Lumeris

Sales Development Rep

• Execute highly targeted, insight-driven outreach across email, phone, and social channels to engage VP and C-level stakeholders within enterprise healthcare organizations.
• Rapidly engage inbound interest (demo requests, content downloads, event leads), qualifying against ICP, strategic priorities, and readiness to evaluate Lumeris’ solutions.
• Research and map complex healthcare organizations to identify key decision-makers, influencers, and buying committees.
• Initiate meaningful conversations that uncover business challenges (e.g., access, care gaps, workforce strain) and align them to Lumeris’ value.
• Generate high quality meetings with “Strategic, Technology, and Timing” criteria gathered. Coordinate seamless handoffs to RSDs, ensuring strong context, clear next steps, and high conversion potential.
• Maintain accurate, actionable data in Salesforce and SalesLoft to provide visibility into pipeline health, activity effectiveness, and account progression.
• Partner closely with Sales, Marketing, and Leadership to refine messaging, improve targeting, and elevate outreach effectiveness. Actively contribute to continuous improvement of the SDR function and workflows.
• Develop a strong understanding of healthcare trends (AI in care delivery, value-based care, workforce challenges) and competitor positioning to inform outreach and conversations.

Sales Development Representative

Manager

• Responsible for improving Primary Care Physician engagement with our provider network partners.
• Establish significant “mindshare” within partners including provider network PHSO and quality teams, practice administrative staff, physicians, nurses, and management.
• Drive awareness and performance around the physician engagement annual priorities with network partners.
• Drive adoption and utilization of the Maestro technology platform in support of achieving the annual physician engagement priorities, and related quality and service offerings.
• Monitor compliance with health plan procedures and policies.
• Act as the main point of contact regarding all constituent issues surrounding practices, clinic, physicians, and patient operations.
• Responsible for training and coaching users on how to use the population health technology platform to achieve excellent performance in the physician engagement priorities and focus areas.
• Compile, analyze, interpret, and present data related to clinical performance to influence value-based care, cost, utilization, and quality care improvement processes.

Population Health Manager

• Direct and manage all phases of workstreams supporting capital raises, strategic investments, and partnerships.
• Design and orchestrate comprehensive diligence processes including data room organization, materials coordination, and information flow.
• Act as the primary strategic liaison with internal Finance and Legal teams and external advisors and counsel.
• Proactively identify, assess, and mitigate deal-related risks while ensuring adherence to critical timelines and milestones.
• Synthesize complex financial and operational data to architect compelling, executive-ready narratives for board, investor, and strategic presentations.
• Ensure financial exhibits and operational metrics clearly tell a value-creation story.
• Lead the comprehensive evaluation of partnership and investment targets, delivering clear recommendations based on rigorous financial, operational, and strategic analysis.
• Collaborate across Legal, Finance, Product, Technology, Operations, Compliance, and People & Culture as strategic initiatives progress.
• Handle highly sensitive financial, strategic, and investor information with discretion and maturity.

Senior Corporate Development Manager

• Develops and maintains long-term relationships and client satisfaction by serving as the primary liaison between the external client and internal cross-functional departments.
• Organizes cross-functional teams and workflows to proactively identify and resolve potential problems.
• Monitors compliance with health plan procedures and policies.
• Acts as the main point of contact regarding all constituent issues surrounding practices, clinic, physicians, and patient operations.
• Responsible for training and coaching users on how to use the population health technology platform to achieve excellent performance in the physician engagement priorities and focus areas.
• Responsible for driving success in plan focus areas, including the following: Access to Care, Quality Metrics, and HCC Risk Adjustment.
• Compiles, analyzes, interprets, and presents data related to clinical performance to influence value-based care, cost, utilization, and quality care improvement processes.
• Development and implementation of initiatives to improve performance against value-based contract metrics.

• Performs pre-service and concurrent reviews of requested services within specified department timelines.
• In-Patient reviews include Acute Facilities and Skilled Nursing Facilities.
• Out-Patient reviews include service authorizations and home health care.
• Applies clinical knowledge for the interpretation and evaluation of clinical data to ensure compliance with established criteria.
• Reviews authorization requests for services according to adopted Plan and InterQual criteria.
• Reviews questionable cases with facility team members and the Medical Director to assess if care requested meets medical necessity criteria.
• Documents denial process and provides timely provider and member notification following specified timelines and department protocols.
• Initiates early discharge planning, incorporating transition of care plans, with facility team members and plan's primary care providers.
• Initiates and coordinates facility transfers, incorporating transition of care plans.
• Coordinates with appropriate state representatives and internal team(s) on member and provider appeals.
• Makes appropriate referrals to quality improvement, behavioral health, and complex case management.
• Completes retrospective chart reviews and pended claims reviews as requested.
• Maintains strong collaborative working relationships with specialty, ancillary, and primary care providers.
• Documents completely and accurately within an electronic clinical record.
• Provides education on the utilization management process to members and providers as requested.
• Ensures utilization management program compliance and successful reimbursements by understanding applicable contract terms.
• Participates in care management as a member of an interdisciplinary team.
• Maintains knowledge of pertinent regulatory and accrediting requirements.
• Maintains HIPAA standards and compliance with all state and federal regulations.
• Ensures confidentiality of protected health information.
• Performs special projects as assigned.

Concurrent Review Case Manager

Customer Support

• Reviews rejected pharmacy claims for appropriateness.
• Becomes a pharmacy claim processing subject matter expert and triages claims issues.
• Assist with resolution of rejected pharmacy claims via provider and/or pharmacy outreach.
• Compiles, interprets, documents, and tracks findings from pharmacy claims monitoring data.
• Becomes subject expert with Medicare Part D policies and procedures.
• Reviews Part D transition claims reports.
• Interacts with the pharmacy benefits manager, pharmacies, prescribers, and members to ensure appropriate and timely member access to prescription drugs.
• Supports medical pharmacy prior authorizations (Part B).
• Supports Medicare Part D Customer Service call center questions and issues received from members, pharmacies, and providers.
• Supports compliance functions and requests, including support of the pharmacy department during CMS (Centers for Medicare and Medicare Services) audits when applicable.
• Supports quality programs including STARS.
• Conducts retrospective claims reviews.

Sales Development Representative

Population Health Manager

Senior Corporate Development Manager

Population Health Manager

Concurrent Review Case Manager

Pharmacy Operations Support Specialist