Cambia Health Solutions

Consultant

• Facilitates provider-facing discussions, delivering recommendations, presentations, and performance narratives, and ensures alignment on goals, expectations, and performance priorities.
• Consolidates internal performance and operational data, validates accuracy, and produces clear summaries, slides, and visualizations to support provider and internal discussions.
• Participates in cross functional initiatives to address provider performance barriers and advance organizational initiatives.
• Owns meeting preparation, facilitation, documentation, and follow‑through for key internal and selected provider‑facing discussions.
• Supports team operations by managing recurring workflows, tracking timelines, maintaining documentation, and optimizing team processes.
• Supports provider‑facing initiatives — including analytical, operational, and coordination support — that drive provider engagement and performance within a defined scope.

Provider Engagement Consultant

Director

• Develop and maintain strong, collaborative relationships with partners joint ventures and the like, including physicians, practice managers, and other stakeholders.
• Provide strategic guidance and oversight to primary care practices partners, ensuring alignment with Cambia's goals and objectives.
• Collaborate with Finance, clinic leadership, and the joint operating committee to provide financial oversight, including budgeting, forecasting, performance monitoring and strategic planning.
• Analyze market trends, competitor activity, and customer needs to inform joint venture strategy and identify opportunities for growth and improvement.
• Collaborate with Marketing, Product, and Sales teams to design benefit plans and campaigns that drive utilization of joint venture clinics, promoting growth and revenue generation.
• Monitor quality, efficiency, and referral patterns, identifying opportunities for improvement and implementing value-based payment models in partnership with clinic provider and network management teams.
• Develop and implement strategies to improve patient outcomes, satisfaction, and engagement, as well as provider satisfaction and retention.
• Stay current with industry trends, regulatory changes, and emerging technologies, applying this knowledge to inform joint venture strategy and operations.
• Stay current with clinical best practices, and applying this knowledge to inform clinical strategy and operations.
• Identify and mitigate risks associated with partnerships, ensuring compliance with regulatory requirements and Cambia's policies and procedures.
• Work with clinical teams to develop and implement clinical programs and initiatives that improve patient outcomes, reduce costs, and enhance the overall quality of care.
• Partner with clinic provider and network management teams to develop and implement value-based payment models that promote quality,
• Define, develop, and deploy a roadmap of new solutions to support provider efficiency, and cost-effectiveness.

Partnership Director – Primary Care Practices

Actuary

• Acquiring skills in Microsoft Office Suite, health plan data, and coding for model development and data queries.
• Creates, maintains, updates and reviews established data queries and models; may recommend methodology or process improvements.
• Accurately prepares, updates and reviews regular work products, including project code, analytic models, data visualizations, and associated documentation; actively collaborates with peers.
• Assembles deliverables for customers and drafts responses to customer questions.
• Performs peer review of technical work products and acceptance testing of new reports, programs, and models, following department and team quality assurance standards.
• Meets established project deadlines; informs manager of work progress, new requests, and conflicts.
• Regular progress on passing actuarial exams to achieve actuarial credentials (ASA, MAAA).
• Effectively manages work and study time; contributes to own development plan.
• Manages regular team projects, workplans and documentation; actively collaborates with peers; may delegate to junior team members.
• Develops new methodologies; recommends methodology or process improvements.
• Presents results to customers; effectively develops and reviews written responses to regulator or customer questions.

Assistant Actuarial Analyst – Assistant Actuary

Full-stack Engineer

• Develops, tests, and documents efficient, maintainable program code and system solutions that solve business problems while meeting established deadlines and maintaining high quality and security standards.
• Provides consulting support to Engineering and Business partners by researching, identifying, and resolving programming problems through innovative solutions.
• Participates in all phases of approved Software Development Lifecycles, including requirement analysis, system analysis and design, data modeling, program design, unit test planning, testing, and comprehensive documentation.

Software Development Engineer I

Software Engineer

• Supervises Business Engineering department staff and oversees development and modifications to the Facets suite of systems.
• Manages team coordination in defining business requirements, functional system design, documentation, and executing system and user acceptance testing.
• Develops and maintains automation and ancillary applications for the Facets system supporting membership, billing, claims processing, and customer service functions.
• Creates realistic project and resource plans, monitors work-plan progress, and adjusts priorities and schedules to ensure efficient completion while ensuring testing follows approved project standards.
• Oversees vendor patch and enhancement implementation, performs detailed problem analysis, and manages acceptance regression testing with comprehensive documentation.
• Coordinates testing activities, post-implementation quality assurance, troubleshooting, and communicates results with end users to validate solutions prior to production launch.
• Participates in hiring, provides ongoing coaching and employee development, writes performance reviews, maintains training documentation, and acts as a resource while partnering across departments to resolve issues.

