Health Care Service Corporation

Infrastructure Engineer

• Design, implement, and manage database assets in cloud environments
• Leverage enterprise automations and monitoring tools
• Customize cloud systems for performance, maintenance, and security requirements
• Set up automation for infrastructure-as-code provisioning of Cosmos DB, Azure SQL Database, Azure SQL Managed Instance, Azure Database for PostgreSQL, and related PaaS databases
• Set up standards for automation
• Establish best practices for PaaS database automation
• Work with database Subject Matter Experts to establish database automation standards and provision environments

PaaS Infrastructure Engineering Consultant – Cloud Automation, Tools

Consultant

• Lead Luminare Health’s enterprise reporting strategy and enforce standardized metric definitions, data governance standards, reporting policies, and best practices.
• Drive the strategic roadmap and prioritization of reporting and analytics initiatives.
• Own end-to-end delivery, adoption, and measurable business impact of enterprise reporting solutions.
• Partner with senior leaders, cross-functional teams, clients, and broker partners to translate business requirements into reporting and analytics solutions.
• Advise stakeholders on reporting and analytics capabilities and advance reporting maturity.
• Lead large-scale, enterprise-critical projects and transformation initiatives.
• Establish and oversee reporting application governance, data quality controls, and validation processes.
• Evaluate, prioritize, and implement enhancements to reporting content, tools, and capabilities.
• Develop and deliver training, system demonstrations, and thought leadership to promote self-service analytics adoption.
• Provide leadership, mentorship, and direction to reporting analysts, project teams, and cross-functional partners.

Strategic Reporting Consultant

• Support strategic planning, portfolio management, and execution of Medicaid initiatives
• Provide visibility into divisional initiatives and support prioritization and resource planning
• Evaluate business impacts and partner with stakeholders to align and coordinate strategic work
• Translate business needs into actionable plans
• Facilitate stakeholder alignment and support implementation of complex initiatives
• Develop business cases, portfolio reports, dashboards, presentations, and leadership materials
• Conduct impact analyses and identify risks and opportunities
• Track progress across a portfolio of strategic projects and programs
• Work with leaders and cross-functional teams across the enterprise
• Use data to support informed decision-making in a fast-paced healthcare environment

Medicaid Business Consultant

Pharmacist

• Conducting clinical reviews to optimize drug therapy for health plan members across medical and pharmacy benefit channels.
• Utilize sound knowledge of member and/or client benefit design to inform drug therapy recommendations at an individual or population level.
• Administration and management of pharmacy programs including applying knowledge of utilization/formulary management programs, specialty pharmacy management, medication therapy management, data analysis, client relationships/support, and development of innovative clinical programs.
• Work directly with a multi-disciplinary team to advise plan members and providers in an effort to improve health outcomes.

Clinical Pharmacist – Managed Care

• Responsible for leading the analytics strategy for evaluating internal and external program initiatives within the Medicare Stars program.
• Provide operational and analytical support to internal and external partners to improve HCSC’s Medicare Star Ratings.
• Lead development of data analyses utilizing pharmacy claims, clinical outcomes, and Stars quality measures to make recommendations based on relevant findings.
• Responsible for building a framework to analyze performance of external vendors and internal groups and building out reports and dashboards to monitor such performance on an ongoing basis.
• Use advanced analytics techniques to dive into root causes of issues.
• Interface across multiple business areas, including, but not limited to pharmacy, clinical, customer experience, product development and operations as needed. Reports and dashboards created will be utilized by business partners and Stars leadership in making critical business decisions related to enhancements to existing programs, development of new pilots and initiatives, and other opportunities to maximize Stars affordability and enterprise value.

Senior Analytics Consultant – Medicare Stars

Analyst

• Developing job descriptions and conducting job analysis and evaluations for assigned business areas.
• Conducting market analyses and recommendations.
• Participating in salary surveys.
• Assisting in the annual salary compensation review.
• Supporting the administration of compensation including salary and API.
• Analyzing data to inform the design, development and updates of compensation programs and compensation projects as assigned.

Compensation Analyst

• Responsible for leadership and coordination of the assigned Medicaid programs in accordance with contractual and regulatory requirements.
• Implementing program changes and working with other areas of the organization on the development.
• Testing and implementation of organization.
• Process and system changes to ensure the requirements of the assigned Medicaid program are met.
• Serves as the liaison with vendors and internal functional areas and assists in the coordination of the contract with state regulatory agencies.

