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<h3> Position Summary </h3> Industry-leading clients. An award-winning culture. Top notch connections. Big opportunities. From learning to leadership, this is your chance to take your career to the next level. Deloitte can show you what it takes to explore an entire universe of ideas, possibilities, and opportunities—and help make an impact that matters with SAP solutions. Recruiting for this role ends on March 21, 2025 Work you’ll do At Deloitte, you’ll collaborate with top professionals to solve complex problems. In this role, you will leverage your technical proficiency, business acumen, and communication skills to deliver high-quality solutions. As a Consultant, you will contribute to the growth and success of Deloitte Consulting LLP and the SAP Offering through: <ul><li>Contributing to functional workstreams on SAP S/4HANA Public Cloud implementation projects from initiation to go-live and support. </li></ul> <ul><li>Collaborating with clients to understand their business processes, requirements, and objectives. </li></ul> <ul><li>Assisting in designing and configuring SAP S/4HANA Public Cloud solutions to meet client needs. </li></ul> <ul><li>Supporting the conduct of workshops and training sessions to ensure successful client adoption. </li></ul> <ul><li>Assisting in developing project plans, timelines, and deliverables in collaboration with stakeholders. </li></ul> <ul><li>Troubleshooting and resolving issues related to SAP S/4HANA Public Cloud implementations. </li></ul> <ul><li>Ensuring project documentation is complete and up to date. </li></ul> <ul><li>Working closely with cross-functional teams to ensure seamless project delivery. </li></ul> <ul><li>Staying current with SAP S/4HANA Public Cloud updates, features, and industry trends.</li></ul> The team Deloitte’s SAP practice helps clients move from legacy systems to enterprise-wide solutions by efficiently designing and implementing SAP solutions. Each SAP implementation focuses on achieving results that support businesses strategies through process improvement, technology, and innovation. Our work is varied and challenging, involving clients considering first time implementations as well as those experienced businesses looking to enhance their business applications. We work with clients who want to improve their ability to react in digital world and enable scalability, remove performance barriers, enable innovation, and modernize core systems and reimagine their business with SAP digital solutions. Our professionals have hands-on access and exposure to the latest technologies and committed thought pioneers. Qualifications Required: <ul><li>Minimum 2 years of relevant SAP consulting experience in a professional services environment, with a large or boutique consulting firm, or as an internal consultant within the industry.</li></ul> <ul><li>SAP implementation experience, with at least 2 years specifically in SAP S/4HANA Public Cloud.</li></ul> <ul><li>Experience in all phases of at least 1 full lifecycle SAP S/4HANA Public Cloud implementation project.</li></ul> <ul><li>Ability to travel up to 50% based on client and project needs.</li></ul> <ul><li>Bachelor's degree or equivalent.</li></ul> Desired: <ul><li>SAP S/4HANA Public Cloud certification.</li></ul> <ul><li>Familiarity with Agile project management methodologies.</li></ul> <ul><li>Experience with SAP Activate methodology.</li></ul> <ul><li>Experience in a consulting environment with a Big Four firm.</li></ul> <ul><li>Knowledge of industry-specific processes and solutions</li></ul> <ul><li>Strong communication and client management skills.</li></ul> <ul><li>Proven ability to work well in a team environment.</li></ul> <ul><li>Strong problem-solving and analytical skills.</li></ul> <ul><li>Master’s degree.</li></ul> Information for applicants with a need for accommodation: <a href="https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html" target="_blank">https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html</a> Wages + Salary The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $88,800 to $148,000. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance. #SAP23 #EPCORE Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. <a href="https://www2.deloitte.com/us/en/pages/careers/topics/recruiting-tips.html" target="_blank">Check out recruiting tips from Deloitte recruiters.</a> Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. <a href="https://www2.deloitte.com/us/en/pages/careers/articles/life-at-deloitte-benefits-and-rewards.html" target="_blank">Learn more about what working at Deloitte can mean for you.</a> Our people and culture Our inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our client most complex challenges. This makes Deloitte one of the most rewarding places to work. Our purpose Deloitte’s purpose is to make an impact that matters for our clients, our people, and in our communities. We are creating trust and confidence in a more equitable society. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. We are focusing our collective efforts to advance sustainability, equity, and trust that come to life through our core commitments. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/purpose-at-deloitte-us.html" target="_blank">Learn more about Deloitte's purpose, commitments, and impact.</a> Professional development From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career.

