Health Network One

Account Manager

• Serve as the primary day to day strategic lead for assigned healthcare payor accounts, supporting client strategy, satisfaction, retention, and growth.
• Responsible for maintenance of comprehensive account strategy plans aligned to client business goals, market dynamics, and organizational objectives.
• Proactively manage client escalations, risks, and sensitive business issues with urgency and professional communication.
• Support the planning and preparation of annual business reviews, strategic planning sessions, and other client-facing meetings.
• Escalate client concerns or risks to the VP, Account Management as appropriate.
• Assist in executing account management strategies and initiatives defined by leadership.
• Coordinate internal resources to ensure timely delivery of services and solutions to clients.
• Track key deliverables, timelines, and action items across assigned accounts.
• Support implementation of health plan strategies in collaboration with internal teams.
• Maintain working knowledge of health plan operations, regulatory requirements, and industry best practices.
• Support compliance with client requirements and industry standards.
• Assist in gathering and analyzing data to support client reporting and strategy execution.
• Track and report on key performance indicators (KPIs) for assigned accounts.
• Prepare client reports, presentations, and performance summaries.
• Identify trends, risks, and opportunities, and communicate insights to leadership.
• Partner with internal stakeholders including operations, clinical, product, and finance teams to support client deliverables.
• Ensure alignment across teams to meet client expectations and service standards.
• Support renewal and rate update processes by gathering required data and preparing materials.
• Identify opportunities for account expansion or additional services and communicate to leadership.
• Assist in maintaining high client retention and satisfaction.
• Support the VP, AM to oversee client contract lifecycle activities, including renewals, amendments, participate in pricing discussions, and strategic negotiations.
• Partner with internal legal, finance, underwriting, operations, and executive leadership teams to support contract strategy and execution.
• Work with VP, AM to ensure contract terms align with business objectives, profitability expectations, and operational capabilities.

Network Operations

• Lead Network Operations (Shared Services), a centralized function that builds and owns the frameworks, tools, operating cadence, and standards used by all network segments to execute contracting, credentialing, training, and provider support.
• Design and implement a single intake-to-execution workflow to make demand visible, prioritized, and governed.
• Establish and manage operating cadence, throughput tracking, and dashboards (cycle time, capacity, delivery).
• Reduce duplication and manual handoffs across segments while improving speed to market.
• Partner with segment leaders to ensure shared services delivery aligns to segment priorities.
• Own the Network Financial Value Framework and performance dashboard (unit cost, utilization, leakage, VBC outcomes), partnering closely with Finance, Analytics, and Actuarial to integrate network economics into enterprise financial planning and board reporting.
• Build a scalable operating model that supports growth without proportional headcount increases.
• Act as a thought partner and extension of the EVP, helping prioritize initiatives and manage executive bandwidth.
• Serve as the first escalation point for cross-segment issues, resource constraints, and operational blockers.
• Provide line-of-sight across all network segments and shared services to anticipate risks and opportunities.
• Ensure alignment between enterprise priorities and network execution.
• Support preparation of key materials and updates for ELT/Board discussions related to network strategy and performance.
• Enable effective matrixed ways of working across segment leaders and shared services.
• Drive clarity around roles, decision rights, and accountability.
• Lead change with a steady, pragmatic approach that builds trust and adoption.
• Partner closely with Finance, Analytics, and other enterprise functions to improve economic visibility and performance reporting.

VP Network Operations – Chief of Staff

Attorney

• Prepare, submit, and track initial and renewal licensing applications across multiple states and regulatory bodies, including California and Texas
• Maintain up-to-date licensing records, documentation, and status tracking systems
• Monitor expiration dates and proactively manage renewals to prevent lapses in licensure
• Ensure all licensing files meet completeness, accuracy, and audit-readiness standards
• Serve as a point of contact with licensing boards and regulatory agencies, including CA and TX licensing authorities
• Respond to requests for information, deficiency notices, and follow-up inquiries
• Stay informed of changes in licensing requirements and regulations, particularly within California and Texas, escalating impacts as needed
• Maintain accurate data within internal systems and tracking tools
• Generate reports on license status, upcoming renewals, and compliance risks
• Identify discrepancies or gaps and take corrective action
• Partner with Credentialing, Provider Operations, Legal, and Compliance teams to ensure alignment
• Support onboarding processes requiring licensure verification or application submission
• Assist with audits, internal reviews, and client reporting requirements
• Provide general administrative support to the Legal/Compliance department, including triaging information requests with business stakeholders and supporting departmental initiatives, documentation, and coordination needs
• Recommend process improvements to enhance efficiency, accuracy, and turnaround times
• Support standardization of documentation and tracking processes
• Leverage technology and systems to improve workflow management

