HealthCare Partners, MSO - Open Positions

Administration

Executive Administrative Assistant

Reporting to the Chief Physician Officer, the Executive Administrative Assistant (EAA) will provide full administrative support to the Executive Leadership Team supporting day-to-day operations relating to high-impact and valued projects. The EAA will be flexible, proactive, resourceful, and efficient, with a high level of professionalism and confidentiality.

Information Technology

Senior Database Administrator

The Senior Database Administrator plays a crucial role in ensuring the operational excellence and stability of our hybrid database architecture, spanning SQL Server on-premises, Azure SQL Databases, Managed Instances, and Fabric Databases in the cloud. Responsible for creating, managing, and monitoring mission-critical databases core to the organization's success.

The ideal candidate will ensure the availability, performance, and security of our databases, supporting both OLTP and OLAP systems, as well as integration and ELT processes. This includes the administration of SQL Server systems, the design and development of new database solutions, solving complex performance problems, capacity planning, and automation. Given our healthcare focus, strict adherence to HIPAA compliance is essential.

As a senior member of Enterprise Architecture team, you will field escalated issues related to data architecture, query design/development/best practice, provide guidance to colleagues, and work collaboratively in delivering database solutions that exceed business expectations. You are the expert and have an opportunity to influence both our data strategy and estate going forward.

Medical Management

Nurse Case Manager, Prior Authorization RN

The Nurse Case Manager, Prior Authorization RN is responsible for reviewing and processing prior authorization requests for medical services, ensuring that all clinical criteria and health plan requirements are met. This role reports to the Manager of Inpatient Utilization Management and involves collaborating with healthcare providers, patients, and internal teams to determine the medical necessity of requested services, ensuring compliance with insurance guidelines, and maintaining accurate documentation. The Nurse Case Manager, Prior Authorization RN will support the goal of delivering timely and efficient authorization decisions while promoting quality patient care.

Nurse Case Manager, RN (Case Management)

The Nurse Case Manager is responsible for engaging members enrolled in case management to provide comprehensive care coordination and education aimed at improving health outcomes. This role involves assessing medical needs, developing individualized care plans, and collaborating with healthcare professionals to address barriers and ensure continuity of care. The Nurse Case Manager also monitors progress, adjusts care plans as necessary, and supports members in navigating the healthcare system to achieve optimal wellness.

Utilization Management Specialist

The Utilization Management Specialist plays a key role in optimizing healthcare resource utilization and ensuring adherence to quality and compliance standards. This specialist-level position involves expertise in reviewing healthcare service requests, including prior authorizations, inpatient services, denials, and appeals. The role implements utilization management strategies while collaborating closely with internal and external stakeholders to drive operational excellence and improve patient outcomes.

Pharmacy

Clinical Pharmacist

The Clinical Pharmacist at a healthcare managed services organization plays a crucial role in ensuring optimal medication management and improving patient outcomes. This position involves reviewing prior authorization requests, evaluating pharmacy utilization, performing medication reconciliation, assisting members with medication adherence, and managing medications for chronic conditions. The Clinical Pharmacist will also assess medications for high-risk members enrolled in case management and for members with recurrent hospital admissions. This role will also assess the appropriateness of sites of service for medication administration, serve as a clinical pharmacy resource for other departments, and contribute to achieving high performance on quality pharmacy measures. Additionally, the Clinical Pharmacist will explore opportunities for improved pharmacy utilization, promote the use of biosimilars when appropriate, review specialty medications, and identify cost containment strategies. Finally, this role will educate and train pharmacy technicians,[providers, and members regarding medication management.

Manager, Clinical Pharmacy

The Manager of Clinical Pharmacy is responsible for overseeing essential pharmacy programs, ensuring optimal clinical outcomes, and leading a team of clinical pharmacists and pharmacy technicians. This role plays a key part in managed care operations, working collaboratively with Medical Management teams, including Utilization Management (UM), Care Management (CM), Population Health, and Quality. Reporting to the Vice President of Clinical Pharmacy & Quality, the Manager of Clinical Pharmacy provides strategic leadership in developing and implementing pharmacy initiatives that drive cost savings, improve clinical outcomes, and enhance care coordination.
The position requires strong leadership, strategic vision, and expertise in managed care operations to ensure compliance with all regulatory standards, optimize medication management programs, and support quality improvement initiatives across all lines of business.

Pharmacy Technician

The Pharmacy Technician in HealthCare Partners Managed Services Organization plays a critical role in supporting the Clinical Pharmacists and the rest of the pharmacy team to help achieve the organization's goals of effective and high-quality patient care. This position will provide crucial support to our utilization management processes related to pharmacy services and to our Quality Department by enhancing medication adherence through proactive patient outreach. Since appropriate medication use and medication adherence are the cornerstones for disease management and excellent clinical outcomes, this role is vital to the health of patients managed by HealthCare Partners.

Supervisor, Clinical Pharmacy

The Pharmacy Supervisor oversees pharmacy technicians supporting Quality and Utilization Management (UM) functions to ensure consistent operations, regulatory compliance, and alignment with organizational goals. Reporting to the VP of Clinical Pharmacy & Quality, this role bridges clinical pharmacists, non-clinical staff, and operational teams to drive effective pharmacy services in a managed care setting. The Supervisor provides daily oversight, leads team development, and leverages clinical pharmacy knowledge to enhance performance, optimize workflows, and support improved member outcomes.

Risk Adjustment

Risk Adjustment Analyst I

The Risk Adjustment Integrity Analyst I plays a critical role in supporting the Risk Adjustment department's analytics and operational initiatives. This position serves as a bridge between data-driven insights and operational execution, helping to identify and resolve gaps in clinical documentation, monitor data integrity, and inform strategies that enhance risk score accuracy and regulatory compliance. The Analyst will work collaboratively with both internal teams and external partners, including health plans and vendors, to execute projects, improve processes, and ensure accurate data submissions.
The ideal candidate is a highly motivated, analytical, and detail-oriented individual who is comfortable managing multiple priorities in a dynamic environment. This position is well-suited for individuals early in their healthcare analytics career, while also offering growth opportunities for those with prior experience in risk adjustment or healthcare data analysis.

Supervisor, Medical Coding

The Coding Supervisor is responsible for overseeing and managing the day-to-day operations related to Affordable Care Act, Medicaid and Medicare coding, project creation/assignment, and compliance. This role ensures accurate and compliant diagnostic capture and validation, adherence to CMS/NYSDOH regulations, staying current with all industry regulations, and acting as the subject matter expert within this area. The supervisor will lead a team of coding specialists, providing training, quality oversight, and performance management. The position also involves collaborating with internal departments, such as Risk Adjustment, Provider Relations, Compliance, and Quality, to ensure streamlined processes and continuous improvement.