CarePay

Analyst

• Design and implement analyses to identify trends, opportunities, and potential risks.
• Build and maintain dashboards and data visualizations for real-time performance tracking.
• Provide actionable insights and recommendations to the team and other internal/external stakeholders.
• Proactively support colleagues in provider engagements as needed.
• Build, own and manage various client relationships as necessary.
• Ensure accuracy and consistency of own/team reports.
• Build and continuously improve our internal processes to ensure compliance, consistency across client portfolios and scalability.
• Provide any other relevant support as needed.

Analyst, Pricing and Portfolio Management

Manager

• Responsible for coordinating and managing inpatient and outpatient preauthorization requests in line with policy guidelines, clinical appropriateness, and cost containment objectives.
• Ensure timely review and authorization of medical requests.
• Effective follow-up of admitted members through hospital visits and phone calls.
• Close monitoring of patient progress to support quality, medically necessary, and cost-effective care.
• Oversee inpatient admissions from preauthorization through discharge, including reviewing interim bills, medical reports, treatment plans, and discharge summaries.
• Engage providers, members, and internal stakeholders to facilitate timely care decisions, manage escalations, and promote positive clinical and financial outcomes.
• Identify utilization trends, potential fraud, waste, and abuse indicators, and areas for process improvement.

Analyst, Pricing and Portfolio Management

Case Manager