TriWest Healthcare Alliance jobs - 7,281 jobs

Become a part of our caring community and help us put health first The Risk Management Lead acts as a consultant to the Risk Adjustment team leaders, as programs and initiatives are executed upon. Leveraging risk management and compliance frameworks, they will identify and analyze potential risks and sources of loss to evaluate business processes and drive improvements aimed at minimizing risk. The Lead will focus on Project Management and is responsible for oversight of the Risk Adjustment Operations processes. The Risk Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Risk Management Lead estimates the potential financial consequences of an occurring loss. Develops and implements controls and cost‑effective approaches to minimize the organization's risks. Assesses and communicates information regarding business risks with functions across the organization. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action. In addition, this role provides consultative services to drive efficient, effective, and compliant risk adjustment processes. This Risk Adjustment Risk Management lead position will be responsible for providing risk management and compliance oversight of Risk Adjustment Operations, including the areas of Provider Data Validation, Provider Support, Provider Reporting, Quality Audit, and risk adjustment operations related to Provider Reconciliation and alternative encounter submission methods. Responsibilities of the role will include the following: Evaluating processes and procedures to ensure adequate controls are included Monitor compliance requirements specific to risk adjustment operations Conduct audits to ensure controls and processes are being executed with minimal risk Conduct risk assessments, as necessary, to identify current gaps in processes Collaborate with business area associates to develop remediation plans to close gaps Collaborate with business area teams and compliance partners to consult on initiatives and drive process excellence Develop annual work plan for responsible areas Understand and assist in financial control assessment and work collaboratively with internal and external auditors Evaluate Provider Data Validation, Provider Reporting, Quality Audit, and core risk adjustment operational business areas monthly progress against goals Track and report on project status Use your skills to make an impact Required Qualifications 3 or more years of project leadership experience 2+ year of audit, compliance, and/or risk experience Must be passionate about contributing to an organization focused on continuously improving consumer experiences Strong relationship building skills Ability to take the initiative Ability to manage multiple initiatives at a time and ensure progress is moving forward Preferred Qualifications Applicable Bachelor's degree - Accounting, Finance, Business, Auditing, Actuarial Certified Internal Auditor, CPA or CPC strongly preferred Risk Adjustment knowledge Experience with risk adjustment provider data and reporting Auditing experience Familiarity with CMS Reimbursement models and claims/encounter submission processes Data analysis and dashboarding experience People leadership experience Additional Information Location: Nationwide (U.S.); however, candidates located in the Eastern Standard Time (EST) Zone are strongly preferred to support alignment with team schedules and collaboration. Work-At-Home Requirements: WAH requirements: Must have the ability to provide a high‑speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Interview Format: As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision‑making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $104,000 - $143,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short‑term and long‑term disability, life insurance and many other opportunities. Application Deadline: 01-23-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our *************************************************************************** #J-18808-Ljbffr

Become a part of our caring community and help us put health first The Risk Management Lead acts as a consultant to the Risk Adjustment team leaders, as programs and initiatives are executed upon. Leveraging risk management and compliance frameworks, they will identify and analyze potential risks and sources of loss to evaluate business processes and drive improvements aimed at minimizing risk. The Lead will focus on Project Management and is responsible for oversight of the Risk Adjustment Operations processes. The Risk Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Risk Management Lead estimates the potential financial consequences of an occurring loss. Develops and implements controls and cost‑effective approaches to minimize the organization's risks. Assesses and communicates information regarding business risks with functions across the organization. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action. In addition, this role provides consultative services to drive efficient, effective, and compliant risk adjustment processes. This Risk Adjustment Risk Management lead position will be responsible for providing risk management and compliance oversight of Risk Adjustment Operations, including the areas of Provider Data Validation, Provider Support, Provider Reporting, Quality Audit, and risk adjustment operations related to Provider Reconciliation and alternative encounter submission methods. Responsibilities of the role will include the following: Evaluating processes and procedures to ensure adequate controls are included Monitor compliance requirements specific to risk adjustment operations Conduct audits to ensure controls and processes are being executed with minimal risk Conduct risk assessments, as necessary, to identify current gaps in processes Collaborate with business area associates to develop remediation plans to close gaps Collaborate with business area teams and compliance partners to consult on initiatives and drive process excellence Develop annual work plan for responsible areas Understand and assist in financial control assessment and work collaboratively with internal and external auditors Evaluate Provider Data Validation, Provider Reporting, Quality Audit, and core risk adjustment operational business areas monthly progress against goals Track and report on project status Use your skills to make an impact Required Qualifications 3 or more years of project leadership experience 2+ year of audit, compliance, and/or risk experience Must be passionate about contributing to an organization focused on continuously improving consumer experiences Strong relationship building skills Ability to take the initiative Ability to manage multiple initiatives at a time and ensure progress is moving forward Preferred Qualifications Applicable Bachelor's degree - Accounting, Finance, Business, Auditing, Actuarial Certified Internal Auditor, CPA or CPC strongly preferred Risk Adjustment knowledge Experience with risk adjustment provider data and reporting Auditing experience Familiarity with CMS Reimbursement models and claims/encounter submission processes Data analysis and dashboarding experience People leadership experience Additional Information Location: Nationwide (U.S.); however, candidates located in the Eastern Standard Time (EST) Zone are strongly preferred to support alignment with team schedules and collaboration. Work-At-Home Requirements: WAH requirements: Must have the ability to provide a high‑speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Interview Format: As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision‑making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $104,000 - $143,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short‑term and long‑term disability, life insurance and many other opportunities. Application Deadline: 01-23-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our *************************************************************************** #J-18808-Ljbffr