Deloitte

SAP Public Cloud Consultant

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.Join HCSC and be part of a purpose-driven company that will invest in your professional development.<h1>Job Summary</h1>This Position Is Responsible For The Coordination Of Workflow And Assignments Among Specialists Responsible For Implementing And Maintaining Electronic Feeds Assisting With Implementation Of Electronic Feeds And Handling Error Reports. Analyzing Feed Issues And Working With Business Analysts And/Or It To Resolve. Training Team Members. (Medical Underwriting) This position is responsible for gathering, analyzing data and developing reports from various sources from the client or vendor to support the Evidence of Insurability processes. Coordination of workflow and assignments among specialists responsible for implementing and maintaining electronic feeds for Medical Underwriting. Assisting with implementation of groups and their enrollment vendors for EOI vendor integration work supporting development, validation, testing &amp; documentation of EOI rules for the integration. Responsible for initiation, validation and completion of EOI census uploads and handling error reports. Analyzing feed issues and working with Business Analysts and/or IT to resolve. Training team members.JOB REQUIREMENTS: *Bachelor degree OR 4 years of business experience. *Clear and concise verbal and written communication skills. *Problem-solving skills. *Organizational skills. *Analytical skills. *Training and coordination skills. *Experience multi-tasking. *PC proficiency to include Word, Excel, and Lotus Notes. PREFERRED JOB REQUIREMENTS: *Experience with Dearborn Group processing systems. *Experience with electronic feed process. *Experience with group products and services.THIS IS A FLEX ROLE WORKING 3 DAYS IN THE OFFICE AND 2 DAYS FROM HOME#LI-HYBRID#LI-CH1Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!Pay Transparency Statement:At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting <a href="https://careers.hcsc.com/totalrewards" target="_blank">https://careers.hcsc.com/totalrewards</a>.The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.<h2>HCSC Employment Statement:</h2>We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.<h1>Base Pay Range</h1>$37,400.00 - $78,400.00

