76 language jobs found

Become a part of our caring community and help us put health first The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors. Earn a $5,000 hiring bonus! Bonus is paid after 180 days of employment; you must be employed until that date to be eligible to receive the payment." Location: Remote - United States Schedule: 8-hour shifts, Monday through Friday, between 10:30 AM and 11:00 PM EST OR 10-hour shifts, Tuesday through Friday, between 10:30 AM and 11:00 PM EST Required to work every 5th Saturday Required to work 1 company holiday...

Become a part of our caring community and help us put health first The Risk Management Professional 2 identifies and analyzes potential sources of loss to minimize risk. The Risk Management Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines and procedures. As a Risk Management Professional 2 - HCPR Compliance, you will work with HCPR Operations to ensure operational processes are complaint with appropriate regulations and report data that accurately reflects operations. In this role you will: In this role you will: Develop data universe generation guidelines (DUGG) for audit universes by interpreting protocols/guidance and reconciling it to processes/system logic Produce monthly...

Become a part of our caring community and help us put health first The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Behavioral Health Professional 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives,...

Become a part of our caring community and help us put health first The Project Management Lead manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Project Management Lead designs, communicates, and implements an operational plan for completing the project; monitors progress and performance against the project plan; takes action to resolve operational problems and minimize delays. Identifies, develops, and gathers the resources to complete the project. Prepares designs and work specifications; develops project schedules, budgets and forecasts; and selecting materials, equipment, project staff, and external contractors. Communicates with other operational areas in the organization to secure specialized resources and contributions for the project. Conducts meetings and prepare reports to communicate the...

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: The Coordinator, Intake Utilization Management at Evolent will serve as a point of contact for processing prior authorization requests in accordance with departmental policies,...

Become a part of our caring community and help us put health first The Director, Home Health Risk Management identifies and analyzes potential sources of risk, proactively ensuring controls and processes are in place to reduce risk. The Director, Home Health Risk Management requires an in-depth understanding of how organization capabilities interrelate across the Home Health segment. The Director of Risk Management for Home Health will be responsible for development and implementation of controls and cost-effective approaches to minimize risks to the organization as well as estimating the potential consequences of risks. Assesses and communicates information regarding business risks with functions across the organization. Their focus will be on CenterWell risk assessments, issue management, auditing and monitoring. Areas of oversight will include CenterWell Home Health, OneHome, as well as new growth initiatives. This role requires an in-depth understanding of Home Health...

Become a part of our caring community and help us put health first Encounter Data Management Professional is responsible for ensuring accurate submission and reconciliation of encounter data to Medicaid and Medicare through effective business processes. Ensures claims submissions meet or exceed all compliance standards via analysis of data and develops tools to enhance the encounter acceptance rate by Medicaid/Medicare. Looks for long-term improvements of claims submission processes. Takes ownership by applying professional standards, regulations, and strategies within their work area. Independently sets priorities and makes decisions on work approach while following established direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. Humana's Encounter Data Management (EDM) team is seeking an Encounter Data Management Professional that has experience with business processing and data...

Company : Highmark Health Job Description : JOB SUMMARY The Director of Data Product Management is a leadership role responsible for developing, implementing, and continually refining our customer data product strategy from its foundational stages. This individual will define, develop, and execute the strategy for our core customer data products, ensuring they meet the evolving needs of Highmark and our customers. This individual will lead a team of product managers and analysts focused on specific areas of customer data, driving the realization of our Customer Data Product Strategy vision to empower downstream teams with personalized, high-quality, and timely interactions. This role requires a strong leader who can translate strategic opportunities into actionable product roadmaps, champion data quality and governance, and foster a data-driven culture. A robust technical background and the ability to effectively collaborate with engineering teams are paramount to...

We believe in the power and joy of learning At Cengage Group, our employees have a direct impact in helping students around the world discover the power and joy of learning. We are bonded by our shared purpose - driving innovation that helps millions of learners improve their lives and achieve their dreams through education. Cengage Group's portfolio of businesses supports student choice by providing a range of pathways that help learners achieve their goals and lead a choice-filled life. Our culture values inclusion, engagement, and discovery Our business is driven by our strong culture, and we know that creating an inclusive workplace is absolutely essential to the success of our company and our learners, as well as our individual well-being. We recognize the value of diverse perspectives in everything we do, and strive to ensure employees of all levels and backgrounds feel empowered to voice their ideas and bring their authentic selves to work. We achieve these...

Company : Highmark Health Job Description : JOB SUMMARY This is a hybrid role if you live within a 50 mile radius of one of our office locations in PA, NY or DE This role is responsible for contributing to the product strategy and roadmap for a defined product area, by managing a team while working under the direction of leadership. This role focuses on deeply understanding customer needs, market trends, and competitive landscape to inform product development decisions. The incumbent works cross-functionally to manage a team that is executing a portfolio roadmap or portfolio of product roadmaps and delivering high-quality products that meet business objectives. They will manage the product backlog for a specific product or feature set. ESSENTIAL RESPONSIBILITIES Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance...

