Work closely with cross functional teams and leadership to build consensus and successfully lead and support strategic planning and delivery for a variety of enterprise strategic initiatives, programs and events Collaborate with internal stakeholders, including C suite executives and matrixed business partners, to understand program and event requirements and goals in ord

Provide realistic cost and resource estimates for algorithms programming Conduct data extraction that may include analyzing, reviewing, trending and presenting information, based on provided specs, to support or refute hypotheses leading to the initial identification of heath care fraud & abuse Able to interpret and create requirements, functional specifications and techn

Develop, drive, and execute a product strategy with respect to value proposition, positioning, product portfolio(s), distribution, and product features/function Manage growth and retention; review product performance against expectations; formulate and recommend changes to achieve optimal performance, identify opportunities for growth and innovation Perform applicable fin

Oversees the strategic planning, budget and execution of all trade shows and industry events Support the team and partner across marketing and sales stakeholders by being the subject matter expert on trade shows, enabling capabilities, proactively meeting their needs, communicating effectively, and working to continuously improve systems, processes and outcomes Ensures ev

Utilize the Preferred One medical criteria and those of other regulatory bodies, (i.e. NCQA, DOH), the exempt and focused review programs, and the patient's benefit plan summary to perform medical necessity, level of service and appropriateness review Perform inpatient and outpatient pre admission, concurrent review and decision support based on medical necessity, appropr

Lead and coordinate client communications. Focusing on providing clear and effective solutions to technical questions, while ensuring customer satisfaction Liaise with our internal stakeholders (senior leadership, legal, privacy teams, technical product teams, sales teams) to help obtain appropriate approvals and drive critical decision making Execute creative problem sol

Build analytics tools that utilize data to provide actionable insights into customer acquisition, operational efficiency, and other key business performance metrics Build, maintain, and production support of analytics tools in Power BI Design, build, and launch efficient and reliable data pipelines in Azure Data Factory and Snowflake Extract, Transform, and Load data from

Provide coding quality auditing services to ensure compliance with Optum and CMS coding guidelines and accuracy of coding data reported Maintain compliance with Optum Coding Guidelines/policies. The minimum productivity goal is set by project, with minimum 96% coding accuracy rate required You'll be rewarded and recognized for your performance in an environment that will

This role will provide coding quality auditing services to ensure compliance with Optum and CMS coding guidelines and accuracy of coding data reported. Must maintain compliance with Optum Coding Guidelines/policies. The minimum productivity goal is set by project, with minimum 96% coding accuracy rate required. You'll be rewarded and recognized for your performance in an

Conduct issue resolution and provide live support for users within Optum Health credentialing teams on the credentialing software platform Manage and monitor internal ticketing process for user support and enhancement requests Engage with vendor to identify repetitive, high volume issues Work with the user population to identify usability enhancements and engage with vend

Serve as a member of the operations senior leadership team and advise executives on external trends, problems, and activities to facilitate both short and long range strategic plans to improve operational performance and enhance growth. Set the vision and strategic plan for OptumRx PBM operations & client services and support scaled operations through solid partnership ac

Twin Cities Orthopedics

Twin Cities Orthopedics

Designs, develops and implements policies and procedures. Measures and analyzes financial effectiveness of plans and programs; develops funding and expense projections. Works closely with team, vendors and internal resources to ensure efficient and compliant administration of benefit plans, programs and policies. Leads benefits related projects and manages plan vendors. Re

You will be part of the pricing team and work closely with other actuaries to improve the pricing and performance of our commercial and specialty products through rate revisions, factor reviews, and model updates. Your primary responsibility will be to provide rate filings to the Product Manager who is responsible for the performance of these states. You will report to the