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

Opportunities with Surest, a UnitedHealthcare Company (formerly Bind). We provide a new approach to health benefits designed to make it easier and more affordable for people to access health care services. Our innovative company is part tech start-up, part ground-breaking service delivery-changing the way benefits serve customers and consumers to deliver meaningful results and better outcomes (and we have just begun). We understand our members and employers alike desire a user-friendly, intuitive experience that puts people in control when it comes to the choices they make and the costs they pay for medical care. At Surest, we pride ourselves in our ability to make a difference, and with the backing of our parent company, UnitedHealthcare, we can operate in the best of both worlds-the culture and pace of an innovative start-up with big company support and stability. Come join the Surest team and discover the meaning behind Caring. Connecting. Growing together. Surest is transforming the way people experience health benefits by offering a smarter, simpler, and more transparent health plan. We empower individuals to make informed care decisions while helping employers manage costs and improve outcomes. As part of our growing team, you'll play a key role in driving adoption and expanding our impact across markets. The Surest AE is responsible for supporting both reactive and proactive sales efforts across local markets. This role serves as a subject matter expert (SME) on Surest products and capabilities, helping to position Surest effectively in competitive opportunities and drive pipeline growth. The ideal candidate will be a dynamic communicator, strategic thinker, and collaborative partner across internal and external stakeholders. If you are located in California, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Reactive Sales Activities Represent Surest as a product SME in "Know Us" meetings, finalist presentations, and broker events Deliver compelling product descriptions and demos tailored to client needs Support RFP responses, including plan positioning, pharmacy and clinical capabilities, exception requests, and product options Respond to ad hoc inquiries related to product functionality and search capabilities Assist in gathering client references and presale analytics to support sales efforts Proactive Pipeline Development Drive additional Surest opportunities through strategic outreach and relationship-building Promote and schedule "Know Us" meetings to educate prospects and deepen engagement Leverage Highspot and other marketing tools to support prospecting and lead generation Collaborate with internal teams to identify and pursue new business opportunities 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: 3+ years of experience in sales, account management, or business development within healthcare or benefits 3+ years of presentation and communication skills, with the ability to tailor messaging to diverse audiences 3+ years of experience supporting RFPs and navigating complex sales cycles Ability to travel 50% in the state of California and neighboring states Located in the state of California or able to relocate Driver's License and access to a reliable transportation Preferred Qualification: Familiarity with digital sales enablement platforms (e.g., Highspot) Ability to work cross-functionally with product, clinical, and underwriting teams Self-starter with a proactive mindset and solid organizational skills *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 $60,000 to $130,000 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. 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.

