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Supports the direction and coordination of medical affairs to include quality management, utilization management, case management, and preventive health services. Provides direct assistance to the Medical Director. Requires a medical degree from an accredited medical school and a license to practice. Experience in a managed health plan is typically desired.: Reviews and makes determinations on all questionable physician review decisions. Assists in the development of clinical practice guidelines or case management guidelines. Participates in the review and approval of inter-rater reliability monitoring. Provides medical input into the development of preventive health, quality improvement, and utilization management activities. Assists with the analysis of provider profiles to identify areas for improvement. Serves as an interface in professional or institutional matters between the plan and its providers. May conduct provider profile consultation visits.

Associate Case Manager

Plans, directs, implements, and evaluates appropriate healthcare services, under direct supervision, in conjunction with Physician's treatment plan to ensure that cost effective, quality care is provided. Typically requires licensure as a Registered Nurse or LPN with at least two year of relevant nursing experience. : Coordinates cases that normally include prospective and retrospective review and prior authorization, determining the appropriate level of care and utilization of services, concurrent review, retrospective review, developing discharge plans, and ensuring quality cost effectiveness. Develops a plan of care for patients from admission to discharge. Monitors patient progress toward desired outcomes through assessments and evaluations. Analyzes referred cases for potential case management interventions. Evaluates the effectiveness of alternate care services and ensures that cost effective, quality care is maintained to meet case management objectives. Determines if proposed medical treatment plans meet contract provisions. May arrange referrals, consultations, therapeutic services, and confer with other specialist on course of care and treatment.

Pharmacy Associate

Assists Pharmacists in filling orders, checking prices, and stocking shelves in a retail pharmacy establishment. Serves customers at a pharmacy counter and processes purchases. Typically requires on-the-job training.: Takes customer orders, delivers customer orders, computes charges, handles payment, and enters data in computer. Cleans equipment and sterilizes glassware according to prescribed methods. Types and files reports and completes forms as directed. Assists in receiving and storing supplies, stocking shelves, checking prices, and maintaining inventory.

Account Installation Specialist Associate

Administers the installation of assigned accounts under general direction including, but not limited to, structure and billing setup, eligibility collection, database loading, and preparation of plan materials, such as administrative documents and customer education materials.: Provides support to assigned accounts by responding to inquiries and resolving issues of concern. May provide guidance or expertise to less experienced representatives.

Credentialing Associate

Provides technical and clerical assistance to facilitate effective and efficient operation of the provider credentialing function.: Coordinates and performs enrollment of assigned providers and physicians in appropriate health plans to ensure satisfaction of the health plan requirement for acceptance. Reviews and processes provider applications and determines eligibility by applying NCQA, JCAHO and URAC standards as related to the network. Performs primary source verification for initial and re-credentialing of assigned providers utilizing NCQA and other federal and state regulatory requirements. Analyzes and resolves basic provider issues relative to credentialing, enrollment, billing and payers. Communicates with providers regarding credentialing status and information. Creates and maintains participating provider or practitioner credentialing files. Reviews and analyzes provider file changes. Creates practitioner profiles for re-credentialed practitioners. Prepares and sends application packets to participating providers and facility applicants, requesting the return of basic credentialing information. Reviews applications for completeness and assists the applicant in completing the application. Prepares routine credentialing reports. This position typically requires a experience sufficient to provide a working knowledge of NCQA and JCAHO.

Associate Professor

Conducts college or university courses for undergraduate or graduate students, with faculty rank lower than that of professor in traditional hierarchy as determined by institution's estimate of scholarly maturity. Teaches one or more subjects, such as economics, chemistry, law, or medicine, within a prescribed curriculum. Prepares and delivers lectures to students.: Compiles bibliographies of specialized materials for outside reading assignments. Stimulates class discussions. Compiles, administers, and grades examinations, or assigns this work to others. Directs research of other teachers or graduate students working for advanced academic degrees. Conducts research in particular field of knowledge and publishes findings in professional journals. Performs related duties, such as advising students on academic and vocational curricula and acting as adviser to student organizations. Serves on faculty committee providing professional consulting services to government and industry.

Associate General Counsel

Provides general legal support and advice for a corporation, as directed by the General Counsel, through timely responses to inquiries and requests. Negotiates agreements with key strategic partners. Serves as a subject matter expert to the Law Department, Compliance, Government Relations, and other business units.: Negotiates contracts and performs legal analysis and drafting. Advises and counsels senior business clients in connection with sales practice issues and other issues. Reviews applicable statutes and regulations. Assists with the preparation of responses to various regulatory inquiries. Supervises and manages regulatory examinations conducted by external agencies. Prepares and reviews registration statements of business development companies. May manage and obtain licenses in various states. May collaborate with business partners on healthcare insurance issues and healthcare regulatory issues. May prepare and report corporate information to the SEC. May collaborate with a team of legal professionals.

Health Data Analyst Associate

Develops and maintains clinical software applications. Designs, produces, and analyzes health data reports. This position is an entry-level analyst position but typically requires a college degree and familiarity with computer information systems.: Analyzes, develops, and maintains computer applications, procedures, and other systems that satisfy the needs of the clinical user departments. Assists in developing design work, including testing and documentation. Designs, produces, and analyzes specific health care reports. Reviews, evaluates, and implements requests from clinical user departments. Assists in monitoring computer applications to ensure proper use and security. Analyzes problems, determines causes, and initiates corrective action. Assists in the development of clear and concise documentation and instruction manuals. Coordinates and installs new software applications with user departments. Maintains a high level of interaction with all clinical areas to continually enhance and improve patient care.

Research Associate

Plans, organizes, and conducts research in variety of areas, such as new or existing products, science, social science, law, or medicine. Analyzes verbal or statistical data to prepare reports and studies for use by professional workers. A combination of over one year of directly related training and/or experience is required for carrying out the responsibilities for this job.: Develops plans for project or studies guidelines for project prepared by professional staff member to outline research and/or development procedures to be followed. Plans schedule according to variety of methods to be used, availability and quantity of resources, and number of subordinate personnel assigned to participate in project. Searches sources, such as reference works, literature, documents, newspapers, statistical records, and other sources of information, to collect, record, analyze, and evaluate facts. Analyzes and evaluates applicability of collected data. Discusses findings with other personnel to evaluate validity of findings. Prepares reports and/or designs and specifications of completed projects. Prepares statistical tabulations. Writes reports or presents data in formats such as abstracts, bibliographies, graphs, or maps. May prepare for publication in technical journals, for presentation to organization requesting project, or for use in further applied or theoretical research activities. May interview individuals to obtain data or draft correspondence to answer inquiries.

Cashier Associate

Receives cash, personal check, or charge or debit card for payment of food, rent, property, deposits, fees, accounts receivable, or other goods and services. Operates cash register, scanners, and computers to itemize and total customer's purchases.: Records prices, subtotals taxable items, and totals purchases on cash register. Collects cash, check, or charge payment from customer and makes change for cash transactions. Checks identification when required by transaction. Checks and verifies to note price changes. Counts money in cash drawer at beginning and end of work shift. Ensures accuracy of collection and disbursement of funds. May open and close cashier window. May record daily transaction amounts from cash register to balance cash drawer. May cash checks. May use electronic scanner to record price. May collect and issue refunds.

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