Strategic Planning and Support Works closely with the EVP to develop and execute strategic initiatives that align with the company's goals. Provides analysis, insight, and recommendations to inform the decision making process. Operational Oversight Serves as a trusted advisor to the EVP closely involved in day to day operations and ensuring alignment with strategic initia

There's a reason we've been selected as a Top Workplace in Northeast Ohio for 14 consecutive years. At Medical Mutual, we are committed to caring for our most valuable asset our dedicated employees. Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans throug

Develop data pipelines to integrate and transform data for analysis Support other data users and enable applied use of data to solve business problems Business meetings to understand data and business needs, socialize knowledge of data products and insights, and generate consensus Data profiling, data documentation, measuring and enforcing data quality Developing data mod

Identifies and analyzes employment legal issues, analyzes and assesses risk, and presents clear recommendations and hands on counsel to all levels of executive staff and management. Negotiates on behalf of the corporation in both litigation and non litigation settings (e.g. with various regulatory agencies, customers, vendors, transaction partners, etc.). Develops standar

Manage client accounts using strong customer service and proactive communication with clients and brokers. When health products exist or are in contention of selling, the Specialty Product Client Director will coordinate strategies and communication with their Client Director counterparts and/or Small Market Medical Mutual team. Serve as client subject matter expert for i

Manages the implementation and operation of the Medical Mutual Compliance Program. Participates in risk assessment and work plan development processes. Develops compliance communications, education and training materials focused on compliance with applicable laws and regulations. Conducts investigations, reviews documents, and develops corrective action plans. Assists in

Evaluates clinical information using established national decision support criteria, company policies, and individual patient considerations to ensure the provisions of safe, timely, and appropriate covered healthcare services. Independently conducts basic to complex post acute care admissions, concurrent, and retrospective reviews, including skilled nursing facility, acu

Provides professional development coaching and training to Members. Coordinates and completes case management of Administrative Referrals. Consults with Human Resources and supervisory personnel from client companies regarding employee issues and concerns and HR practice policy. Conducts telephonic triage and assessment on issues including behavioral health, substance abu

Conducts telehealth and in person intake assessments and triage, providing in the moment support to members on issues, including but not limited to behavioral health, substance abuse, relationship, and work life, and coordinates resources. Provide onsite support and training to client organizations. Coordinates and completes case management of intakes. Makes clinical dete

Ready for a change? We offer flexibility in making your own schedule and offer remote or hybrid work locations. We're building our teams across America and hiring in 30 states! Our team Reserve National Insurance Company is now MedMutual Protect! We stand for integrity, fairness and financial stability. Our company has the approval and confidence of policyholders througho

Ready for a change? We offer flexibility in making your own schedule and offer remote or hybrid work locations. We're building our teams across America and hiring in 30 states! Our team Reserve National Insurance Company (formerly known as Kemper Health) is now MedMutual Protect! We stand for integrity, fairness and financial stability. Our company has the approval and co

Develops and maintains new and existing applications by analyzing, designing and writing code of increasing complexity that satisfies a logical, efficient and optimal systems design. Leads program level and system level testing, implementation, and break fix tasks associated with business applications, including multiple platforms. Develops documentation of technical work

Managing and administering the Microsoft Azure cloud environment, including provisioning, configuration, performance monitoring, policy governance and security Designing, developing, and implementing highly available, multi region solutions within Microsoft Azure Analyzing existing operational standards, processes, and/or governance to identify and implement improvements.

HEDIS Analyst I Supports corporate and departmental strategies and goals in alignment with regulatory specifications for the annual Healthcare Effectiveness Data and Information Set (HEDIS) lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment of Healthcare Providers

Manages operations and projects of assigned commercial and government care management area in accordance with departmental and corporate objectives. This may include precertification review, concurrent review, prospective review, retrospective review and discharge planning, or clinical quality improvement. Manages and monitors workload, staffing, and training and developm