljbffr

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together Can we all can agree that the quality of health care is marching forward and upward with great momentum? Yes. But it's not just quality of care. The entire system is becoming more efficient and effective thanks to companies like UnitedHealth Group and people like you. Here's your opportunity to use your expertise in new ways as you strike the balance between health care costs and resources. Performing unit cost and contract valuation analysis, you'll ensure that healthcare contracts are priced accurately and fairly for all involved. As you do, you'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 5 leader. This position supports and validates Provider Network (physicians, hospitals, pharmacies, ancillary facilities, shared/full risk delegation, etc.) contracting and unit cost management activities through financial modeling, analysis of utilization, and reporting. Conducts unit cost and contract valuation analysis in support of network contracting negotiations and unit cost management strategies. Manages unit cost budgets, target setting, performance reporting, and associated financial models. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: Support network pricing strategies and tactics, in collaboration with local network field leaders and network managers Analyze financial impact of provider contracts (e.g., facility; physician; ancillary) Analyze financial impact of corporate initiatives (e.g., policy changes; healthcare affordability) or external regulations (e.g., healthcare reform) Analyze payment appendices to provide options for various contracting approaches and methodologies Communicate results of financial impact and analysis to appropriate stakeholder groups (e.g., Network Management; Network Pricing leadership) Conduct financial and network pricing modeling, analysis and reporting Perform unit cost and contract valuation analysis in support of network contracting negotiations and unit cost management strategies Lead large, complex projects to achieve key business objectives Influence pricing strategies and rate development by highlighting opportunities for improvement or protecting favorable rate structures Strategize rates or contract methodology with network management to create optimal contract Review competitive analysis to identify appropriate pricing rate for provider You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: 4+ years of analytical experience in financial analysis, healthcare pricing, network pricing, healthcare economics or related discipline 3+ years of experience with provider payment methodologies and healthcare products 3+ years of experience in creating and using financial modeling tools, spreadsheets and information acquisition tools Experience with provider capitation, both diagnostic risk-adjustment and age/sex adjusted rate banding Experience in interpreting and reviewing financial modeling results to evaluate the financial impact of contract changes and develop forecasts Presentation experience to internal or external stakeholders or customers Expert level proficiency in MS Excel Proven expertise in financial impact analysis, risk management and data manipulation Proven solid interpersonal, collaboration, negotiation and communication skills Proven excellent communication skills, both written and verbal Proven ability to manage multiple projects simultaneously and meet deliverable deadlines Proven ability to research and solve problems independently Preferred Qualifications: Postgraduate degree in Math, Statistics, Finance, Economics or Actuarial Science Experience in MS Access, SAS, SQL, R, or Python Experience with advanced statistical functions for financial modeling Experience with medical coding (CPT, MSDRG, REV, ICD-10, etc.) Knowledge of Commercial, Medicare, and Medicaid PPO and HMO revenue and expense, as well as delegation financial modeling *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

A leading healthcare provider in Alaska is seeking an Actuarial Analytics/Forecasting Principal to join their Financial Planning & Analysis team. This role involves analyzing and forecasting financial data and providing strategic guidance to business leaders. Candidates should have a Bachelor's degree, strong communication skills, and 10+ years of technical experience. The position offers significant exposure to leadership and opportunities for advancement. Competitive salary and benefits included. #J-18808-Ljbffr

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job SummaryUnder Supervision, This Position Is Responsible For Processing Complex Claims Requiring Further Investigation, Including Coordination Of Benefits And Resolving Pended Claims. Required Job Qualifications: * High School diploma or GED. * Data entry and/or typing experience. * Clear and concise written and verbal communication skills. * Experience processing medical claims. Preferred Job Qualifications: * Referral preference given to applicants able to take and meet testing criteria. * Must have trained on the six-eight-week Blue Chip claims processing system or have the ability to fully complete the six-eight-week Blue Chip Training class. * Knowledge of medical terminology and CPT, HCPCS, and ICD9 coding. * Knowledge of coordination of benefits principles and terminology. * Experience with multi-tasking and prioritizing. Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting ************************************** The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range$17.75 - $26.17 Exact compensation may vary based on skills, experience, and location.

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job SummaryThis ten-week paid internship can be located in Chicago, IL or Richardson, TX What Are Your Responsibilities? The Customer Service Business Analyst Intern position is responsible for actively participating in an Internship program that leverages your skills, knowledge and capabilities within the Customer Service division while exposing you to different methodologies and tools. This role will assist with applying emerging technologies to assist with developing best-in-class systems and solutions for our clients and members. The Customer Service Business Analyst Intern is responsible for learning specific aspects of the processes, programs and technology. Additional project support, administrative tasks and ad hoc requests to support business needs. This role will also need to: Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies. Maintain complete confidentiality of company business. Maintain communication with management regarding development within areas of assigned. responsibilities and perform special projects as required or requested. Create a final internship PowerPoint presentation to share with department leadership covering the internship experience, the assigned project over the course of the summer, including the results along with any solutions or recommendations that can be leveraged by the department in the future. What Do You Need To Be Successful? Prior related technical internship or work experience is a plus Volunteerism or leadership experience is a plus Eagerness to learn, grow and contribute Demonstrated interpersonal skills including clear and concise verbal and written communication Strong analytical and problem-solving skills Be coachable and open to feedback Have a professional presence Results-oriented with a continuous improvement mindset and an ability to grasp new and unfamiliar concepts Strong organizational and multi-tasking skills with the ability to prioritize and support multiple projects Practical, developed PC skills, especially Office 365 and virtual team collaboration tools (MS Teams, Word, SharePoint, etc.) What Are the Requirements You Must Meet? Pursuing a bachelor's degree in business, data analytics, information technology, information systems, computer science or other related degree Graduation date between December 2026 - June 2027 A minimum GPA of 3.0/4.0 Availability to work ten weeks during the summer (June - August) Unrestricted authorization to work in the United States. (Currently, we are not offering this program to students on a visa) What Does the Internship Program Entail? Formal Intern Orientation to build business and industry acumen Challenging real-world, hands-on project Weekly networking opportunities among interns and company leaders Professional development workshops Volunteer activities #LI-Hybrid #LI-JT1 #hcscintern Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting ************************************** The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range$18.46 - $37.84 Exact compensation may vary based on skills, experience, and location.