Become a part of our caring community and help us put health first The Director, Workforce Capacity Planning is responsible for setting and executing CenterWell's workforce capacity strategy across CenterWell Call Centers, Pharmacy operations, Primary Care Clinics, and Home Health services. This position will integrate advanced and predictive analysis, people metrics and reporting to develop strategic and operational insights for workforce decision‑making. The Director, Workforce Management requires an in‑depth understanding of how organization capabilities interrelate across the function or segment. The Director Operating as a strategic partner to Operations, Finance, Clinical Leadership, Product, and Technology, the Director provides clear, data‑driven recommendations to senior leadership, enables disciplined planning and governance, and builds scalable capabilities that support CenterWell's long‑term growth and transformation. The Director, Workforce Management assesses organizational staffing and identifies requirements and solutions to meet workforce objectives. Enterprise Capacity Strategy & Planning The Director owns the end‑to‑end workforce capacity planning framework for CenterWell. This includes developing short‑term, annual, and multi‑year capacity plans that align demand forecasts, productivity assumptions, staffing models, and financial targets across all supported lines of business. The role ensures capacity strategies are forward‑looking, scenario‑based, and aligned to evolving care models, regulatory requirements, and growth initiatives. Demand Forecasting & Scenario Modeling This leader establishes and governs enterprise forecasting methodologies, ensuring consistency, rigor, and transparency across call center, pharmacy, clinical, and home health environments. The role leads scenario planning to assess risks and tradeoffs related to volume volatility, labor availability, productivity changes, technology adoption, and policy or market shifts. Insights are translated into actionable options for executive decision‑making. Financial Partnership & Investment Decisions The Director partners closely with Finance to support budgeting, re‑forecasting, and long‑range planning processes. This includes headcount planning, labor cost modeling, productivity targets, and return‑on‑investment analysis. The role clearly articulates the financial and operational implications of capacity decisions and provides recommendations that balance affordability with service and access commitments. Cross‑Functional Leadership & Influence Success in this role requires strong influence across a matrixed organization. The Director works in close partnership with Operations, Clinical Leaders, Workforce Management, HR, Product, and Technology teams to ensure capacity plans are executable and integrated with hiring, scheduling, training, and system roadmaps. The role aligns stakeholders around a single, enterprise capacity narrative and resolves competing priorities through data and structured decision frameworks. Governance The Director establishes a disciplined governance model for capacity planning, including standard assumptions, review cadences, escalation paths, and executive forums. The role ensures leadership has clear visibility into capacity risks, constraints, and performance, and that plans are regularly reviewed, refined, and aligned to business outcomes. Team Leadership & Capability Development The Director builds, leads, and develops a high‑performing workforce capacity planning team. This includes defining clear roles and expectations, strengthening analytical and business acumen, and standardizing tools, models, and processes. The role fosters a culture of accountability, continuous improvement, and intellectual curiosity. Communication A critical component of the role is translating complex analyses into clear, concise executive communications. The Director prepares and delivers materials that enable senior leaders to quickly understand capacity drivers, risks, and options, supporting timely and informed decisions. Communication is tailored for executive, operational, and clinical audiences. Outcomes & Measures of Success Success is measured by the accuracy and usability of capacity plans, improved alignment between demand and staffing, reduced operational volatility, stronger financial predictability, and leadership confidence in capacity insights. Over time, the role enables CenterWell to scale efficiently while maintaining high standards of access, quality, and member experience. Use your skills to make an impact Required Qualifications Bachelor's Degree 8 or more years of Workforce Management experience 5 or more years of management experience Comprehensive knowledge of Microsoft Word, Excel and PowerPoint Excellent written and oral communication skills Advanced forecasting and modeling techniques Strong analysis, critical thinking, and analytical problem solving skills Ability to handle multiple tasks and deadlines with attention to detail Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Advanced Degree Prior experience in Process or Project Management Additional Information: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision‑making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Work at home requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self‑provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi‑weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. SSN Alert: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $168,000 - $231,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short‑term and long‑term disability, life insurance and many other opportunities. Application Deadline: 01-22-2026 About us About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over‑the‑counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior‑focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole‑person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry‑leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well‑being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options ************************************************************* #J-18808-Ljbffr

