Identify opportunities to reduce medical expenses and collaborate with other areas to implement and monitor performance. Develop studies, analyses, and presentation materials needed to appropriately inform decision makers. Complete pricing analysis, experience analysis and studies, financial projections, and other actuarial/financial calculations. Run, modify, and create

Identify opportunities to reduce medical expenses and collaborate with other areas to implement and monitor performance. Participate in product development, pricing, filing, and rating implementation of new products and strategies. Develop studies, analyses, and presentation materials needed to appropriately inform decision makers. Answer questions of less experienced sta

of Job Manage the day to day sales activities of the Direct to Consumer and Individual markets (Medicaid, Child Health Plus, The Essential Plan and QHP) and implement any strategic or tactical plans. Work closely with the Regional Sales Leader, Government Assisted Program (GAP), Enrollment and Customer Service to ensure high levels of service and responsiveness. Responsibi

of Job Responsible for implementing end to end campaign creation, execution, delivery and measurement, primarily leveraging Salesforce Marketing Cloud email/journeys, Adobe Campaign, Adobe Experience Manager (CMS), and Adobe Analytics. Participate in the creation of SFMC campaign journey/workflow design, to execute email campaign activation and delivery. Develop automated

of Position Serve as the key operational liaison with Provider Network Management and Finance responsible for the reconciliation, reprocessing/recoupment and provider communication for claim payment integrity challenges. Oversee contract review; ensure that contract provisions are in alignment with corporate goals. Develop and implement dashboards to monitor performance. D

of Position We are seeking a dynamic Contract Specialist who will be responsible for loading all Professional, Facility, and Ancillary contracts across all EmblemHealth lines of business in a timely and accurate manner. This individual will provide subject matter expertise in all areas of contract configuration, fee schedules/groupers, and rate reimbursement. The Contract

of Job Ideate, develop, and deliver formal and informal training for the new hire and current sales employees. Coach and mentor staff to meet sales and retention goals. Collaborate on development of production reports/metrics; analyze production reports and adjust coaching and training as necessary and present the findings to leadership. Responsibilities Lead, develop, and

of Job Identify opportunities to improve efficiency; lead small to mid size projects; assist other project managers on larger, more complex projects related to operational business functions that affect team members and providers at the market level. Utilize critical reporting and data analysis to support broker performance and training. Provide support and issue resolutio

Participates and supports the health team in direct patient care. Performs duties involving direct patient care as assigned by the physician within the framework of the New York State Nurse Practice Act and AdvantageCare Physicians' policies and procedures. Identifies physical, behavioral, and emotional characteristics typical for the age group of the patient receiving ca

of Position Assist the Manager, Nursing in the management and education of care team members providing professional nursing care to patients. Proactively support efforts to ensure that standards for quality of care, patient satisfaction, and patient safety are maintained, as established by AdvantageCare Physicians including best practices, regulatory requirements, and clin

of Position Provide professional nursing care to patients and proactively support efforts to ensure that standards for patient satisfaction, patient safety, and quality of care are maintained, as established by AdvantageCare Physicians. Primary liaison between patients, staff and physicians and support the Advanced Care Model. Organize and provide clinical supervision to t

We are seeking an Internal Medicine or Family Medicine trained physician to join us in pursuit of high quality patient care to provide a full scope of primary care services including but not limited to diagnosis, treatment, coordination of care, preventive care and health maintenance. Responsibilities Review patient's history and perform physical examinations. Evaluate, d

of Position Provide professional nursing care to patients and proactively support efforts to ensure that standards for patient satisfaction, patient safety, and quality of care are maintained, as established by AdvantageCare Physicians. Primary liaison between patients, staff and physicians and support the Advanced Care Model. Organize and provide clinical supervision to t

We are seeking a Family or Internal Medicine trained physician to join us in pursuit of high quality patient care. Responsibilities Provide a full scope of primary care services including but not limited to diagnosis, treatment, coordination of care, preventive care and health maintenance. Review patient's history and perform physical examinations. Evaluate, diagnose and

of Position Provide professional nursing care to patients and proactively support efforts to ensure that standards for patient satisfaction, patient safety, and quality of care are maintained, as established by AdvantageCare Physicians. Primary liaison between patients, staff and physicians and support the Advanced Care Model. Organize and provide clinical supervision to t