PS Utilization Review Nurse-NM


Utilization Review Nurse (RN/LPN)

This position is remote. There is also a weekend rotation, will need to be available approximately one Saturday a month on average. On weeks that they are scheduled for Saturday, they are given the prior Monday off (allowing for a 3 day weekend).

RN or LPN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.

Required: Clinical License, RN/LPN
Preferred: Previous MCO or UM experience. Microsoft Office familiarity

Developer Specialist-IL


Developer Specialist

Job Purpose: This position is responsible for developing, integrating, testing, and maintaining existing and new applications; knowing one or more programming languages; knowing one or more development methodologies / delivery models alongside the Domain expertise in Healthcare. This position requires extensive data and integration experience. An integration or data architecture background is preferred, but not required.

Required Job Qualifications:
*Bachelor Degree and 5 years Information Technology experience OR Technical Certification and/or College Courses and 7 year Information Technology experience OR 9 years Information Technology experience. Master’s degree (in a technical related subject) preferred but not required.
*Possess ability to manage workload, manage multiple priorities, and manage conflicts with customers/employees/managers, as applicable. Furthermore, ability to direct / manage a team of integration designers, developers, and testers in building large scale, complex integrations throughout a modern data ecosystem.
*Must have experience with NoSql Databases like HBASE, Mongo, CosmoDB, Graph Databases or Cassandra
*Must have working knowledge of cloud computing infrastructure (e.g. Amazon Web Services EC2, Azure) and considerations for scalable, distributed systems. Pivitol Cloud Foundry (PCF)
* Must have extensive knowledge working with version control tools like GIT and SVN.
* Hands on experience with PCF using Talend suite.
* Experience implementing complex business rules in Talend by creating Reusable Transformations and robust mappings/mapplets. Experience in loading data, troubleshooting, Debugging and tuning of Talend mappings.

* Hands-on experience in Performance tuning of Talend and Informatica ETL, Integration, Queries and Jobs.
*Demonstrates broad knowledge of technical solutions, design patterns, and code for medium/complex applications deployed in Hadoop production. Additionally, experience in design for sustainability – minimize impact on operations crews in the event of systems outages, unexpected data, etc., as well as engineering the code base for straightforward extensions / expansions.
*Must have working experience in the data warehousing and Business Intelligence systems. Additionally, experience in building in data quality analysis in-line in integration flows. Experience in working with metadata across the integration landscape in support of data governance and operational needs.
*Participate in design reviews, code reviews, unit testing and integration testing.
*Assume ownership and accountability for the assigned deliverables through all phases of the development lifecycle.
*SDLC Methodology (Agile / Scrum / Iterative Development).
*System performance management.
*Systems change / configuration management.
*Business requirements management.
*Problem solving /analytical thinking.
*Creative thinking.
*Ability to execute.
Preferred Job Qualifications:
*Master’s Degree in Computer Science or Information Technology.

Required: Java (8), React.JS, Javascript with experience hooking APIs up to webpages

???????Preferred: Cloud Experience (we use PCF on prem and Azure cloud)

PS Health Coordinator-NM


Health Coordinator

This position is responsible for conducting research, performing data entry, responding to inquires from agencies, and supporting the clinicians in the Medical Management department with their provider and member activities.

? 1 year of college and 2 years experience with automated systems OR 3 years experience with automated systems.
? 1 year experience with managed care system(s).
? Knowledge of medical terminology.
? PC proficiency including Microsoft Office applications.
? Customer service skills.
? Verbal and written communications skills including developing written correspondence to members and to other department personnel and coaching skills to educate members on medical issues.

Senior Program Manager-IL


Senior Program Manager

Both technical and soft skills to deliver a complex programs · Worked for large health care insurance companies in past, stakeholders across all levels and built customer relationships · Experience in program management life cycle and portfolio management · Overall coordination of project managers that projects within program are delivered on time, within budget and to an agreed quality level, status reporting and ensure stability of program efforts · Experience in both operational and program budgets · Handled project interdependencies and providing quick business decisions for program based on the consideration of other projects · Strong verbal and written communication to tailor for specific audience · Experience implementing action plans to allocate resources in program · Experience in negotiation, influencing others and managing conflict · Lead dynamically and energize work teams to respond to business needs · Client management and working with diverse business units · Assists in planning for, communicating, and mitigating risks to program · Budget size is $50m and up · Multiple ?programs? under one umbrella · Transformational and Disruptive · Complexity across multiple business areas or entire enterprise that include changes to systems, process, and tools · Responsible for 50+ PM resources and 100+ project team including business/IT resources · Business sponsors are EVPs and C-Level Executives · Strategy, Governance and Direction, assist in the prioritization · Big Picture – Broad knowledge across enterprise and/or broad industry expertise · Cross the Enterprise · Ability to recover any type of program · Develop program structure, staffing needs · Focus is corporate strategic goals · Provides mentoring to project team and Business customers (usually focused on business direction, transformational change agent, and alignment to corporate goals) · In-depth knowledge of Budgeting, Planning and Forecasting · 10yrs+ managing
projects, 5 years managing large programs

Technology Risk Management Consultant


Technology Risk Management Consultant

Background to Role:

The Global Information Security (GIS) Technology Risk Management Senior Analyst will work with peers in GIS and across the Technology Division to ensure that third party technology risks are properly identified, assessed, monitored, and communicated in support of the overall Third Party Risk Management (TPRM) program. The Senior Analyst will assist with the continuous improvement and daily operation of the GIS Third Party Risk Management (GIS TPRM) program.