Blue Cross and Blue Shield of Oklahoma

Electronic Service Specialist

About Us: Our mission is to catalyze human flourishing through stewardship, serving people in all nations. We seek a transcendent impact, second to none, crossing geographies and making a permanent mark on history. We aim to uplift investors, foster flourishing families, create enduring trust, and contribute to a more beautiful world through our investments, products and services, and new ventures. Our investments are primarily in real estate, with additional allocations to tech, energy, and alternatives, employing a downside-protected, long-term approach to investing. We are grounded in timeless morals and seek to preserve and grow both our investors' capital as well as our own. We serve a diverse ecosystem that includes: <ul> <li>Multifamily apartment management with 20,000+ apartments.</li> <li>Hotel and office buildings. </li> <li>Tech ventures.</li> <li>Insurance companies.</li> </ul> Our businesses, with over 500 employees, are primarily throughout Texas and Florida, but we aim to expand globally with our products and services, impacting people in all countries. Our Mission: <ul> <li>Fanatical Investor Focus: Serve our investors by maximizing their return on equity while fostering human progress through stewardship of the assets and companies.</li> <li>Operational Excellence: Ensure assets are maintained thriftily, performance is optimized, and banking and financial obligations are met and structured wisely.</li> <li>Community Impact: Position assets as centers of profit and human flourishing for guests, residents, local governments, and the broader community.</li> <li>Ecosystem Alignment: Provide seamless oversight across all components of the Rex ecosystem, including primarily owned multifamily apartment assets and other real estate but also tech companies.</li> </ul> The Opportunity: We are seeking an elite, missionary-minded individual to join us as anCEO Project Lead. This is a rare opportunity for a driven, ambitious person to gain invaluable experience working directly on high-impact projects. The role is mission-critical, highly entrepreneurial, and demands a relentless commitment to learning, growth, and results. This is not an easy path. The journey will be demanding, challenging, and, at times, uncomfortable. However, for the right person, it will be deeply rewarding and invaluable for long-term growth. Key Responsibilities: <ul> <li>Work directly with leadership on critical business initiatives and strategic projects.</li> <li>Engage in a 24-month rotational program designed to build comprehensive business acumen and leadership capabilities.</li> <li>Support mission-critical initiatives across diverse business sectors, including real estate, private equity, and technology ventures.</li> <li>Contribute to high-impact projects requiring quick thinking, creative problem-solving, and aggressive execution.</li> <li>Embrace ambiguity, navigating complex situations with adaptability and resilience.</li> <li>Operate in a fast-paced, demanding environment that requires commitment outside traditional working hours (early mornings, late nights, weekends, holidays).</li> </ul> Ideal Candidate Profile: <ul> <li> 5-10 years of strong business experience, ideally in entrepreneurial environments or high-stakes projects. </li> <li>Demonstrated capacity to operate effectively in uncertain, dynamic environments.</li> <li>Strong business judgment, coupled with deep intellectual curiosity and a desire to drive impact.</li> <li>Insanely hard-working with an aggressive, cowboy-like mentality willing to push boundaries to achieve results.</li> <li>Embraces politically incorrect, direct communication with teammates; values forthrightness and clarity.</li> <li>Thrives in high-pressure environments with significant learning opportunities.</li> <li>Must possess exceptional grit, humility, and an intense drive for success.</li> <li>Views work as a mission—a means of making a meaningful impact on people and businesses.</li> </ul> Cultural Fit: <ul> <li>Deep desire to leave a lasting impact on the world; thrives in environments where idealism and pragmatism intersect.</li> <li>Seeks out challenging experiences that demand dedication and sacrifice.</li> <li>Prefers ambiguity over clarity and thrives in environments requiring independent thinking.</li> <li>Willing to embrace discomfort, difficult conversations, and unconventional approaches to succeed.</li> <li>Values humility, resilience, and tenacity in equal measure.</li> </ul> Rex Ecosystem-Wide Mission: Catalyze Human Flourishing. Seeking to empower customers through our products and services &amp; to elevate/further humanity in all our business dealings. Rex Values / Rex Culture <ul> <li>Customer Fanatic. We fanatically focus on customers, seeking to ever-deliver more value, and inventing/innovating on their behalf. </li> <li>Product/Service Passion. Our business thrives or dies by products/services. </li> <li>Ludicrous speed. Our default pace is extremely fast. Time is precious, life is short; and moving fast is more fun and effective.</li> <li>FAWOMO. We will find a way, or make one. </li> <li>Loves going to war: prefers wartime to peacetime, always hungry to move forward, do more, and push growth.</li> <li>Cojones: overcomes fear, uncertainty, pushing self and team.</li> <li>Fun. We should only do work, over the long run, that’s fun; and work with fun people. Jokes and humor welcomed; PC stuff and uptight behavior prohibited. </li> <li>Never-lose-money approach: protects the downside, using careful analysis before deploying significant resources, and ensuring cash is plentiful; never risking what others have and need for what they don’t have and don’t need.</li> <li>Other-centered: idealist, desperate more than anything to leave an impact with their life by helping other people, seeing money as a means to serve.</li> <li>Creative cost cutting constantly. There's always a smarter way, always room to cut, always ways to do more with less – a cost advantage is a competitive edge.</li> <li>Fewer, more capable. Bias to as lean of a team as possible, with the highest competency – reducing communication and coordination, creating more effectiveness.</li> <li>Other attributes valued: pointblank forthrightness in conversation with teammates, brutally facing problems; velvet glove with iron fist in human dealings; shrewd as a serpent innocent as a dove; hardcore work hustle; invictus mentality; swagger with humility; quiet professionalism; thrifty and not materialistic; loves who they work with, loves what they do, and loves who we serve.</li> </ul> Compensation: <ul> <li> Base Salary: $80,000 annually. </li> <li>Exceptional opportunity for personal and professional growth, including direct mentorship from senior leaders.</li> <li>Immense learning potential that will equip you with invaluable skills to accelerate your career.</li> </ul> If you are driven by impact, thrive in challenging environments, and are willing to embrace an intense journey in pursuit of leadership growth, we encourage you to apply.