A healthcare services provider is seeking an Actuary for Analytics/Forecasting to join their Financial Planning team. This role involves analyzing financial data, collaborating with stakeholders, and providing strategic insights to support business decisions. Candidates should possess a Bachelor's degree, FSA or ASA certification, and strong communication skills. The position offers remote work flexibility with occasional office travel required. A competitive compensation package and benefits are provided. #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 You never thought your career could help millions of lives. Well, here you can. As a Community Outreach Eligibility Specialist, you'll utilize innovative strategies and programs to ensure access to health care coverage for the underserved and impact millions of lives. You'll use your energetic, empathetic approach to marketing and add value to our team. Through community marketing and outreach efforts, you will have direct impact on membership growth and retention. You'll use your creativity, strategic lens and outspoken attitude to be part of an elite team to rewrite the history of UnitedHealth Group. If you are located in Boston, MA, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Maintain detailed knowledge of State and Federal insurance programs and effectively utilize such programs to insure all eligible are enrolled in appropriate MassHealth programs Maintain detailed knowledge of MassHealth and attend all required MassHealth training forum meetings Assist in eligibility determination and completion of MassHealth applications Monitor, analyze and investigate pending applications and follow up as necessary Interview all prospects/members and authorized representatives to screen for eligibility and obtain vital information for the purpose of completing and submitting MassHealth applications Work with individual and/or family to obtain all required documentation for the completion of MassHealth application Maintain proper documentation of all consumer interactions Assist existing members with MassHealth Renewal process Support the Sales/Marketing team by facilitating MassHealth applications for purpose of enrollment Support existing COR team by conducting community events when needed Establish and maintain internal and external relationships by leveraging the MassHealth Eligibility program Conduct educational presentations to community organizations Meeting or exceeding targeted growth, retention, and enrollment expectations Provide explanations and interpretations within area of expertise Share our mission to help people live healthier lives, throughout the communities we service 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: To be considered for this position, applicants need to meet the qualifications listed in this posting Ability to obtain Health/Accident Insurance License within first 60 days of employment Basic knowledge of MassHealth/Medicare Ability to work flexible hours as needed Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area Ability to travel up to 75% of the time (local domestic travel within the community) Preferred Qualifications: Experience completing MassHealth Applications Community Outreach experience within Healthcare Bilingual in English/Spanish *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 $28.94 to $51.63 per hour 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 organization is seeking a Market Vice President of Pharmacy Professional Practice to oversee pharmacy compliance across various settings. This role requires a Bachelor's degree in Pharmacy and at least 5 years of relevant experience. The candidate will ensure regulatory compliance and lead a high-performing team. Candidates should possess extensive pharmacy knowledge and significant management experience. This position offers competitive compensation and requires occasional travel for meetings and training. #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

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 The Member and Administrative Operations Leader is responsible for overseeing all elements of the Health Plan member experience along with assigned administrative functions including policies and procures, audit readiness, contract compliance and business continuity. While the role will give preference to candidates living in Washington and familiar with Washington Medicaid programs, this is not a requirement. This position will require limited travel to Washington (10%). You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Washington preferred. 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: Member Operations Leadership: Lead a team of professionals primarily focused on member and provider materials Create and execute the member experience strategy. This includes maintaining awareness of current member sentiment, creating strategies to improve experience within budget limitations, collaborating across the health plan and UHG enterprise to execute that strategy, and monitoring outcomes to adjust future iterations of the plan Maintain situational awareness of local market factors that may impact members and create and implement member engagement strategies to address Responsible for state required reporting on a monthly, quarterly and annual basis Create new solutions to address difficult and long-standing challenges in improving health care outcomes including development and oversight of value added benefits Oversee value added benefits (VABs) for Washington Medicaid. Maintain awareness of market dynamics and member needs. Understand and communicate strategic advantage of VABs. Advocate to leadership for VABs. Partner with national procurement teams to implement VABs. Track utilization of VABs Set priorities to ensure task completion and performance goals are met for Enrollment Services Oversee member call center functions and member materials creation and execution, including member handbook, ID card, welcome kit materials and member website Communicate any observed enrollment issues to Washington Health Care Authority (HCA) state partners and ensure the adoption of policies, processes and best practices required for success Partner with UHC policy team to create member experience and enrollment advocacy strategy. Represent that strategy directly to HCA and equip other Health Plan leaders to do so Maintain awareness of all contract elements related to member experience and create and execute business plans to manage those requirements Responsible for all elements of member materials, including creation, HCA approval, and publication. Responsible for selected provider materials, including, but not limited to Provider Manuals Administrative Operations Leadership: Oversee Health Plan Policy and Procedure committee and process Represent Health Plan in regulatory audits for assigned business areas Partner with enterprise resiliency team to oversee Health Plan Business Continuity requirements, including simulation facilitation, recovery team contact testing, and completion of related HCA reports Partner with Compliance Officer and COPA Director to lead Health Plan leaders in the creation and maintenance of contract compliance business plans 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: 5+ years of Medicaid experience 3+ years project management or strategy development and execution 2+ years representing Health Plan to regulators, such as HCA or other Medicaid agencies 1+ years of supervisory/leadership experience with direct responsibility for managing performance of employees Proficiency with MS Office, which includes the ability to navigate and learn new and complex computer system applications Solid history of quickly gaining credibility, partnering with business leaders and exhibiting executive presence Proven ability to articulate business strategies and formulate concise solutions to complex problems Ability to travel to Washington periodically (no more than 4 times annually) Preferred Qualification: Resident of Washington and familiarity with Washington Medicaid *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 $89,900 to $160,600 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 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