Become a part of our caring community and help us put health first Care Manager Support Assistants assist in ensuring TRICARE beneficiaries receive the highest quality health care for Autism Spectrum Disorder (ASD) related services in accordance with the Autism Care Demonstration (ACD). This role supports the Autism Service Navigator (ASN) by verifying eligibility for the ACD and monitoring and supporting the family for 180 to assist with any barriers to accessing services; education and initial registration into ECHO registration portal for active duty family members; assistance with regional transfers and ensuring the receiving Managed Care Support Contractor receives the appropriate paperwork; processes faxes for ECHO eligibility or other paperwork pertaining to ACD requirements such as eligibility, referrals, etc.; and identification of ABA providers and researching necessary resources to support the beneficiary. KEY ACCOUNTABILITIES Assist beneficiaries with...

Company : Highmark Health Job Description : JOB SUMMARY *This will be a hybrid role if you live within a 50 mile radius a Highmark Office This senior-level job will lead and facilitate integrated process improvement and change management initiatives across multiple functional units Responsibilities encompass designing and implementing process optimization strategies, developing and executing comprehensive change management plans across all impacted stakeholders throughout the change lifecycle, coaching leaders and teams as applicable, and ensuring seamless alignment between people, process, and technology solutions - all while directly contributing to successful business outcomes and ongoing improvements. The successful candidate will leverage expertise in Lean Six Sigma, as well as change management methodologies to drive efficiency, effectiveness, and improved business outcomes. ESSENTIAL RESPONSIBILITIES Process Improvement and Change Management...

Rubrik has partnered with the World's leading Global Systems Integrators to develop successful and profitable outcomes for our joint customers, and for our respective companies. The GSI Account Executive (BDM) candidate will be responsible for managing and driving unprecedented growth with select Global Systems Integrators. This senior GSI account executive would come to the role with a successful track-record of managing Global GSI partnerships, with a focus on business development, enablement, cost models, financial selling, and business negotiations. This candidate will lead from the front, communicate openly, and set the example of a positive and collaborative work environment. Required Capabilities & Experience : Successful track record of partnering with said GSI Ability to set up GSI meetings with key business executives from day one Lead from the front as the main conduit for new logo, pipeline generation, business development for the Rubrik...

Become a part of our caring community and help us put health first The Principal Product Manager Conceives of, develops, delivers, and manages products for customer use. The Principal Product Manager provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical experience. A high-performing, independent role dedicated to tackling cross-team, cross-functional technology and analytics problems in with a focus on innovation, action, and speed-to-market. Primary focus will be on ensuring complete and accurate diagnosis and follow up for our members. This role will work with 2-5 developers within our team on high-profile projects. Responsibilities will include partnering with the business, gathering requirements, developing project plan including resource needs, supervising project execution, hands-on development and analysis as appropriate, customer feedback loop, executive presentation. Critical skills include independent project...

About Team & About Role: Rubrik is revolutionizing data security with Zero Trust Data Protection, enabling organizations to safeguard their most critical assets from cyber threats, operational disruptions, and data loss. As the leader in data security and cloud management, Rubrik empowers enterprises to simplify and secure their digital infrastructure. Rubrik is seeking a CXO Experiences & Community Manager to support the development and execution of high-impact executive engagement programs that deepen Rubrik's relationships with CIOs, CISOs, and other senior leaders. Reporting to the Director, CXO Experience and Community, the role is responsible for designing and delivering exclusive CXO experiences that drive strategic dialogue, accelerate trust, and reinforce Rubrik's position as a leader in cyber resilience. What You'll Do: CXO engagement strategy: Participate in the development and execution of a global strategy for immersive and differentiated...

About Team & About Role: Rubrik's Marketing Team is growing and we're looking for individuals to join us at one of the most pivotal moments in our journey. Our team breaks boundaries and challenges the status quo, innovating along the way. We embrace a culture of opportunity and empowerment, allowing team members to take their best ideas and see them to fruition, while constantly exploring one-of-a-kind strategies. Come be part of a team bringing a fresh perspective to data security. Join us and let's be unstoppable, together. We are looking for a talented individual to join our team as a Field Marketing Manager. In this role, you will be an integral part of the Marketing team, overseeing the success of all demand generation initiatives and marketing events in the Southeast region (AL, FL, MS, TN). What you'll do: Develop strategic and effective regional marketing plans to build pipeline and drive revenue goals Work with Marketing and Sales teams to...

Rubrik's sales organization is a united group of elite cross-functional sales professionals that help companies & government entities achieve resilience against cyberattacks, malicious insiders, and operational disruptions. We offer continuous professional development through our world class sales enablement program and our One Rubrik selling approach provides all the resources you need to exceed your goals, maximize your earnings potential and take your career to the next level. All this while doing something that truly matters, protecting the world's data. As a Healthcare Enterprise Account Executive, you will have ownership of all elements of bookings growth in new and existing Healthcare accounts across a specified set of accounts in the TOLA region. We are seeking a relentless self-starter who is hyper-focused on acquiring new logos by discovering and developing new opportunities, managing pipeline and executing account strategies, while also encouraging existing...