CEO Project Team

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryFully remote position. Work from home anywhere in the U.S.A. Shift: Monday through Friday 11:30am to 8pm EST Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health.Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate.<ul> <li>Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.</li> <li>Provides triage and crisis support.</li> <li>Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation.</li> <li>Coordinates with providers and other parties to facilitate optimal care/treatment.</li> <li>Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.</li> <li>Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.</li> </ul>Required Qualifications<ul> <li>Must have active current and unrestricted Independent clinical behavioral health license in the state of residence (LPC, LCSW, LMFT, LMHC, etc) </li> <li> 3+ years of behavioral health experience </li> <li>Must be able to talk on the telephone and type at the same time as this is a queue based position.</li> <li>Must be able to work Monday through Friday 11:30am to 8pm EST</li> </ul>​Preferred Qualifications<ul> <li>3+ years of direct clinical practice experience post master's degree, including hospital setting or alternative care setting such as ambulatory care or outpatient program</li> <li>Managed care and utilization review experience preferred.</li> <li>Crisis intervention skills preferred.</li> </ul>Education<ul><li>Master's degree required if social worker, LPC, LCSW, LMFT, LMHC, </li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$60,522.00 - $129,615.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 04/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Utilization management Clinician Behavioral Health

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.<ul><li>Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.</li></ul><ul><li>Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making.</li></ul><ul><li>Supports effective implementation of performance improvement initiatives for capitated providers.</li></ul><ul><li>Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.</li></ul><ul><li>Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.</li></ul><ul><li>Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership.</li></ul><ul><li>Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes.</li></ul><ul><li>Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.</li></ul><ul><li>Participates in provider network development and new market expansion as appropriate.</li></ul><ul><li>Assists in the development and implementation of physician education with respect to clinical issues and policies.</li></ul><ul><li>Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.</li></ul><ul><li>Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.</li></ul><ul><li>Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality.</li></ul><ul><li>Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.</li></ul><ul><li>Develops alliances with the provider community through the development and implementation of the medical management programs.</li></ul><ul><li>As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.</li></ul><ul><li>Represents the business unit at appropriate state committees and other ad hoc committees.</li></ul><ul><li>May be required to work weekends and holidays in support of business operations, as needed.</li></ul>Education/Experience: Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population preferred. License/Certifications: Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services. Current Texas state license as a MD or DO without restrictions, limitations, or sanctions from government programs. Pay Range: $231,900.00 - $440,500.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Oklahoma Complete Health

Remote Medical Director - Texas

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Create contracts and manage the contracting process for new business opportunities, prepare contract status and metric reporting, identify gaps and risks in contracting process, and assist with work assignments and training for temporary staff.<ul> <li>Create contracts and manage contracting process utilizing the Emptoris Contract Management System to ensure that new business contract deadlines are met.</li> <li>Assist with work load assignment for temporary contract coordination staff.</li> <li>Maintain spreadsheets and databases; collect, track, prepare, compile, and distribute statistical data for daily and ad hoc reports.</li> <li>Interface with credentialing staff to ensure data and systems are in sync.</li> <li>Provide support to contract negotiators to ensure successful completion of contracting process.</li> <li>Identify gaps and risk in contracting process and coordinate with multiple departments to ensure contracting process is completed timely and accurately and within required established standards and guidelines.</li> <li>Train temporary staff as needed.</li> <li>Maintain physical and electronic file systems.</li> <li>Provide support to other departments to ensure compliance with corporate contracting standards. Position Purpose: Create contracts and manage the contracting process for new business opportunities, prepare contract status and metric reporting, identify gaps and risks in contracting process, and assist with work assignments and training for temporary staff.</li> </ul>Education/Experience: High school diploma or equivalent. 1+ years of contracting, customer service, administrative, or related experience. Intermediate skills with MS Word and Excel required. Healthcare experience and experience with provider information or Emptoris system preferred. Intermediate skills with Access preferred.Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Contract Coordinator

