Provide strategic management oversight in designing, implementing, directing, and monitoring the Alliance’s Risk Adjustment Department functions.
Direct the Risk Adjustment Department, act as a subject matter expert, and provide executive-level advice and guidance on coding and risk adjustment methodologies and overall business operations.
Direct, manage, and supervise Risk Adjustment Department staff
Central California Alliance for Health is a regional non-profit health plan. They are committed to providing accessible, quality health care guided by local innovation, with over 500 dedicated employees and a culture that is respectful, diverse, professional and fun.
Own the multi‑year Member Care staffing strategy across channels and roles.
Oversee the management of BPO relationships and ensure BPO partners are trained.
Lead, coach, and develop a high‑performing team of individual contributors and people-managers.
Included Health is a healthcare company that delivers virtual care and navigation. They are on a mission to raise the standard of healthcare for everyone and break down barriers to provide high-quality care for every person in every community.
Supervise day-to-day operations of assigned Utilization Management staff.
Provide full people management for assigned Utilization Management teams, including hiring and performance management.
Drive team performance against key metrics, including engagement, productivity, and quality scores.
Personify Health has created a personalized health platform, bringing health plan administration, wellbeing solutions, and care navigation together. Their data-driven solutions aim to reduce costs while improving health outcomes, empowering people to lead healthier lives.
Responsible for the performance, scalability, and continuous improvement of enterprise clinical programs.
Translate clinical strategy into scalable operating models, workflows, technology requirements, and performance management systems.
Improve outcomes, reduce total cost of care, strengthen care coordination, and ensure patients receive the right care at the right time.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach. They are committed to improving patient outcomes and quality of life. They listen to the needs of their patients, employees and client partners.
Lead and inspire a team of Patient Support Specialists.
Establish and refine team KPIs related to outreach volume and scheduling conversions.
Partner with clinical, engagement, and product teams.
Zócalo Health is the first tech-driven provider built specifically for Latinos, by Latinos. They are developing a new approach to care that is designed around shared and lived experiences and brings care to the community. The company was founded in 2021 and is backed by leading healthcare and social impact investors.
Leads a team of clinicians and serves as a senior clinical owner for care delivery workflows.
Provides clinical support for program development and customer-facing clinical work.
Partners closely with Operations, Product, Member Success, Clinical Outcomes, Legal, Commercial, Customer Success, Solutions Consulting, and Marketing.
Carrot is a global, comprehensive fertility and family care platform, supporting members and their families through many of life's most memorable moments. Its award-winning products serve all populations, from preconception care through pregnancy, IVF, male factor infertility, adoption, gestational carrier care, and menopause.
Lead process improvement initiatives to increase compliance, efficiency, and quality assurance.
Manage projects, gather requirements, build timelines, and drive completion of improvement initiatives.
Create and maintain client- and member-facing marketing materials.
VytlOne is the nation’s only independent, fully integrated total pharmacy solutions partner. They have over 1,600 passionate professionals across nearly every U.S. state, and they operate as One Team, united by a bold mission and a spirit of innovation.
Define, maintain, and execute the product and solution roadmap, balancing long-term vision with near-term priorities.
Actively identify and adopt new and emerging technologies that improve product outcomes.
Lead product planning activities and facilitate product forums to ensure timely, high-quality delivery.
Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems. With a focus on empowering people, Ensemble fosters collaboration, growth, and innovation, creating a culture where associates can thrive and deliver exceptional service.
Oversee the Care Navigation program, ensuring efficient operation and successful implementation of new programs.
Manage relationships with health plan partners and oversee internal policies and procedures for care navigation activities.
Provide telephonic care navigation services to individuals receiving services through various programs as needed.
Mom's Meals is a provider of home-delivered meals. They focus on delivering medically tailored meals to individuals with chronic health conditions. The company values its team members and strives to show it through benefits and other offerings.
Own the full lifecycle of associate therapists at Mood Health.
Ensure associate clinicians deliver safe, high-quality care and are fully compliant.
Design a structured, supportive associate journey and address early signs of burnout.
Mood Health aims to change how people access mental healthcare. They match each client with the right clinician, delivering therapy and medication management from home with expert clinicians. They are an equal opportunity employer committed to fair hiring practices, fostering an inclusive, respectful culture.