A leading health insurance provider in Boston is looking for a Lead Experience Researcher to drive high-impact experiences by blending qualitative and quantitative research. This role will lead research engagements, partner with cross-functional teams, and provide insights to shape product design. Candidates should have a strong background in experience research methods, strategic problem-solving, and human-centered design. Competitive pay range is between $138,900 and $191,000 annually, plus benefits. #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. There are changes happening in health care that go beyond the basics we hear in the news. People like you and organizations like UnitedHealth Group are driving ever higher levels of sophistication in how provider networks are formed and operate. The goal is to improve quality of service while exploring new ways to manage costs. Here's where you come in. You'll use your solid customer service orientation and knowledge of insurance claims to serve as an advocate for providers in our networks. 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. If you are in the State of Kansas or within 50 miles of the border, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Assist in end-to-end provider claims processing and resolution Assist in efforts to enhance ease of use of physician portal and future services enhancements Assist in identifying gaps in network composition and services to support network contracting and development teams Use pertinent data and facts to identify and solve a range of problems within area of expertise Investigate non-standard requests and problems, with some assistance from others Work exclusively within a specific knowledge area Prioritize and organize own work to meet deadlines Provide explanations and information to others on topics within area of expertise. Use pertinent data and facts to identify and solve a range of problems within area of expertise Investigate non-standard requests and problems, with some assistance from others Work exclusively within a specific knowledge area Provide explanations and information to others on topics within area of expertise. Analyzes and investigates claim issues Responsible for training providers on a variety of topics in both small and large settings 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: 2+ years of experience working with Medical Providers 1+ years of experience with Medicaid Regulations 1+ years of experience in providing training or education 1+ years of medical insurance claims/billing experience Willingness and ability to speak and meet with Providers directly on a variety of topics Demonstrated excellent written and oral communication skills Ability to work independently and remain on task with little to no day to day supervision Demonstrated good organization, planning skills Ability to prioritize and meet deadlines from multi staff members through the department Intermediate level of proficiency in claims processing and issue resolution Exceptional presentation, written and verbal communication skills Intermediate level of proficiency with MS Word, Excel, PowerPoint and Access Driver's license and access to reliable transportation Ability to travel on up to 25% of the time within the State of KS Preferred Qualifications: 2+ years of provider relations and / or provider network experience 2+ years of experience of Medicaid experience 1+ years of KS Medicaid and Kansas Billing requirements Previous experience with CSP Facets Intermediate level knowledge MS Word, Excel, PowerPoint Intermediate level of claims processing and issue resolution *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 $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. 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 insurance provider is seeking an Actuary for their Financial Planning & Analysis team in Juneau, Alaska. This role involves analyzing and forecasting financial data, ensuring data integrity, and supporting business intelligence efforts. Candidates should hold a Bachelor's Degree, preferably have FSA or ASA designations, and possess strong communication skills. This position provides flexibility and opportunities for career advancement, along with competitive pay and benefits. #J-18808-Ljbffr

A leading healthcare company seeks a Market Vice President of Pharmacy Professional Practice to ensure compliance with pharmacy regulations across various locations. This role requires a licensed pharmacist with over 5 years of leadership experience in pharmacy compliance environments. Responsibilities include overseeing regulatory compliance, providing strategic guidance, and leading a high-performing team in a remote work setting. This position allows travel as needed, with competitive compensation and benefits. #J-18808-Ljbffr

A leading health services company is seeking a Risk Management Lead responsible for oversight of risk adjustment operations. The role includes advising on risk management strategies, compliance, and project management. The ideal candidate should have significant experience in project leadership and risk analysis, with a passion for enhancing consumer experiences. This remote position requires strong initiative and the ability to manage multiple projects simultaneously. Interested candidates are encouraged to apply for a rewarding opportunity focused on health improvement. #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

A leading healthcare provider in Hawaii seeks an Actuary Analytics/Forecasting professional. The role involves analyzing and forecasting financial data to support strategic decisions. Ideal candidates will hold relevant degrees and possess strong communication skills with experience in modeling and pricing. This remote position offers a competitive salary range between $129,300 and $177,800, along with comprehensive benefits and a bonus incentive plan. #J-18808-Ljbffr