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Reviews, interprets and summarizes proposed and enacted legislation and regulatory updates to the business as a subject matter expert on various complex topics. Performs state or federal policy research and regulatory change monitoring with a goal of achieving formal regulatory approval of commercial/Marketplace products.<ul> <li>Identifies, analyzes and interprets proposed or enacted legislation related to Centene's commercial product at the federal and state level and communicates findings to impacted departments. Independently performs risk assessments, including impact to business applications and downstream output. Maintains database and other reference materials related to legislative and regulatory issues and compliance.</li> <li>Performs comprehensive, complex regulatory analyzes, including the review, summarization and dissemination of key regulatory updates and changes related to Commercial/ACA rules and regulations at the state and/or federal level. Leads regulatory interpretation related to Commercial/ACA Rules and regulations and the commercial product explaining concepts clearly and adapting language and presentation based on audience level. Provides advice to business as new regulations emerge.</li> <li>Uses persuasive arguments and secures cooperation from the business in order to address potential legal, contractual and/or regulatory issues. Ability to determine appropriate approach for solving regulatory problems.</li> <li>Develops trust-based relationships within varied audiences and collaborates with other functional areas to lead large projects and initiatives. Attends cross-departmental meetings as department representative, provides guidance to the business related to commercial regulatory requirements and appropriately escalates matters to management. Solutions to address potential legal, contractual and/or regulatory issues which arise working closely with Legal and Compliance.</li> <li>Support and manage relationships between health plans and regulatory agencies, including state and federal regulators. Independently drafts responses to external requests for information required by the organization for its regulatory filings and/or for policy needs.</li> <li>Responsibility for understanding regulations and business needs for multiple states, as well as federal regulations pertaining to the commercial health insurance market.</li> <li>Assesses and analyzes objections related to regulatory interpretation and leads drafting of appropriate responses which are provided to regulators related to commercial/ACA filings. Partners on response with cross-functional partners as needed.</li> <li>Leads the research and regulatory guardrails for new state entry and new product development, working closely with legal on preparation of COA application materials/submissions for new states and/or products.</li> <li>Assists in developing and mentorship of junior employees, supporting creation and revisions to training materials. May attend external and/or virtual conferences and seminars to evaluate industry trends.</li> <li>May attend external and/or virtual conferences and seminars to evaluate industry trends.</li> <li>Performs other duties as assigned</li> <li>Complies with all policies and standards</li> </ul>Education/Experience: Bachelor's Degree in Business, Communications, Healthcare, Political Science/Pre-Law or equivalent experience required: Master's Degree in a related field, Juris Doctorate degree may be considered in place of experience preferred. 4+ years experience in health insurance, legal, compliance or related field required. Experience reviewing regulations and providing interpretation using terms appropriate for the audience preferred. Experience in commercial health insurance and/or behavioral health managed care preferred. Please note: this is a remote position with Central Time (CT) work hours.Pay Range: $68,700.00 - $123,700.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Regulatory Operations Analyst III

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.Join HCSC and be part of a purpose-driven company that will invest in your professional development.<h1>Job Summary</h1>This position is responsible for assigned aspects of edical policies and programs. Performs medical reviews and interacts with the provider communities for assigned areas.JOB REQUIREMENTS:. * Physician (M.D. or D.O) with a current and unrestricted physician license in a the state of Oklahoma. * Maintain Board Certification by a specialty board approved by the American Board of Medical Specialties, National Board of Physicians and Surgeons, or the Advisory Board of Osteopathic Specialists * 5 years of clinical experience * Analytical and communication skills * Strategic thinking skills * Proficiency in computer skills (including software applications such as Microsoft Office Product and Lotus Notes) needed for electronic documentation of case reviews PREFERRED REQUIREMENTS: * 3 years Managed Care experienceThis is a Telecommute (Remote) role: Must reside withing 250 miles of the office or anywhere within the posted state.#LI-MG1Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!Pay Transparency Statement:At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting <a href="https://careers.hcsc.com/totalrewards" target="_blank">https://careers.hcsc.com/totalrewards</a>.The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.<h2>HCSC Employment Statement:</h2>We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.<h1>Base Pay Range</h1>$187,700.00 - $348,600.00

