Legal Counsel, Carelon Contracting - Toronto

The Legal Counsel is responsible for providing legal advice and recommendations for initiatives and projects developed in response to clients overall objectives and needs. · ...

This role requires associates to be in-office 1-2 days per week, · ...

The Business Consultant will play a critical role in uncovering claims overpayments and guiding clients through implementation of data-driven insights. · ...

The Senior Investigator is responsible for the independent identification, investigation and development of complex cases against perpetrators of healthcare fraud in order to recover corporate and client funds paid on fraudulent claims. · Claim reviews for appropriate coding, dat ...

Care Navigator enables associates to work virtually full-time except for required in-person training sessions promoting productivity and supporting work-life integration. · ...

The Care Navigator Transitions of Care is responsible for ensuring that appropriate member treatment plans are followed on less complex cases and for proactively identifying ways to improve the health of our members and meet quality goals. · Coodinates follow-up care plan needs f ...

The Business Consultant is responsible for translating moderately complex and varied business needs into application software requirements. · May lead teams of analysts assigned to complex projects. · Determines specific business application software requirements to address compl ...

+ Collaborate on automation to validate claims overpayment. · + Responsible for translating moderately complex business needs into application software requirements. · +,Job summaryThis role requires associates to be in-office 1 - 2 days per week while providing flexibility to su ...

The Provider Network Manager is responsible for developing the provider network through contract negotiations (language and rates), relationship development, and servicing. · This role requires associates to be in-office 1 - 2 days per week. The position involves contracting and ...

This role requires associates to be in-office 1 - 2 days per week and provides flexibility to support productivity and work-life balance. · Primary focus of this role is contracting and negotiating contract terms. · Serves as a communication link between professional providers an ...

The Business Consultant is responsible for translating moderately complex and varied business needs into application software requirements. · May lead teams of analysts assigned to complex projects. · Analyze, design and determines specific business requirements... · ...

This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity while providing flexibility to support productivity and work-life balance. · This approach combines structured office engagement with the autonomy of virtual work promoting ...

This role enables associates to work virtually full-time with maximum flexibility and autonomy. The Medical Director is responsible for reviewing cases for IN Medicaid members. · ...

This role as Behavioral Health Medical Director enables associates to work virtually full-time with required in-person training sessions. · ...

This role enables associates to work virtually full-time with maximum flexibility and autonomy. The Behavioral Health Medical Director is responsible for reviewing cases for IN Medicaid members including child and substance use disorders. They ensure appropriate medical care is r ...

The Clinical Quality Navigator is responsible for ensuring that appropriate clinical data and documentation exists, · as well as proactively identifying ways to improve the health of our members and meet clinical quality goals. · ...

The Behavioral Health Medical Director is responsible for the administrative oversight of behavioral health medical services, · ensuring the appropriate and most cost-effective medical care is received. · ...

The Clinical Quality Navigator II is responsible for ensuring that appropriate clinical data and documentation exists, as well as proactively identifying ways to improve the health of our members and meet clinical quality goals. · ...

The Behavioral Health Medical Director-Psychiatrist Appeals is responsible for the administration of behavioral health medical services to ensure appropriate and cost-effective medical care. This role enables associates to work virtually full-time with maximum flexibility and aut ...

The Behavioral Health Outreach Care Specialist is responsible for ensuring that appropriate member treatment plans are followed on less complex cases. They proactively identify ways to improve members' health and meet quality goals. · ...