Cambia Health Solutions

Implementation Specialist

• Plan, direct, coordinate, and report project activities in alignment with department standards and project management methodology.
• Oversee multiple department-level projects, ensuring timely deliverables within budgetary constraints and cost effectiveness.
• Drive project outcomes through planning, scope management, resource allocation, risk mitigation, and stakeholder communication.
• Assemble and lead project teams by assigning responsibilities, securing resources, and providing guidance to team members.
• Prepare and present key discussion topics, decisions, and recommendations to leadership.
• Proactively manage the people side of change to ensure the organization sustains project benefits.
• Define, collect, and analyze metrics to keep projects on target and recommend corrective actions as needed.
• Keep leadership informed of key issues impacting project completion, budget, or outcomes, and ensure timely problem resolution.

Project Implementation Manager I/II

Analyst

• Collects assigned medical records from EMR/EHR systems and prepares them for medical record abstraction
• Documents retrieval progress/findings for each EMR accessed
• Communicates effectively and professionally with provider offices
• Reviews assigned medical records in order to abstract specified, clinical data elements for HEDIS reporting (e.g. date of service of breast cancer screening, date of service and results of laboratory tests related to chronic conditions)
• Documents abstraction findings on appropriate paper and/or electronic tools as directed by the HEDIS MR Team
• Communicates additional pursuit strategies, if needed, to other members of the team as defined in the department’s policies and procedures

HEDIS Medical Record Analyst, Temporary

Program Manager

• Manage new and buy-up pharmacy benefit programs, collaborating with Rx Product, Rx Informatics, Clinical, GTM, and StratFi teams on strategic decisions, implementations, and program enhancements
• Develop and maintain comprehensive monitoring and assessment protocols in partnership with program leaders and cross-functional directors, recommending improvements as needed
• Define, collect, and analyze program metrics to ensure performance targets are met and deliver insights to appropriate leadership forums including Echo report-outs
• Oversee vendor relationships and performance management, including regular scorecarding, SLA monitoring, risk identification, and continuous improvement initiatives
• Work with Rx Informatics and configuration teams on metrics development, StratFi for pricing and revenue updates, Clinical for vendor-proposed drug list changes, and vendor dashboards
• Lead problem management resolution efforts, validate issue prioritization, engage appropriate teams, and escalate to management when necessary to ensure timely resolution
• Prepare and present operational plans, status reports, and program documents to organizational leadership, project teams, and stakeholders
• Educate and train leadership, colleagues, business associates, and stakeholders on new program elements, processes, and implementations
• Drive continuous improvement across all vendor oversight processes, evaluating program outcomes and implementing sustainable operational solutions
• Facilitate multiple interdependent projects, maintaining accountability for scope, schedule, budget, risk management, and successful delivery of quality outcomes

Pharmacy Operations Program Manager

Accounting Manager

• Prepare journal entries and account reconciliations to support monthly financial statements and analysis
• Generate reports for month-end and quarter end reporting
• Complete the annual asset review
• Assist in the preparation of the insurance industry regulatory reporting
• Assist with financial examinations and audits
• Assist with ad-hoc reporting and analysis as needed
• Implement process improvements, including those you discover
• Participate in the development of policies, procedures and practices that are essential to internal controls

Accounting Internship

Director

• Accountable for the performance and results of teams focused on delivering care management programs and services that support members mental and physical wellbeing and health.
• Supports implementation of an industry leading health strategies that are integrated with utilization management, pharmacy, and provider network teams.
• Works closely with cross-functional leaders to clarify goals and priorities and create operational plans to ensure successful execution of initiatives.
• Prepares and presents program summaries, and outcomes to various committees, levels of stakeholders and executive leadership.
• Represents program goals and initiatives with various audiences, internal and external.
• Supports evaluation and recommendations regarding use of vendors to support health strategies.
• Provides clinical expertise and leadership to improve the quality and cost of care delivered to members through provider partnerships.
• Collaborates with Medical Directors, Health Informatics, Provider Services and other departments as needed to collect, analyze, and report on health utilization trends and effectiveness of programs, quality and outcomes.
• Aligns health program strategy and goals with organization's vision and strategy.
• Champions and creates a sense of urgency within the organization related to evolving health programs.

Project Implementation Manager I/II

HEDIS Medical Record Analyst, Temporary

Pharmacy Operations Program Manager

Accounting Internship

Assistant Director, Clinical Services