Medical Director

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. ***Remote role. Preferred candidate has strong background in Utilization Management/Claims Review and/or Appeals.***Position Purpose: Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards.<ul> <li>Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal</li> <li>Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards</li> <li>Communicates with members, providers, facilities, and other departments regarding appeals requests</li> <li>Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards</li> <li>Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeals requests</li> <li>Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices</li> <li>Performs other duties as assigned</li> <li>Complies with all policies and standards</li> </ul>Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification:<ul> <li>LPN - Licensed Practical Nurse - State Licensure required or</li> <li>LVN - Licensed Vocational Nurse required or</li> <li>RN - Registered Nurse - State Licensure and/or Compact State Licensure required or</li> <li>LCSW- License Clinical Social Worker required or</li> <li>LMHC-Licensed Mental Health Counselor required or</li> <li>LPC-Licensed Professional Counselor required or</li> <li>Licensed Marital and Family Therapist (LMFT) required or</li> <li>Licensed Psychologist required</li> </ul>Pay Range: $26.50 - $47.59 per hourCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Clinical Review Clinician - Appeals

<h3> Position Summary </h3> Position Summary As a Sr. GenAI Engineer, you will actively engage in your engineering craft, taking a hands-on approach to multiple high-visibility projects. Your expertise will be pivotal in delivering solutions that delight customers and users, while also driving tangible value for Deloitte's business investments. You will leverage your extensive GenAI &amp; engineering craftsmanship and advanced proficiency across multiple programming languages and modern frameworks, consistently demonstrating your exemplary track record in delivering high-quality, outcome-focused solutions. Recruiting for this role ends on 4.1.25 Work you’ll do <ul> <li> Outcome-Driven Accountability: Embrace and drive a culture of accountability for customer and business outcomes. Develop engineering solutions that solve complex problems with valuable outcomes, ensuring high-quality, lean designs and implementations.</li> <li> Technical Leadership and Advocacy: Serve as the technical advocate for products, ensuring code integrity, feasibility, and alignment with business and customer goals. Lead requirement analysis, contributing to low-level architecture and component design, development, unit testing, integrations, and support.</li> <li> Engineering Craftsmanship: Maintain accountability for the integrity of code design, implementation, quality, data, and ongoing maintenance and operations. Stay hands-on, self-driven, and continuously learn new approaches, languages, and frameworks with significant focus on infusing AI/ML/GenAI where possible/appropriate. Create technical specifications, and write high-quality, supportable, scalable code and review code of other engineers, mentoring them, to ensure all quality KPIs are met or exceeded. Demonstrate collaborative skills to work effectively with diverse teams.</li> <li> Customer-Centric Engineering: Develop lean engineering solutions through rapid, inexpensive experimentation to solve customer needs. Engage with customers and product teams before, during, and after delivery to ensure the right solution is delivered at the right time.</li> <li> Incremental and Iterative Delivery: Adopt a mindset that favors action and evidence over extensive planning. Utilize a leaning-forward approach to navigate complexity and uncertainty, delivering lean, supportable, and maintainable solutions.</li> <li> Cross-Functional Collaboration and Integration: Work collaboratively with empowered, cross-functional teams including product management, experience, and delivery. Integrate diverse perspectives to make well-informed decisions that balance feasibility, viability, usability, and value. Foster a collaborative environment that enhances team synergy and innovation.</li> <li> Advanced Technical Proficiency: Possess deep expertise in modern software engineering practices and principles, including AI/ML/GenAI, Agile methodologies and DevSecOps to deliver daily product deployments using full automation from code check-in to production with all quality checks through SDLC lifecycle. Strive to be a role model, leveraging these techniques to optimize solutioning and product delivery. Demonstrate strong understanding of the full lifecycle product development, focusing on continuous improvement and learning.</li> <li> Domain Expertise: Quickly acquire domain-specific knowledge relevant to the business or product. Translate business/user needs, architectures, and UX/UI designs into technical specifications and code. Be a valuable, flexible, and dedicated team member, supportive of teammates, and focused on quality and tech debt payoff.