Medicaid Contract Consultant

Claims Specialist

• responsible for the accurate adjudication and processing of medical, dental, vision, or other related claims
• calculate benefit payments and communicate claim decisions on new and continuing claims within established turnaround times
• provide responsive and caring customer service

Claims Analyst

Recruitment

• Manage full-cycle recruitment for senior-level, technical, and hard-to-fill roles
• Serve as a trusted advisor to hiring managers and business leaders throughout the hiring process
• Develop and execute strategic sourcing and recruiting initiatives
• Build diverse talent pipelines
• Evaluate and select qualified candidates
• Provide market intelligence on talent availability, compensation, and industry trends to support hiring decisions
• Foster strong stakeholder relationships
• Promote a positive candidate experience
• Support employer branding efforts
• Ensure compliance with applicable employment laws and company policies
• Drive continuous improvement of recruiting practices to deliver effective, cost-conscious talent acquisition solutions

Senior Recruiter

• Driving value through leadership and business execution of projects related to Pharmacy strategy development, planning, and implementation
• Helping drive growth, improve the affordability of products and services, and react to shifting competitive trends and external forces in the Pharmacy space
• Leading a team focused on execution of pharmacy strategy deliverables
• Participating in strategy development/planning, building execution plan, translating strategy as goals and operationalization for team.

Senior Manager, Pharmacy Strategy

• Drive strategic initiatives supporting Medicaid growth, operational performance, and enterprise priorities
• Lead collection, analysis, and evaluation of complex business and reporting requirements
• Translate data and business insights into actionable plans, business cases, executive presentations, dashboards, and recommendations
• Support Medicare RFP procurements and identify opportunities for savings
• Develop executive-ready materials and provide strategic support for high-priority business initiatives

Senior Business Consultant, Medicaid

Strategy

• Lead the Medicaid Strategy team
• Enable state Medicaid RFPs from content generation to formal submission
• Identify strategic opportunities for cost saving/value deriving initiatives
• Support divisional planning to ensure alignment across enterprise and matrixed partners
• Bridge the gap between data driven insights and actionable implementation activities
• Supply a strategic lens on new state/federal legislation requirements
• Establish yearly and quarterly goals to display progress
• Display strong written and verbal communication skills
• Influence a team of strategic thinkers and build a culture of creative solutioning

Manager, Medicaid Division Strategy – Planning

Compliance

• This position is responsible for supporting evaluation of government programs (Medicare and Medicaid) regulations, guidance and contracts, assessing the risk that those items present with respect to HCSC government contracts.
• Supporting the compliance department oversight of the business' operational compliance with the requirements through multiple mechanisms such as review of reports, attendance at operational meetings, and targeted monitoring of areas of concern.
• Assisting in identification of risks and issues of noncompliance, development of strategies to mitigate and remediation of those risks and issues and work with compliance and business personnel, all levels of HCSC management and governmental agencies in order to implement controls and processes and report on results.
• Validate that business remediation activities successfully addressed agreed-upon root causes, deliverables and remediation steps.
• Document results and communicate findings to the business.
• Create summary reports for management on issues and risks of non-compliance.

Government Programs Compliance Consultant

Human Resources

• Developing, modifying, and maintaining employment practices, policies and procedures to support regulatory processes and compliance for the enterprise
• Consulting with the enterprise on federal, state and local EEO laws ensuring compliance with such laws
• Evaluating selection criteria for reductions in force
• Supervising staff
• Providing applicable HR Regulatory Compliance training
• Partnering with Legal, Corporate Compliance and other business units to resolve issues
• Direct management of HCSC’s Affirmative Action Program (AAP), Administrative Charges and HCSC’s Immigration program
• Serving as corporate liaison with local, state, or federal agencies

Manager, HR Regulatory Compliance

Financial Planning and Analysis

• Manage a team of financial analysts supporting budget, forecasting, and financial metric analysis across business areas and corporate level.
• Be a team player with an aptitude for understanding financial and operational concepts.
• Develop financial strategy, monitor/analyze financial metrics, reporting, and forecasting.
• Manage financial initiatives and strategies, accounting and invoicing systems, capital planning for IT equipment/software.
• Responsible for Enterprise Portfolio Management including financial reporting, analysis, forecasting, and estimation.