Principal Technology Product Manager – Data Foundation Location: U.S Remote Position Summary Pearson Virtual Schools (PVS) is seeking a Principal Product Manager to lead our Data Foundation program as a senior expert, serving as a key individual contributor. This role is for an experienced, high-impact professional with deep expertise and strategic influence. In this capacity, you will drive the vision and execution of a critical platform modernization initiative (Data Foundation) without direct reports, leading cross-functional teams by influence across engineering, architecture, data science, and design. You will blend strong technical acumen in data platforms and cloud architecture with top-tier product management skills to deliver forward-looking milestones on the program’s roadmap. The ideal candidate is also passionate about innovation in the software development lifecycle, leveraging generative AI and intelligent agents to enhance product development and user...

About Team & About Role: The AI Product Sales Manager is a sales professional characterized by intimate understanding of their specific product, the pain it resolves, the competitors, market, qualification, objections, and value proposition. Through a quantity of focused interactions they become exceedingly specialized and competent in their discipline making great impressions on prospects, business partners and core sales team alike. They own the cloud product number for a large region that spans across Rubrik's various core segments in a given geography. Their success is ensured by their expertise, their champion building, and their high level of effective activity. They champion and evangelize their product in the field, internally and externally, and with our resellers. They are the point of contact for PnP, PM, PMM as a consolidated voice of field and customer. What You'll Do: Define and execute sales plans for the assigned territory to meet and exceed...

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for Cengage Group. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice. We believe in the power and joy of learning At Cengage Group, our employees have a direct impact on helping students around the world discover the power and joy of learning. We are bonded by our shared purpose – driving innovation that helps millions of learners improve their lives and achieve their dreams through education. Cengage Group's Higher Education business, Cengage, supports learning and student success by providing materials and digital solutions to faculty and...

Become a part of our caring community and help us put health first At Humana, we are focused on the elimination of unjust, avoidable and unnecessary barriers in health and health care. The Data Manager 2 (DM2), reporting to the Health Equity Strategy Lead, supports the whole-person, integrated care model for members in our Medicaid and Medicare market to help build the toolkit for equitable population health. In particular, we partner with executives, managers and other leads to advance Care Management, Quality Improvement, Community Engagement, Marketing, Health Economics and Finance to bring a greater understanding of factors that apply to wellbeing from a view of physical, behavioral and spiritual health. The Data Manager 2 supports all aspects of configuration control, data management, and deficiency reporting. The Data Manager 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action....

About Team & About Role: Rubrik's sales organization is a united group of elite cross-functional sales professionals that help companies & government entities achieve resilience against cyberattacks, malicious insiders, and operational disruptions. We offer continuous professional development through our world class sales enablement program and our One Rubrik selling approach provides all the resources you need to exceed your goals, maximize your earnings potential and take your career to the next level. All this while doing something that truly matters, protecting the world's data. Rubrik is looking for a Sales Engineering Manager to lead a team of NAS Cloud Direct Specialist Sales Engineers and provide technical direction and business guidance to the regional sales team. You will be accountable for regional revenue goals, recruiting and hiring top talent, enabling Sales Engineers to be best in business and by driving innovative technical programs and overseeing...

Are You Craving A Career With An Industry Leader? Panda Express is searching for experienced leaders to join our store management team. Panda is 100% committed to the professional and personal development of our family of associates. That’s why we offer paid Store Management Leadership Training, mentorship, and support from our Panda community that cares about your success. What You'll Do As A Store Manager You are in charge of the operation of a single store. This includes, but is not limited to, hiring, managing and directing of associates to achieve financial goals and ensuring the delivery of exceptional guest experiences. It's up to you to make your store a success. Don’t worry! In order to prepare you for success, we will provide an 8 or more weeks of store leadership training program. How we reward you:** Free meals while working at Panda Generous compensation package with bonus opportunities Medical, Vision, Dental, Voluntary Short-Term Disability, Cancer...

Become a part of our caring community and help us put health first The Customer Success Manager is a key leadership role responsible for ensuring customer retention through proactive engagement, strategic initiatives, and operational excellence. This role works collaboratively to ensure alignment and consistent performance, managing up to 25 Customer Success Agents to deliver on retention objectives and test new business initiatives. The Customer Success Manager plays a critical role in driving customer retention through proactive engagement with customers and the implementation of strategic retention initiatives. In addition to core retention campaigns and allegation mitigation, the role supports Call Quality for their team, contributes to broader enterprise value by test & learning new initiatives, and can be part of building something from the ground up. The Customer Success Manager should be ready to receive objectives and determine approach, resources, goals, and...