Duties:    The primary purpose of the job is to:• Tracking and monitoring pharmacy credentials to ensure compliance with plan standards, accreditation agencies and state and federal regulatory guidelines.  Issuing notification to pharmacies when there are lapses in complianc...
Location: 200 Stevens Dr, Philadelphia, PA 19113, USA, Pennsylvania, USA
Duties:    •    The primary purpose of the job is to:•    The Personal Care Connector (PCC) is a high-touch, extremely effective service specialist, responsible for supporting the daily operations of Medicare Member Services (Personal Service Pr...
Location: 200 Stevens DrPhiladelphia, PA 19113, USA, Pennsylvania, USA
Duties:    • The primary purpose of the job is to:• The IT Sourcing Consultant is responsible for developing category sourcing and negotiation strategies for acquiring complex goods and services (i.e. IT hardware, software, and services), reducing costs, and achieving organi...
Location: 200 Stevens Drive, Philadelphia, PA 19113, Pennsylvania, USA
Duties:    • The primary purpose of the job is to:• The Investigative Data Analyst will provide data analysis support to the SIU.  • Conduct data mining efforts to identify outliers and trends based on relevant fraud, waste, and abuse topics and media, state, and f...
Location: 200 Stevens Drive, Philadelphia, PA 19113, Pennsylvania, USA
Project Analyst Oct-11-2018
Duties:    The primary purpose of the job is to: • To support major existing client projects and new business implementations through coordinating and completing detailed documentation ensuring timely, accurate, and efficient requirements and deliverables for on-time execution. S...
Location: 200 Stevens Drive, Philadelphia, PA 19113, Pennsylvania, USA
Duties:    The primary purpose of the job is to: Under the general supervision of the Supervisor of Pharmacy Prior Authorization Technicians, the Pharmacy Services Technician I assists in the prior authorization process. • Responsible for reviewing and approving physician or memb...
Location: 200 Stevens Drive, Philadelphia, PA 19113, Pennsylvania, USA
Grievance Associate Oct-24-2018
Duties:    • The primary purpose of the job is to: Working with the Operations Supervisor or Grievance Coordinator, the Grievance Associate is responsible for ensuring all problems, complaints and grievances, presented by Plan members or their representatives are resolved in acco...
Location: 200 Stevens Dr, Philadelphia, PA 19113, Pennsylvania, USA
Duties:    • Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely...
Location: 200 Stevens Drive, PA001, Pennsylvania, USA
Duties:    • Under the direct supervision of the Supervisor, Pharmacy Services Call Center, the Pharmacy Call Center Technician is responsible for providing knowledgeable and courteous customer assistance and response to members, providers and Pharmacy Call Center Technician inqu...
Location: 200 Stevens Dr, Philadelphia, PA 19113, USA, Pennsylvania, USA
OA-OIT - A4 Core BA3 Nov-30-2018
Short Description:Business Analyst 3 (BA3) - 7 plus years relevant experience The Senior Business Analyst will develop and document the business analysis and requirements to build an automated performance dashboard for Human Resources and Information Technology.  The dashboard will be upda...
Location: Harrisburg, Pennsylvania, USA