Quantum Health

Salesforce Administrator

• Participate in requirements gathering, scoping, and completion of new enhancement requests
• Provide impact analysis for change requests and communicate downstream process considerations
• Perform ongoing system administration and configuration (flows, roles & profiles, reports and dashboards, user maintenance and other routine tasks
• Ensure proper integration and data security with other Quantum information systems
• Help drive end-user adoption of Salesforce through documentation, support and training of new and current employees
• Create and maintain documentation on processes, policies, application configuration and help related materials for users
• Participate in delivery of high complexity project engagements including developing requirements, solutioning, creating test scripts, performing testing, leading UAT exercises and promoting change sets to production and other sandbox environments as needed
• Troubleshoot and resolve ad hoc platform issues
• Assist with clean-up procedures, including data migrations and mass data uploads
• Collaborate with all stakeholders to ensure Salesforce is the source of truth for defined data points and processes within the platform to support team functions and strategic initiatives
• Drive and uphold Salesforce best practice standards to ensure scalable design and high-quality delivery through a platform resource/limitation forward design approach and upholding sandbox usage and testing policies
• Prioritize learning and training into your weekly/monthly schedule focusing on established team training topics and platform scalability and best practices

Client Services Representative

• Supporting and facilitating weekly client meetings, owning the agenda, minutes and action items
• Ensuring all appropriate attendees are invited and attending
• Building and maintaining strong operational and systems knowledge, and risk mitigation
• Establishing trust and credibility with clients and consultants as a strategic partner by ensuring accurate and timely communications and issue resolution
• Participating in process improvement and annual activities, and administrative duties as required
• Leading client performance reporting, translating data into actionable, strategic insights that influence client decisions and demonstrate measurable value
• Leveraging data insights to develop, maintain and execute strategic accounts plans focused on retention, growth and satisfaction
• Providing guidance to Client Success Executive IV to optimize the partnership with Quantum Health
• Reinforcing the Quantum story and value by protecting and elevating the member experience, ensuring client confidence, strengthening membership satisfaction, and fueling long ‑ term revenue growth
• Acting as the primary client liaison within Quantum Health’s operations and cross-functional teams
• Working with the dedicated implementation team as needed to successfully onboard new clients
• Managing resolution for escalated operations issues, ensuring root cause awareness and timely action
• Managing cross-functional operational deliverables, based on client needs, to ensure client and Quantum success

Client Support Manager

Clinical Operations

• Lead the strategic direction, selection, and performance management of clinical and pharmacy vendors
• Provide executive-level consultation on vendor strategy
• Drive vendor selection, contract negotiation, performance oversight, and risk management
• Serve as the primary interface between clinical program/strategy and other internal/external stakeholders
• Shape the enterprise's preferred partnership strategy roadmap
• Direct leadership in deciding whether to add, replace, or terminate a service line
• Develop and maintain a comprehensive multi-year roadmap
• Lead contract negotiations by establishing service level agreements (SLAs) and performance guarantees (PGs)
• Develop revenue model in conjunction with Finance
• Create and finalize all Program Descriptions and Order Forms for market launch
• Develop and implement key performance indicators (KPIs) and benchmarks
• Monitor contract terms and conduct proper oversight
• Identify and implement opportunities to enhance vendor management processes
• Draft the development of technical business requirements for project success
• Maintain regular communication with clinical vendors
• Partner with sales, technical, legal, procurement, and finance teams
• Present data and information to internal and external stakeholders
• Report to legal and risk any potential compliance or regulatory issues.

Clinical Vendor Program Manager

Customer Success Manager

• Support the onboarding process for new clients, including setting up initial configurations, training, best practices, and ensuring a smooth transition to ongoing support for their specific needs.
• Serve as the primary point of contact for assigned clients, addressing their day-to-day needs, resolving issues, and acting as an advocate for their success.
• Anticipate evolving client needs based on market dynamics and knowledge of Edge and Edge-adjacent solutions and of the health plan space, and proactively recommend high-impact initiatives.
• Develop and maintain strong relationships with clients to ensure high satisfaction, retention, and renewals.
• Monitor account health using performance, engagement, and financial indicators to proactively mitigate risk and surface opportunities for improvement.
• Utilize analytics tools to generate insights and reports that demonstrate the value of our solutions and drive strategic discussions with clients.
• Serve as the voice of the client internally - collect and relay client feedback to Product, Solutioning, and Engineering teams to drive continuous improvement and innovation.
• Conduct training sessions, webinars, and workshops to ensure clients and their identified partners (health plans, benefits staff, etc.) are fully educated on the features and benefits of our solutions.
• Convey client strategic priorities internally and mobilize cross-functional teams to deliver against plans to achieve client goals, drive adoption, and maximize the value derived from our solutions.
• Address and resolve any issues or challenges clients may face in a timely and effective manner.
• Partner closely with Sales, Product, Marketing, Client Operations, and Insights teams to ensure seamless execution, consistent messaging, and alignment with client strategy and solution value.
• All other duties as assigned.