Management and oversight of a quality team conducting quality assurance activities.
Responsible for the successful execution of the Quality Improvement Program in accordance with CMS requirements.
Plans, organizes, and directs activities of Clinical Quality, including planning, training, and staff development.
HealthEdge is committed to workforce diversity and actively encourages all qualified persons to seek employment. They provide effective and efficient solutions to complex business problems.
Owns the design, evolution, and execution of the AI forward Care Teams Management System, to ensure Care Teams verticals operate as a single, integrated system.
Accountable for operational performance, efficiency, quality, and outcomes for the Care Teams Management System and its horizontal functions.
Foster a culture of continuous improvement across Care Teams by building engagement, shared ownership, and passion for better ways of working.
Omada Health is reverse engineering healthcare to deliver personalized care at scale, supporting chronic conditions outside of doctor visits. The company has served over two million members across 2,000+ employers, health plans, and health systems, and is certified as a Great Place to Work, striving for an inclusive culture.
Provides leadership and supervision to Revenue Recovery products under the Denials umbrella.
Leads dedicated product and service teams across Revenue Integrity to deliver best-in-class results to clients.
Develops and supports leadership within the department, while driving operational performance and client satisfaction.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM ™ intelligent automation platform to improve financial sustainability. The company has been recognized as a top workplace and is among the top one percent of companies to make the Inc. 5000 list for the last eleven years.
Plan and execute ongoing strategic initiatives and planning for all practices.
Monitor practice performance; review and approve monthly financials.
Integrated Dermatology is a leading national dermatology practice that acquires and partners with dermatology practices across the United States. Their environment is filled with hard-working, dynamic individuals who come together to ensure the success of their partner dermatologists.
Define and execute the strategic vision, operating model, goals, and long-term roadmap for the Client Management organization.
Serve as executive sponsor and strategic leader for key client, broker, and consultant relationships.
Represent the voice of the client within executive leadership discussions and influence organizational priorities, service models, and business decisions.
AffirmedRx aims to improve healthcare outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. They are committed to making pharmacy benefits easy to understand, straightforward to access, and always in the best interest of employers.
Oversee, manage, and continue to iterate on end-to-end delivery of Devoted’s card-based and supplemental benefit offerings to drive a compliant and financially optimal member experience.
Set and monitor KPIs for card-based and supplemental benefit administration and delivery.
Partner cross-functionally with Devoted Member Experience, Guide, Integration Ops, and tech teams to drive improvement.
Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. Founded in 2017, they've grown fast and now serve members across the United States.
Provide executive oversight of all clinical programs, including Behavioral Health and EAP services, establishing strategic direction and quality frameworks.
Lead and supervise AVP-level clinical leaders, ensuring accountability and cross-functional alignment across clinical operations.
Develop clinical strategies, policies, and procedures, oversee utilization management, and drive quality improvement initiatives.
Uprise Health transforms the delivery and accessibility of mental and behavioral healthcare, bringing whole person care to individuals worldwide. The company values compassion, integrity, collaboration, velocity, and advocacy, and seeks to foster a culture of care and support.
Lead end-to-end revenue cycle strategy and operations.
Improve billing, denial management, AR performance, and collections.
Scale systems and processes to support company growth.
SOL Mental Health is dedicated to shaping the future of behavioral healthcare. We are a fast-growing, mission-driven organization focused on improving patient access and operational excellence, fostering a workplace where everyone feels valued and empowered.
Serve as the primary partner for ACOs and Medicare Supplement carriers partnering with Ceresti.
Ceresti Health pioneers a technology-enabled program centered around family caregivers in dementia care and is selected by CMS to participate in the GUIDE Model. They aim to transform dementia care nationwide, with a focus on activating family caregivers by providing them with the knowledge, skills, and confidence to detect early changes in their loved one's condition.
Serve as the Contractor's primary lead for all assigned HEFP portfolio program areas.
Supervise and mentor contractor personnel across assigned programs.
Lead senior management briefings and executive-level communications for VA leadership.
Aptive partners with federal agencies to achieve their missions through improved performance, streamlined operations and enhanced service delivery. Based in Alexandria, Virginia, they support more than a dozen agencies including Veterans Affairs, Transportation, Defense, Homeland Security and the National Science Foundation.