Health Care Service Corporation

QA Engineer

• Responsible for performing oversight on essential credentialing functions to attain and maintain quality providers in the dental network
• Conducts audits for credentialing as well as network data quality
• Understands credentialing policies and procedures per NCQA, URAC and CMS standards and other regulatory requirements
• Serves as a liaison to delegated entities and vendors to ensure current and adequate credentialing processes are in place
• Develops and performs queries for data reporting purposes to include directories, ad hoc reports, and network management reports
• Responsible for the monitoring and maintenance of credentialing and re-credentialing policies and programs as well as state and federal requirements to ensure compliance is met
• Provides operational and industry knowledge to ensure credentialing practices

Credential Analyst – NCQA, URAC, CMS

Consultant

• shape how we grow, develop, and mobilize talent across the enterprise
• serve as a trusted partner to business and HR leaders
• deliver strategic talent consulting, leadership coaching, and integrated talent mobility solutions aligned to evolving business priorities
• help leaders build strong pipelines, accelerate development, and ensure the right talent is in the right roles at the right time

Lead Talent Consultant

Strategy

• Support leadership with projects related to strategy development, planning, and implementation
• Help drive growth, improve affordability of products and services
• Transform operating model enabled by technology
• Focus on transformation across clinical areas
• Work closely with Healthcare Management leaders

Senior Consultant, Corporate Strategy

Affiliate Manager

• Developing and executing education strategy in alignment with the goals of a specific line of business and in alignment to learning methodology and culture
• Developing and nurturing consultative partnerships across organization
• Analyzing performance gaps and learning needs; recommending strategic, effective performance and non-performance solutions; evaluating the effectiveness and results of solutions
• Coaching and developing team members
• The scope includes instructional strategies for instructor-led, web-based, and blended solutions
• Fostering and maintaining strong ongoing client-facing relationships
• Autonomously and effectively managing multiple complex initiatives
• Participating with teams and consulting with customers and internal workgroups
• The coordination of communication plans and project management activities related to divisional and/or enterprise implementations
• The evaluation of learning and business outcomes

Learning Partner

• Support leadership by delivering projects related to strategy development, planning, and implementation
• Focus on transformation across clinical areas
• Work closely with Healthcare Management leaders

Principal Corporate Strategy Consultant

Medical Reviewer

• responsible for pre-authorization reviews in accordance with the medical contract and regulations
• medical criteria, utilization review, and quality of care

Medical Reviewer, LPN/LVN

General Counsel

• Responsible for providing legal advice and support on a variety of moderately complex legal projects and assignments.
• Provide legal support on more routine day-to-day business matters with reasonable degree of independence.
• Work proactively with business and legal partners to identify and address potential regulatory, legal and business risks.
• Exercise judgment and ability to manage competing deadlines.
• Represent the Company in more routine litigation and administrative proceedings.
• Provide functional advice and guidance to legal support staff when assigned.
• Collaborate with legal colleagues to identify legal issues with potential cross-functional impact.
• Communicate and interact effectively and professionally with co-workers, management, customers, and other stakeholders.
• Demonstrate ability and interest in learning and willingness to take on new challenges.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Maintain complete confidentiality of company business.

Assistant General Counsel

Manager

• Directing all negotiations, strategies and direct execution of the business plan for providers in our HealthSpring Alabama and Georgia markets.
• Emphasis on key health systems and providers that contribute $10M or more in annual allowed spend.
• Responsible for contracting all medical agreements across these markets.
• Market and partner direct relationship development.
• Critical contract negotiations, establishing fee-for-service and value based contracts.
• Enable financial and operational engagement strategies and internal cross-functional engagement with matrix partners.
• Leading and/or supporting select additional strategic plan initiatives that involve high value partners, inclusive of cross-functional strategic projects within Healthcare Delivery and network and value-based care program evolution.
• Work collaboratively with key network finance, contracting, analytics and operations areas as well as with enterprise areas to ensure alignment with partner strategies and financial implications.
• Documenting and conducting analysis of current and proposed contract arrangements and its impact on HealthSpring strategy and managing its impacts on divisional and departmental short term and long term planning.

Senior Manager, Key Provider Contracts

• Supporting business analysis to ensure alignment and integration across functional areas
• Supporting efforts to track progress of the division’s activities to goals
• Assisting initiative leads in documenting and conducting analysis of processes
• Defining metrics needed to measure process success

Associate Business Consultant

Infrastructure Engineer

• collaborating with solutions engineering, infrastructure operations, and infrastructure service management teams in the design and build of infrastructure solutions/blueprints for area of responsibility
• participating in the design and build of repeatable patterns (build-kits) to improve deployment times for non-prod and prod environments
• transitioning knowledge to infrastructure operations

Senior Infrastructure Engineer – FileNet

• Providing support to the provider recruitment and contracting process
• Ensuring strategic coverage of providers for assigned territory
• Developing and maintaining relationships with providers
• Supporting complex hospital systems and physician contracting activities

Network Management Consultant – Ancillary Contracting

• Providing support to the provider recruitment and contracting process to ensure strategic coverage of providers for assigned territory
• Small to mid-size contract negotiations for ambulatory surgery centers, other ancillary provider types (dialysis, SNFs, home health, etc.)
• Developing and maintaining relationships with providers
• Support for complex hospital systems and physician contracting activities

Network Management Consultant – Ambulatory Surgery Centers

Administration

• Coordinate and administer various responsibilities within the HCSC Privacy Office
• Work with low and moderate risk issues and departments
• Ensure HCSC is compliant with various federal and state regulations
• Oversee the annual updates of regulatory policies and procedures
• Ensure all HCSC employees complete the regulatory training
• Responsible for development and distribution of regulatory information via intranet and internet web site
• Track and report on a variety of required initiatives under federal and state laws

Privacy Office Administrator

• Coordinating and administering various responsibilities within the HCSC regulatory office.
• Working with high-risk issues and departments to ensure compliance with various federal and state regulations.
• Overseeing the annual updates of regulatory policies and procedures.
• Ensuring all HCSC employees complete the regulatory training.
• Responsible for development and distribution of regulatory information via intranet and internet web site, tracking and reporting on a variety of required initiatives under federal and state laws.

Senior Privacy Office Administrator

• Creating reports, insights, and analytics in support of the Network Business Solutions team
• Creating specifications for reports and analysis based on business needs
• Possibly providing consultation to users and leading cross-functional teams to address the division's issues
• Producing datasets and reports for analysis using system reporting tools
• Possibly performing research and assisting in analyzing data related to the division's strategic initiatives and broader research needs
• Interfacing between the business and divisional data teams to generate tools for analysis and reports which are actionable
• Working closely with customers to build relationships
• Continuously gaining a deeper understanding of the division's data to meet business needs
• Analyzing complex business problems and issues using data from internal and external sources to provide insight to decision makers
• Identifying and interpreting trends and patterns in datasets to locate influences