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  • Brentwood, TN, USA
    Req #17
    Friday, March 20, 2020
    Job Summary: Functions as an innovative technical resource, guide, and collaborative visionary to help myNEXUS achieve profitable growth through exceptional and proactive financial analysis, forecasting, reporting, and provider analytics.   Essential Job Functions/Responsibilities: Own the pricing process for all new clients Own rate review for current clients to determine if adjustments are needed Create financial analysis of all proposed payment arrangements (e.g. ... More
  • Virtual
    Req #7
    Friday, March 20, 2020
    Job Summary:  Perform pre-certification, certification and/or authorization activities for Home Health Services for members with wound care needs included as contracted services that meet eligibility and benefits coverage. Oversee members who have complex wound needs to determine if the member has the current wound care for the type of wound.  Contact the home care agency and ordering physician to discuss changing the member plan of care for wound care.  Promote healing and decrease home c ... More
  • Brentwood, TN, USA
    Req #2
    Tuesday, March 17, 2020
    Job Summary:The Director / VP, Talent Development will assess organizational talent needs; design and/or source development programs; and execute all talent development efforts for myNEXUS.  This includes but is not limited to NextGen Leadership development and Supervisor Basic Training.   This candidate will also be involved in other aspects of Human Resources and will be on track to lead other HR functions. Essential Job Functions/Responsibilities:·       Leads company in assessing organizatio ... More
  • Brentwood, TN, USA
    Req #13
    Friday, March 13, 2020
    Job Summary:  The VP of Sales will report to the SVP of Business Development and will be a major contributor to the growth of myNEXUS. The VP of Sales will consistently meet or exceed revenue goals, demonstrate consistent prospecting activity to maximize new business development and maintain a robust and qualified new business development pipeline.   DUTIES AND RESPONSIBILITIES: Demonstrates Competency in the Following Areas: Contribu ... More
  • Brentwood, TN, USA
    Req #8
    Friday, March 13, 2020
    Job Summary: The VP, Product Development is responsible for providing leadership, planning, strategic direction and financial oversight for new and existing products. You will leverage existing ideas, your industry and government experience, and input from customers and prospects to improve and build new products. You will work with sales, account management, IT and finance to develop product business cases and business requirements. You will work with legal to develop products that are com ... More
  • Brentwood, TN, USA
    Req #18
    Friday, March 13, 2020
    Job Summary: This role is responsible for defining, maintaining, and implementing the principles and processes to create, and evolve all tenets of data quality. This includes understanding and documenting business rules and requirements then transforming them into a data quality construct by data subject area. Tasks include, but not limited to defining completeness, accuracy and consistency specifications by data element, writing scripts and developing tools to monitor quality at the source ... More
  • Brentwood, TN, USA
    Req #10
    Friday, March 13, 2020
    Job Summary: As a Senior Software Engineer you will be responsible for design, development and unit testing of software components in a Microsoft Azure PAAS environment. The candidate will work in a highly collaborative, cross-functional Agile team. The candidate will also be responsible for design reviews and code reviews and thereby ensure technical quality of the product deliverable.  The candidate will work in an environment where onshore and offshore development team members are workin ... More
  • Brentwood, TN, USA
    Req #9
    Friday, March 13, 2020
    Job Summary:  The Provider Network Analyst will assist the VP of Provider Performance and Strategy and the Network Team in developing and executing analytics to support the development of myNEXUS’ post-acute network strategy and growth. This role is extremely collaborative, requiring analytic experience, critical thinking skills, attention to detail, strategic mentality, and an ability to multi-task in a rapidly growing environment. Experience with health plan or post-acute care analytics is i ... More
  • Brentwood, TN, USA
    Req #21
    Friday, March 13, 2020
    Job Summary:  The Client Services Specialist is responsible for the day-to-day servicing of internal and external service requests and projects related to health plan clients. As the day-to-day service line contact for the client, the Client Services Specialist will work closely with all departments and staff to aim for the highest level of client satisfaction. This position will be directly responsible for managing the service requests, projects, reporting, and performance standards of assign ... More
  • Brentwood, TN, USA
    Req #22
    Friday, March 13, 2020
    Job Summary:  The Client Implementation Manager is responsible for managing the implementation of new business and client expansion activity. This position will manage multiple, concurrent projects while monitoring program and data work streams progress against schedule. The position will be responsible for collaborating with internal and external resources to develop the program and data requirements as well as be the voice of the client in decision making.     DUTIES AND RESPONSIBIL ... More
  • Brentwood, TN, USA
    Req #14
    Friday, March 13, 2020
    Job Summary:  The Claims Examiner I is responsible for processing claims for payment or denial to include detailed assignment including validation of claims for accuracy and completeness, confirmation of member eligibility, and verification of claim pricing and authorization to ensure service appropriateness.   Demonstrates Competency in the Following Areas: Processes claims timely for payment or denial with detailed assignment. Va ... More
  • Brentwood, TN, USA
    Req #20
    Friday, March 13, 2020
    Job Summary: The Pre-Payment Clinical Reviewer will be primarily responsible for conducting post-service, pre-payment claim reviews based on CMS and myNEXUS requirements for proper documentation, billing and coding rules, and screening for additional clinical review   Duties/Responsibilities: Complete pre-billing validation activities to ensure submitted claims for payment meet regulatory requirements to ensure the provider, home health agency, or service provider organization ... More
  • Brentwood, TN, USA
    Req #16
    Friday, March 13, 2020
    Job Summary:  The Chief Development Officer will report to the Chief Operations Officer (COO), and will be a major contributor to the growth of myNEXUS. The Chief Development Officer will consistently meet or exceed revenue goals, demonstrate consistent prospecting activity to maximize new business development and maintain a robust and qualified new business development pipeline.   DUTIES AND RESPONSIBILITIES: Demonstrates Competency in the Following Areas:   Contributes to a ... More
  • Brentwood, TN, USA
    Req #24
    Friday, March 13, 2020
    Job Summary: The Post Decision Support Specialist is responsible for daily processing and communication of all decisions following physician review.  This process requires skill in review of medical documentation, data entry, effective verbal and written communication, and documentation of actions taken. The Bilingual PDS Specialist will need to have the ability to speak, read, write, and translate Spanish.   Duties/Responsibilities: Performs management of Turn Around Time r ... More
  • Brentwood, TN, USA
    Req #11
    Friday, March 13, 2020
    Job Summary:  This role is responsible for performing risk and health analytics that cover a broad range of providers, patients, and payers.  Tasks include, but not limited to working with operations/finance/claims staff to strengthen existing payment integrity initiatives, analyzing utilization and cost data to develop medical cost drivers of the organization, producing monthly reports on utilization and cost, delivering actionable insights from analysis of utilization and cost data on key me ... More