Responsibilities Include:

  • Work with peers to identify and assess Information Security risks
  • Conduct risk assessments using established GIS Third Party Risk Management assessment process
  • Collaboratively author and edit various assessment related documents including Deficiencies Observed, Summary of Work, Risk Advisory Memos, exceptions from GIS technical policies and standards, and other related output resulting from risk adjudication activities
  • Participate in and contribute to various working groups across the Technology Division, including, but not limited to, Third Party Risk Management working group, GRC working group, etc.
  • Assist the GIS Third Party Risk Management function with:
    • Continuous improvement and maturation of the methods, instrumentation, training, documentation, and processes required to properly manage third party technology risks
    • Providing advisory and consulting services to the Information Technology Management Team related to InfoSec risks, treatment strategies, and decision-making
    • Assist in the preparation of management reports, presentations, metrics, and other documentation required to support governance functions
    • Assist in compiling and delivering business and operational metrics at regular intervals
    • Promoting a culture of risk awareness and accountability through training, education, and risk management consultative support
  • Problem Solving:
    • Objectively assess the impact, likelihood, and velocity of identified risks
    • Objectively advise on any number of controls that will mitigate risk while not imposing undue burden on those who must implement the controls
    • Drive objectivity and build consensus among stakeholders with widely divergent perspectives and drivers
    • Rapidly analyze complex technical details
    • Synthesize detailed analysis into a “big picture” view that can be easily understood by non-technical stakeholders in order to support risk-based decision-making for senior managers within the company
  • Decision Making:
    • Recommend risk treatment decisions
    • Recommend remediation actions when risk mitigation is desired
    • Recommend improvements to methods, instrumentation, training, documentation, and processes
    • Recommend solutions for automating and streamlining GIS TPRM risk management practices
  • Working Relationships:
    • Interacts with peers across all elements of the Technology Division
    • Communicate regularly with cross-functional peers outside of the Technology Division, including Legal, Information Governance, Global Operations, Global Assurance (Internal Audit), Enterprise Risk Management, Third Party Risk Management, and other business unit leadership
    • Interact occasionally with industry peers from other SIFMUs, research organizations, solution providers, etc.

Required Experience:

  • Bachelor’s Degree or equivalent experience
  • Minimum of 4 years of relevant experience in publicly traded companies or finance/technology industry operations with third party risk management experience a plus
  • Experience in at least two of the following: InfoSec (Operations, Program Management, Governance, Risk Management, etc.), Enterprise Architecture, Identity & Access Management, Application Development, Infrastructure & Operations, IT Compliance, or Internal Audit
  • Experience working with industry based information security and / or control frameworks (NIST Cyber Security Framework, ISO 27002, COBIT, etc.)
  • Demonstrable knowledge of a broad range of InfoSec technologies and practices
  • Demonstrable, impeccable writing skills for technical, management, and executive audiences


Additional preferred experience:

  • Demonstrable knowledge of InfoSec risk management methods and practices
  • Experience with operating GRC solutions
  • Professional certification in InfoSec or Risk Management (such as CRISC, CISM, CISSP, CGEIT, CISA, etc.)

Systems Analyst-IL


Sr System Analyst
This position is responsible supporting enhancements and new capabilities to an existing, critical, distributed based business application within our applications space. As a systems analyst, it is required you bring strong experience of performing Systems Analysis for various projects and build a backlog of systems requirements that can be assigned to various developers. You are also responsible for ensuring reviews of the requirements, designs, code and help plan SIT and UAT testing as well as releases. You will be working closely with the business team comprising of business analysts, business owners, QA team as well as IT team members like Applications Architects, Developers, product and project managers and other team members.

Required Job Qualifications
*Bachelor Degree and 4 years Information Technology OR Technical Certification and/or College Courses and 6-year Information Technology experience OR 8 years Information Technology experience.
* Experience with Source Code management tools like GitHub
* Knowledge of code deployments and SIT / UAT across Test, Cycle and Production environments
* Inter-testing with various applications
* Exposure to integration with various applications
*Requirements analysis, Systems Analysis and Developing Logical & Physical designs
*SDLC Methodology – Optimized Waterfall. Exposure to Agile / Scrum / Iterative Development
*Problem solving and analytical thinking
*Strong oral/written communication skills
*Deep Application Development experience on distributed side
*Ability to execute projects against tight timeframe
* Ability to work in fast paced environment with concurrent projects
* Mentor and guide developers and ensure delivery with high quality for all the projects you are assigned to

Required: Java 8 /J2EE/ Spring Framework 5 , MVC, JDBC, Microservices, Spring Boot, Messaging (IBM MQ)

Preferred Job Qualifications: React.JS, Backbone.JS

Solution Architect-IL


Solution Architect

This position will be defining the solution architecture definition for a new line of business as it relates to Corporate Services function including automated marketing with Adobe. 