Licensing & Legal Specialist

Business Intelligence Analyst

• Direct, guide and support the activities of the Business Intelligence (BI) team
• Ensure compliance with client service level agreements and reporting requirements
• Oversee daily status meetings with the BI team
• Establish trends based on seasonality and data projections
• Support the development of healthcare scopes for contracts
• Lead the analysis of provider profiles generated by IT
• Prepare ad-hoc analyses upon request
• Coordinate monthly meetings with network owners

Director, Business Intelligence

Analyst

• Lead the design, development, and optimization of enterprise clinical performance dashboards (e.g., utilization, care management effectiveness, access metrics, and quality performance).
• Development of recurring and adhoc analytics using SQL, Excel, and Power BI.
• Translate complex clinical datasets into strategic recommendations for executive leadership, operational teams, and quality stakeholders.
• Establish data validation standards and ensure accuracy, completeness, and integrity across reporting environments.
• Serve as a senior subject-matter expert for clinical analytics methodologies, performance measurement, and reporting best practices.
• Partner with clinical and operational leadership to define KPIs aligned with enterprise performance goals.
• Lead cross-functional collaboration with IT, data engineering, operations, and quality teams to improve data architecture and reporting accessibility.
• Present insights and narratives to senior stakeholders in clear, decision-ready formats.
• Guide prioritization of analytics initiatives supporting organizational strategy and regulatory requirements.
• Mentor junior analysts and strengthen analytics capabilities across teams.
• Partner with Compliance and clinical stakeholders to support state, federal and health plan reporting requirements, including NCQA, CMS, JOC.
• Development of performance metrics used in audits, accreditation readiness, and compliance monitoring.
• Support enterprise readiness for regulatory reviews through proactive analytics monitoring and documentation.
• Drive automation of manual reporting workflows and implementation of scalable reporting solutions.
• Establish documentation standards, reporting governance processes, and analytics best practices.
• Lead initiatives to modernize clinical reporting infrastructure and improve enterprise data usability.
• Identify opportunities to leverage analytics for performance optimization and cost-of-care improvement.

Lead Clinical Analyst

Medical Director

• Provide clinical oversight and medical direction for vision related programs and services.
• Ensure clinical policies, guidelines, and practices align with evidence based ophthalmology standards and applicable regulatory requirements.
• Serve as the senior clinical authority for ophthalmology related questions, escalations, and complex case reviews.
• Ensure compliance with GAAP, healthcare-specific regulations, and internal policies.
• Perform and oversee utilization management reviews related to ophthalmology and vision services.
• Conduct medical necessity determinations for prior authorization, concurrent, and retrospective reviews.
• Review and adjudicate clinical appeals and denials, including peer to peer discussions with ordering and rendering providers.
• Collaborate with operational and compliance teams to ensure utilization management activities meet contractual, regulatory, and accreditation standards.
• Act as a client‑facing clinical leader and ophthalmology specialist for Health Network One’s vision service lines.
• Participate in client meetings, presentations, and consultations to explain clinical programs, utilization management decisions, and outcomes.
• Support client relationships, retention, and growth by providing credible, thoughtful clinical guidance.
• Represent Health Network One with external stakeholders, including health plans, provider partners, and regulatory entities, as appropriate.
• Partner with the CEO and executive leadership team to support strategic planning, clinical program design, and growth initiatives for vision services.
• Provide clinical insight to inform organizational decision making, risk management, and performance improvement efforts.
• Contribute to the development and refinement of clinical workflows, quality initiatives, and performance metrics aligned with organizational goals.
• Ensure compliance with federal and state regulations, accreditation standards, and client contractual requirements.
• Support quality management activities related to ophthalmology and vision services, including audits, reporting, and corrective action planning.
• Promote a culture of clinical excellence, accountability, and patient centered decision making.