Client Success Manager

Strategy

• Design and implement frameworks that evaluate provider performance across total cost of care, clinical quality, and downstream utilization
• Quantify variation across providers to identify actionable savings opportunities driven by differences in appropriateness, effectiveness, site of service, unit price, and utilization patterns
• Develop methodologies to evaluate the downstream impact of provider selection on overall healthcare spend and member outcomes
• Translate complex performance and cost dynamics into clear, defensible scoring outputs that are both analytically rigorous and practically actionable
• Apply the total cost of care provider scoring framework to develop benefit strategies (e.g., cost-sharing structures, deductible shifts)
• Evaluate financial impact of plan changes at the population level and ensure that incentive structures are economically sustainable and aligned to expected savings
• Look at what our competitors are doing and identify gaps and opportunity areas (forward looking)
• Innovate to anticipate and meet needs of prospective clients/the market
• Partner closely with Product, Solution Engineering, Actuarial, and Data teams to inform solution design
• Collaborate with market-facing teams on GTM initiatives to refine design to meet the needs of existing clients and to evaluate opportunities for prospective clients
• All other duties as assigned

Total Cost of Care Strategy Lead

Director

• Develop and implement strategic plans for the clinical appeals program aligned with organizational goals
• Lead a team of clinical reviewers, nurses, and support staff in managing appeals and grievances
• Serve as a subject matter expert on clinical appeals, providing guidance and training to staff and leadership
• Provide daily oversight and support to the teams
• Ensure that all appeals and letters are completed within required timeframes
• Develop and review monthly reports to ensure compliance and to identify any trends
• Work with our TPA partners to develop any necessary workflows
• Oversee the end-to-end appeals process, including intake, clinical review, documentation, and resolution
• Ensure compliance with URAC and other regulatory bodies
• Monitor performance metrics (e.g., turnaround times, overturn rates, quality scores) and implement process improvements
• Review complex cases and provide clinical expertise in appeal determinations
• Collaborate with Medical Directors and external physician advisors for secondary reviews
• Maintain high standards of documentation and clinical rationale in all appeal responses
• Liaise with payers, providers, and internal departments to resolve escalated cases
• Partner with Legal, Compliance, and Quality teams to address regulatory inquiries and audits
• Represent the appeals function in cross-functional committees and initiatives
• Provide reporting for Client Executives for their groups; maintain monthly appeals/non-certification reporting
• All other duties as assigned

Director, Appeals

Manager

• Identify and assess members with the potential for solid organ or bone marrow transplant, end stage renal disease, and hematologic malignancies
• Apply the nursing process when actively case managing transplant members
• Utilize well-developed critical thinking and interpersonal skills to problem-solve and make knowledgeable recommendations for needed actions
• Document all activities specific to members, caregivers, providers, facilities and clients in appropriate database
• Maintain a collaborative relationship with members’ health care teams by communicating information, responding to requests, building rapport , and participating in team problem-solving methods
• Serve as member and provider advocate by educating and guiding through the transplant process
• Provide benefit and health information to each member so they are able to make informed health decisions
• Maintain a working knowledge of all policies and procedures related to Clinical Operations
• Work closely with and provide updates to internal client executives and employer contacts for transplant patients
• Maintain a working knowledge of employer health benefit plans and know where to access benefit information
• Be a clinical resource for all Quantum Health work teams
• Maintain working knowledge of Transplant Vendor contracts, single case rate agreements, access agreements, and negotiated agreements as required by client plan design
• Assist members and clients with wellness activities, enhanced benefits, behavioral incentives

RN, Registered Nurse – Transplant Case Manager

Vice President

• Develop and execute a health plan market strategy that supports long-term growth
• Own health plan market positioning strategy, defining how our broad portfolio of solutions is differentiated and perceived across the healthcare ecosystem
• Collaborate with commercial team leaders to define and evolve the value proposition for health plans, including persona-based messaging and storytelling tailored to executive stakeholders such as CFOs, Heads of Product, Clinical leaders, and Innovation leaders
• Map and refine the health plan buying journey to ensure messaging, positioning, content, and market engagement strategies align to the priorities and decision-making processes of key buyer personas throughout the sales cycle
• Lead the development of strategic messaging, narratives, and storytelling frameworks that clearly communicate the value of our solutions within the health plan market
• Recommend and execute conference, event, and thought leadership strategies to increase visibility and credibility within the health plan ecosystem
• Partner cross-functionally with Sales, Marketing, Product, and Strategy leadership to ensure market positioning and thought leadership reflect the evolving Quantum Health business strategy
• Define and evolve the health plan branding strategy, including recommendations for how and when the Quantum Health, Embold Health and CirrusMD brand should be leveraged within the health plan market
• Translate market positioning into clear strategic direction for Marketing, Communications, and Design execution teams
• Serve as the internal advocate for the health plan market opportunity within Quantum Health
• Collaborate on opportunities to advance and amplify the broader Quantum Health portfolio and help executive leadership understand the long-term value of sustained brand investment in a health plan context

VP Health Plan Market Strategy

• Work closely with clients to understand their business objectives and ensure the company’s product or service delivers measurable value aligned with their goals.
• Serve as the primary point of contact for key accounts, managing day-to-day communications and ensuring strong relationships with client stakeholders at all levels.
• Lead clients through the onboarding process and drive product/service adoption by providing training, best practices, and ongoing support tailored to their specific needs.
• Identify opportunities for account growth, including upselling additional services, cross-selling complementary products, and recommending new solutions that enhance client success and increase revenue.
• Proactively manage client renewals, minimizing churn through ongoing engagement and demonstrating continuous value.
• Regularly track and assess client health, using data and insights to identify risks and opportunities for deeper engagement and growth.
• Develop and execute client success plans that align with client goals and foster long-term partnerships, driving retention and growth within assigned accounts.
• Monitor key success metrics such as adoption rates, client satisfaction scores (NPS/CSAT), and revenue growth.
• Regularly report progress and outcomes to both clients and internal stakeholders.
• Act as a trusted advisor and advocate for the client, ensuring any issues or concerns are addressed swiftly and effectively, coordinating with internal teams as necessary.
• Work closely with Sales, Product, Marketing, and Support teams to ensure a seamless client experience and identify opportunities for improvement or innovation in the client journey.
• Collect and relay client feedback to internal teams, providing insights to improve product offerings, services, and overall client experience.