Senior Solution Architect to define the architecture for a new line of business as it relates to our Corporate Services functions including automated marketing and communication with Marketo, Adobe Target, Adobe CDP, Adobe Experience Platform and other Adobe services. The architecture will also need to support the migration of existing lines of business built on our legacy solution to this new solution.

1. Architecture Definition – Responsible for the definition, documentation, and communication of the solution architecture congruent with Enterprise direction while operating in a matrix environment including,
* Translating business requirements into architected solutions
* Collaboratively developing and clarifying architectural options with Business and IT delivery stakeholders
* Providing business and technical justification including CBA, ROI, impacts and risks of the options
* Gaining agreement on proposed solution architecture
2. Architecture Realization – Responsible for supporting project and/or product teams on functional and technical design activities to ensure alignment of detailed designs with the approved solution architecture.
3. Stakeholder Management – Maintain close working relationships management and delivery teams.
4. Raise risks, issues and key decision to leadership as required using structured and supporting analysis.
5. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
6. Maintain complete confidentiality of company business.
7. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.


• Bachelors’ degree in related technical / business areas or equivalent work experience.
• 10+ years of relevant work experience including significant Solution Architecture experience in a large enterprise
• Understands all domains of architecture, APIs and Analytics.
• Strong integration skills and understanding of how data, function and integration intersect.
• Ability to drive outcomes in a matrixed environment even when requirements are ambiguous.
• Experience in reviewing detailed designs to ensure architectural alignment and project success.
• Strong stakeholder management skills, negotiation and leadership skills.
• Strong written and verbal communications skills with ability to quickly develop impactful presentations.
• Strategic minded thinking with critical thinking skills, strong analytical skills and creative problem-solving ability.


• Architect solutions with Adobe Suite of Products
• Healthcare industry desired

Required: Solution Architecture skills and ability to operate in Adobe product environment

Application Architect-IL


Java Full Stack

Java Full Stack Developer with React JS and hands on experience, Microservices, Spring, Rest, DB2

Provides design recommendations based on long-term IT organization strategy · Develops enterprise level application and custom integration solutions including major enhancements and interfaces, functions and features · Uses a variety of platforms to provide automated systems applications to customers · Provides expertise regarding the integration of applications across the business · Determines specifications, then plans, designs, and develops the most complex and business critical software solutions, utilizing appropriate software engineering processes?either individually or in concert with project team · Will assist in the most difficult support problems · Develops programming and development standards and procedures as well as programming architectures for code reuse · Has in-depth knowledge of state-of-the art programming languages and object-oriented approaches in designing, coding, testing and debugging programs · Understands and consistently applies the attributes and processes of current application development methodologies Researches and maintains knowledge in emerging technologies and possible application to the business Viewed both internally and externally as a technical expert and critical technical – Requires specialized depth and/or breadth of expertise- Interprets internal or external business issues and recommends best practices- Takes initiative to solve complex problems; takes an ?outside ?in perspective to identify innovative solutions- Works independently, with guidance in only the most complex situations- May lead functional teams or projects Bachelor's Degree in Computer Science, Information Systems or other related field. Or equivalent work experience. 7 years of experience in multiple IT areas and 3 years of relevant architecture experience. Requires advanced to expert level knowledge and understanding of architecture, application systems design and integration.

Required: Java Full Stack Developer with React JS and hands on experience, Microservices, Spring, Rest, DB2

Preferred: BackboneJS

Business Analyst-IL


Business Analyst

This position is responsible for functions on projects of moderate to high complexity by working with business partners within multiple business functions to align technology solutions with business strategies; eliciting, documenting, and refining business requirements for the IT organization; serving as a liaison across multiple facets of the business community and the IT organization in order to provide technical solutions to meet user needs; leveraging an informed knowledge of business areas to identify and/or resolve problems on an ongoing basis.

Skill set requirements:
• Hands on BA experience (2-4 years) with scrum background
• Strong communication skills
• Ability to lead meetings and document outcomes
• Jira expertise
• Nice to have: Front end portal background (UI understanding) to help document user stories and epics

Required: Strong communication skills •Salesforce Experience • Jira expertise

Preferred: Front end portal background (UI understanding) to help document user stories and epics

Systems Analyst-IL


System Analyst

Analyze business systems needs working with various levels of end-users to create the logical specifications for software/hardware systems that will provide a solution for the needs of moderation to complex business problems. Performs the research necessary to create technical designs and logical functionality which will ensure that business application systems can be effectively developed and implemented to meet actual business needs. This position does not involve hands-on programming but focuses on the analysis, definition and logical design of hardware/software systems.

Required: Java 8 /J2EE/ Spring Framework 5 , MVC, JDBC, Microservices, Spring Boot, Messaging (IBM MQ)