</li> <li> Effective Communication and Influence: Capable of articulating complex technical concepts clearly and compellingly. Inspire and influence teammates and product teams through well-structured arguments and trade-offs supported by evidence. Create coherent narratives that align technical solutions with business objectives.</li> <li> Engagement and Collaborative Co-Creation: Engage and collaborate with product engineering teams at all organizational levels, including customers as needed. Build and maintain constructive relationships, fostering a culture of co-creation and shared momentum towards achieving product goals. Align diverse perspectives and drive consensus to create feasible solutions.</li> </ul> The successful candidate will have and/or be able to: The ideal candidate will be a dependable team player and mentor, collaborating with cross-functional teams to design, develop, and deploy advanced software solutions. <ul> <li>Understanding and experience in managing big data of various forms to generate insights and create intelligence.</li> <li>Understanding of methodologies &amp; tools like, XP, Lean, SAFe, DevSecOps, SRE, ADO, GitHub, SonarQube, etc. to deliver high quality products rapidly.</li> <li>Excellent interpersonal and organizational skills, with the ability to handle diverse situations, complex projects, and changing priorities, behaving with passion, empathy, and care.</li> </ul> The Team US Deloitte Technology Product Engineering has modernized software and product delivery, creating a scalable, cost-effective model that focuses on value/outcomes that leverages a progressive and responsive talent structure. As Deloitte’s primary internal development team, Product Engineering delivers innovative digital solutions to businesses, service lines, and internal operations with proven bottom-line results and outcomes. It helps power Deloitte’s success. It is the engine that drives Deloitte, serving many of the world’s largest, most respected companies. We develop and deploy cutting-edge internal and go-to-market solutions that help Deloitte operate effectively and lead in the market. Our reputation is built on a tradition of delivering with excellence. Qualifications Required: <ul> <li>Bachelor's degree in computer science, software engineering, or related field.</li> <li>6+ years of engineering experience focused in AI/ML</li> <li>2+ years of recent experience in GenAI utilizing technologies such as: OpenAI, Claude, Gemini, LangChain, Agents, Vector databases and approaches like Prompt Engineering, fine-tuning, etc.</li> <li>Limited immigration sponsorship may be available</li> </ul> Preferred: <ul> <li>8+ years of engineering experience focused in AI/ML</li> <li>Prior experience in Python, R, TensorFlow, PyTorch, Keras, Julia, ML libraries, NLP.</li> <li>Prior experience with Angular, React, NodeJS, Python, Streamlit, C#, .NET Core, Golang, SQL/NoSQL.</li> <li>Prior experience with experience with cloud-native engineering, using FaaS/PaaS/micro-services on cloud hyper-scalers like Azure, AWS, and GCP.</li> <li>Prior experience and familiarity with XP, Lean, SAFe, DevSecOps, SRE, ADO, GitHub, SonarQube.</li> <li>Advanced degree (e.g., MS) in computer science, software engineering, or related field.</li> </ul> The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $102,500 to $ 210,600. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance. Information for applicants with a need for accommodation: Hyperlink: <a href="https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html" target="_blank">https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html</a> EA_ITS_ExpHire Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. <a href="https://www2.deloitte.com/us/en/pages/careers/topics/recruiting-tips.html" target="_blank">Check out recruiting tips from Deloitte recruiters.</a> Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. <a href="https://www2.deloitte.com/us/en/pages/careers/articles/life-at-deloitte-benefits-and-rewards.html" target="_blank">Learn more about what working at Deloitte can mean for you.</a> Our people and culture Our inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our client most complex challenges. This makes Deloitte one of the most rewarding places to work. Our purpose Deloitte’s purpose is to make an impact that matters for our clients, our people, and in our communities. We are creating trust and confidence in a more equitable society. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. We are focusing our collective efforts to advance sustainability, equity, and trust that come to life through our core commitments. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/purpose-at-deloitte-us.html" target="_blank">Learn more about Deloitte's purpose, commitments, and impact.</a> Professional development From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career.

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