This position is responsible for implementing various initiatives that cross department lines in support of HCM's strategic goals and will interface with all levels of management to ensure that all objectives are met and initiatives are implemented. This position is also responsible for ensuring compliance with accrediting, state and federal guidelines as well as division

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

The Regulatory Compliance Associate is responsible for the identification and communication of new, revised, and pending federal and state laws, regulations, and standards relevant to a Horizon Lines of Business (LOB). This position administers and coordinates the functions associated with compliance and regulatory guidelines related to each market and will develop and ma

This position provides Rating & Underwriting services and support to the Sales team and is responsible for the production of rates for the 51+ markets. Develops and issues proposal rates for group size 51+ and experience rated proposals. Develops and issues experience rated renewals for group size 51+. Develops and issues renewal and proposal rates for alternately funded

This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care, as well as, planning for the transition to the continuum of care and developing a member centric plan of care. Primary Nurses will outreach to high risk members and will work to engage members in preventative care opportu

This position is responsible for the resolution of voucher billing, billing inquires, collection of delinquent premiums and preparation of accounting journal entries and schedules. The position is accountable to review account records (i.e. income schedules, write off, schedule checks), enroll transactions to ensure accuracy of billing, prepare journal entries to update G

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

This position is responsible for being the lead on site audits of hospital billing and coding practices and desk audits; forms development, profiling and tracking institutional audit trends. Designing audit protocols and special projects. Performs and finalizes multiple per diem, bill verification, DRG Validation (utilization review audits) and credit balance. Additionall

This position provides guidance and operational support to designated division(s) on the employee and labor relations function. Facilitates Human Resources initiatives and services to division(s) in support of divisional objectives and goals. Assists with the implementation of HR programs within division(s) to assure their success. Responds to employees and managers on HR

This position is responsible for maintaining individual account receivable including, but not limited to , the reconciliation of adjustments to accounts, billing records, co op billing, financial analysis investigation , calculations, and collection of delinquent accounts. This position is also responsible for analyzing unallocated cash and bank reconciliation in addition

This position reports to a director and is accountable for contributing to the efficiency of departmental operations through the performance of various administrative functions. Responsibilities Screen inquiries and memos for referral to appropriate areas within the division or company or organize such material for the director to expedite resolution. Provide the director

This position contributes to reporting and forecasting efforts through the research, analysis, design, programming, implementation and coordination of accurate and timely reporting systems for the division. Ensures integrity of databases and program files for departmental use via extensive division contact. Responsibilities Analyzes reporting needs, available data, and va

The ASO Accountant I is responsible for the preparation, analysis, and completion of Minimum Premium and Self Insured invoices. This also includes compiling claims and traditional bills on a daily, weekly and monthly basis. The role is responsible for managing high dollar accounts and high priority Groups. Job Responsibilities Maintain accurate accounting sub ledgers for

This position supports HR leadership and is accountable for contributing to the efficiency of departmental operations through the performance of various administrative functions. Responsibilities Screen inquiries and memos for referral to appropriate areas within the division or company or organize such material for the director to expedite resolution. Provide the directo

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. Responsibilities Assesses patient's clinical need against established guidelines and/or standards to ensure that the l