Supervisor, Business Engineering

Data Analyst

• Analyze data and prepare comprehensive reports related to health care services, utilization, costs, trends, enrollment, incentives, and revenue across providers, members, networks, groups, products, and lines of business
• Create and modify complex reports and underlying SQL queries, including BOE universes and automated enterprise dashboards, while identifying needed reporting and directing assembly as appropriate
• Perform statistical analysis and data modeling based on user requests, making strategic recommendations that support business objectives
• Validate own work and complex reporting produced within and outside the department, providing final sign-off and defining procedures, processes, and tools to automate validation
• Maintain existing and develop new information reporting systems to support requirements of internal and external users, evaluating impacts of new products, systems, and work processes on data and reporting systems
• Collaborate with departments responsible for transaction systems to ensure reporting data is captured accurately and that data integrity and reliability are maintained throughout the data warehouse
• Develop and execute balancing and validation routines to ensure data warehouse updates are complete, accurate, and maintain integrity
• Assist business analysts across departments with data interpretation and appropriate uses of data tools and reporting algorithms, providing training in query and report preparation to improve consistency
• Make decisions on issues with significant financial impact and risk to the corporation, proactively identifying concerns and bringing them to management attention
• Communicate analysis results and recommendations in both verbal and written form to stakeholders, determining reporting requirements through ongoing dialogue with information users, and may mentor or lead other analysts on projects

Pharmacy Data Analyst I, II, III

Customer Support

• Completes non-clinical tasks assigned by BH UM Clinicians related to case completion, care coordination, and discharge planning, including initiating referrals to care management (CM) and single case agreements (SCA) as needed.
• Communicates effectively and professionally within and across teams, and with providers to prompt concurrent review submissions, convey UM determinations, cancellations, and other necessary communications in compliance with all regulatory and quality requirements.
• Facilitates written and verbal notifications to providers to request medical records and additional information, ensuring all communications meet regulatory standards and timeliness requirements.
• Adheres to all performance criteria including timeliness, production, and quality standards while performing detailed research and problem-solving using sound decision-making skills to ensure BH UM case accuracy and completeness.
• Exhibits excellent time management and organizational skills to ensure all UM activities meet regulatory and quality requirements, keeping reference documents, policies, and procedures readily accessible.
• Follows strict guidelines to ensure all work meets corporate standards for accuracy, timeliness, quality, and compliance with federal, state, BCBSA, and accreditation regulations.
• Demonstrates and promotes a professional and ethical work environment with all stakeholders while contributing to continuous improvement by identifying opportunities for improvement within systems and workflows, and may assist with systems testing if applicable.

Behavioral Health Utilization Management Clinical Support Specialist

Client Partner

• Provide clinical guidance, reporting, program recommendations and benefit strategies.
• Works in collaboration with the Pharmacy Sales and Account Management team.
• Identifies, leads, and measures the impact of pharmacy program opportunities that impact client cost, utilization, and quality metrics.
• Synthesizes client utilization data, benefit designs, employee value proposition goals, and pharmacy clinical programs.
• Provides client specific recommendations to improve pharmacy program performance.
• Provides professional and clinical expertise for Pharmacy clients in making clinical decisions based on best practices.
• Assists the Pharmacy Sales and Account Management Team in planning, developing, and implementing clinical strategies for Pharmacy clients.
• Collect, analyze, interpret, and forecast healthcare cost information based on prescribing patterns and medication utilization reports.
• Deliver creative thinking and leadership to accomplish quality improvement and cost-effective prescription drug program goals.

Clinical Pharmacist, Client Manager

AI Engineer

• Designing, implementing, and maintaining AI operations infrastructure for AI applications.
• Collaborating with ML scientists, engineers and stakeholders for effective AI model integration.
• Automating workflows, optimizing performance, and monitoring model outcomes.
• Building rapid GenAI prototypes to accelerate innovation.
• Advancing AI capabilities and supporting data-driven decision-making.

Platform Engineer

• Design, Build and Maintain scalable data pipelines using ETL and ELT on cloud platforms
• Develop Data Integration Solutions to connect various data sources to a single unified data source while ensuring data architecture that supports a single source of truth
• Develop efficient, effective, and maintainable program and system solutions to solve complex business problems
• Develop automated workflows for data ingestion, transformation, and applications integration
• Writes efficient code in languages such as SQL and Python.
• Responsible for supporting our Product and Business partners by researching, identifying and resolving highly technical programming problems
• Meets established deadlines while maintaining a high level of quality of work
• Performs testing and documents the results
• Adheres to policies, procedures, and standards in place within IT/Engineering as well as all corporate policies, procedures and standards established by Cambia.