Medical Director, Vision

• Provide clinical oversight and medical direction for dermatology‑related programs and services.
• Ensure clinical policies, guidelines, and practices align with evidence‑based dermatology standards of care and applicable regulatory requirements.
• Serve as the senior clinical authority for dermatology‑related questions, escalations, and complex case reviews.
• Perform and oversee utilization management reviews related to dermatology services.
• Conduct medical necessity determinations for prior authorization, concurrent review, and retrospective review.
• Review and adjudicate clinical appeals and denials, including peer‑to‑peer discussions with ordering and rendering providers.
• Collaborate with operational and compliance teams to ensure utilization management activities meet contractual, regulatory, and accreditation standards.
• Act as a client‑facing clinical leader and dermatology specialist for Health Network One’s dermatology service lines.
• Participate in client meetings, presentations, and consultations to explain dermatology clinical programs, utilization management decisions, and outcomes.
• Support client relationships, retention, and growth by providing credible, data‑driven clinical guidance.
• Represent Health Network One with external stakeholders, including health plans, provider partners, and regulatory entities, as appropriate.
• Partner with the Chief Medical Officer and executive leadership team to support strategic planning, clinical program design, and growth initiatives for dermatology services.
• Provide clinical insight to inform organizational decision‑making, risk management, and performance improvement efforts.
• Contribute to the development and refinement of clinical workflows, quality initiatives, and performance metrics aligned with organizational goals.
• Ensure compliance with federal and state regulations, accreditation standards, and client contractual requirements.
• Support quality management activities related to dermatology services, including audits, reporting, and corrective action planning.
• Promote a culture of clinical excellence, accountability, and patient‑centered decision‑making.

Medical Director, Dermatology

Underwriter

• Build pricing and underwriting models and analyses to guide new deal pricing and review of existing pricing arrangements.
• Perform detailed medical cost, utilization, and trend analyses to support rate development and pricing recommendations.
• Evaluate profitability of quotes, renewals, and book-level performance relative to pricing assumptions.
• Track performance of existing contracts.
• Support evaluation of risk and pricing strategies for new and existing products through multiple scenarios, such as base, downside and upside cases.
• Analyze and assess the integrity of the data being used for underwriting.
• Identify and recommend mechanisms and contract terms that mitigate known and unknown risks and uncertainties.
• Partner with operations, medical economics / business analytics, product, sales, account management and others as appropriate.

Underwriting Analyst

Accountant

• Preparing journal entries and conducting month end close task with minimal supervision.
• Preparing account reconciliations, including bank accounts and credit card statements.
• Reconciling intercompany balances.
• Preparing documentation for external auditors.
• Collaborating with preparation of annual budgets.
• Preparing balance sheet reconciliations.
• Ensures compliance with company HIPAA policies and procedures.

Accountant II

• Provide clinical oversight and medical direction for musculoskeletal and therapy related programs and services
• Ensure clinical policies, guidelines, and practices align with evidence based PM&R and MSK standards of care and applicable regulatory requirements
• Serve as the senior clinical authority for MSK related questions, escalations, and complex case reviews
• Perform and oversee utilization management reviews for MSK services, including physical therapy, occupational therapy, and related interventions
• Conduct medical necessity determinations for prior authorization, concurrent, and retrospective reviews
• Review and adjudicate clinical appeals and denials, including peer to peer discussions with ordering and rendering providers
• Collaborate with operational and compliance teams to ensure utilization management activities meet contractual, regulatory, and accreditation standards
• Act as a client facing clinical leader and PM&R specialist for Health Network One’s MSK service lines
• Participate in client meetings, presentations, and consultations to explain MSK clinical programs, utilization management decisions, and outcomes
• Support client relationships, retention, and growth by providing credible, data driven clinical guidance
• Represent Health Network One with external stakeholders, including health plans, provider partners, therapy networks, and regulatory entities, as appropriate
• Partner with the CEO and executive leadership team to support strategic planning, clinical program design, and growth initiatives for MSK services
• Provide clinical insight to inform organizational decision making, risk management, and performance improvement efforts
• Contribute to the development and refinement of clinical workflows, quality initiatives, and performance metrics aligned with organizational goals
• Ensure compliance with federal and state regulations, accreditation standards, and client contractual requirements
• Support quality management activities related to MSK services, including audits, reporting, and corrective action planning
• Promote a culture of clinical excellence, accountability, and evidence based decision making