This position supports the Clinical Operations functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators Responsibilities Performs review of service requests for completeness of information, collection and transfer of non clinical data, and acquisition of structured clinical data from physicians/pa

This position is responsible for performing behavioral health duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management. Responsibilities Assesses patient's behavioral health clinical need against established guidelines and/

Job Description Summary The Application Security Analyst II will partner with developers to conduct application security assessments. The individual will work closely with technical teams and analyze potential security impacts and pitfalls associated with threats and vulnerabilities to applications and systems. Candidate will advise developers, business owners and technic

This position is responsible for focusing stop loss risk management activities on the centralized stop loss team and coordinating risk oversight with care delivery related areas of the company. Assures care is coordinated across the company and throughout the care delivery system for high risk members of groups with stop loss coverage underwritten by the company. Uses est

This field based position is accountable for the assessment and case management of members to ensure facilitation of health care services. Responsibilities Assist with implementation and facilitation of services to members in the program. Collaborates with member/family, physician and all members of the healthcare team, internal and external to this organization. Coordina

Data analysts are experts with strong understanding of data structures and analysis. They are responsible for ensuring requirements around the accuracy, quality, completeness and timeliness of data are captured and understood. They work hand in hand with Data Modelers, Data Developers, Data Stewards and Business SMEs to ensure the customers data needs are accurately captu

The position is responsible for leading a specific clinical care team in a hands on manner to provide exceptional service to the customer and contain medical claims cost. This is accomplished through active involvement and leading of the day to day operations of a clinical care team and ensuring staff is consistent with Horizon's policies and procedures and are compliant

In partnership with business customers, creates technology and digital strategy for a single business application (software) product ensuring integration with Horizon's overall strategic plan. Maintains, plans and implements major modifications to a technology portfolio up to 35 applications in pursuit of IT and business goals. Accountable for exemplary quality, performan

This position supports the Clinical Operations functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators Responsibilities Performs review of service requests for completeness of information, collection and transfer of non clinical data, and acquisition of structured clinical data from physicians/pa

This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management. Serves as mentor/trainer to new RN's and other staff as needed. Subject matter expert for the various projects and com

Responsible for conducting research and root cause analysis for customers with the goal of recommending and implementing new processes and solutions to operational deficiencies. Resolves issues and improves operational performance on a cross functional/departmental basis. This is a senior level position working independently with guidance only in the most complex situatio

This position is responsible for receiving verbal and written request for prior authorization from pharmacists, physicians and/or patients and is responsible for supporting and assisting in the coordination of Pharmacy Services activities including claim utilization analysis, prescription plan design, ad hoc reporting, correspondence and special projects. Must maintain pe

This position is responsible for leading execution and implementation activities for specific projects within HNS. This role will facilitate the development, coordination, communication, and accomplishment of short and long term business and clinical initiatives. The incumbent will act as a liaison between the department and other constituencies, will communicate and lead

This field based position is responsible for performing assessments of members using established guidelines to ensure appropriate level of care and develop a member centric plan of care. Job Description Responsibilities Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members'

This field based position is responsible for performing assessments for PCA and MDC services using established guidelines and assessments to ensure appropriate level of care and services are authorized. Responsibilities Assesses patient's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members