Guide Healthcare

Manager

• Support client success through client onboarding, operational support, and service delivery
• Engage virtually with clients, health plans, and internal teams
• Own onboarding, ongoing operational support, and service delivery from go-live through steady state
• Build and maintain relationships with client administrators, network providers, and management teams
• Manage delegated-service delivery across Eligibility, non-clinical UM, PHM, Claims, Quality, CX, and Credentialing/Provider Relations
• Serve as primary accountability owner for delegated-function performance
• Ensure regulatory and contract compliance
• Prepare monthly delegated-services report-outs and quarterly executive review materials
• Support URAC, HCAPA, and health plan pre-delegation audit preparation
• Track, analyze, and report operational data and performance metrics monthly
• Identify trends and drive issues to resolution across internal functions
• Own eligibility, capitation, and reconciliation processes and resolve discrepancies with Finance and Eligibility
• Contribute to new-client implementations, scope expansions, platform transitions, network builds, and accreditation renewals
• Track SLA performance against contract requirements and drive remediation
• Lead client operational meetings and participate in UM committees, JOCs, and monthly close meetings
• Conduct client check-ins, satisfaction reviews, and quarterly executive business reviews
• Track CSAT and NPS against annual targets
• Own escalations involving claim denials, authorization issues, eligibility questions, provider complaints, roster discrepancies, payment issues, and other operational issues
• Support renewals, including SLA restructuring, PMPM negotiation input, scope expansion proposals, and BAA updates
• Represent Guidehealth at BCBSIL forums and translate regulatory and program changes into operational actions
• Maintain client contract documentation, DORs, SOWs, and SLA schedules
• Contribute to operational-improvement initiatives such as paper-claims reduction, EFT/ERA adoption, OON reduction, and denial workthrough
• Use EMR systems, payer portals, Guidehealth applications, and Microsoft 365
• Collaborate with internal teams to deliver integrated services and a consistent client experience

Client Business Manager

Data Analyst

• Handle a wide-ranging portfolio of analytic needs across internal teams and external clients
• Work with claims, eligibility/enrollment, clinical, and supplemental healthcare data
• Produce reliable, well-documented analytic datasets
• Design, build, and deliver analyses addressing business and clinical questions from scoping through presentation
• Own custom client builds end-to-end, including scope definition, development, iteration, and maintenance
• Develop analyses supporting value-based care programs, quality measure performance, risk adjustment, risk score accuracy, and utilization and cost-of-care trends
• Serve as an analytic point of contact for assigned clients
• Validate results and investigate anomalies
• Balance competing priorities across accounts and internal initiatives
• Communicate findings to technical and non-technical audiences through written summaries, presentations, and visualizations
• Document methodology, assumptions, and data limitations for reproducibility and transferability
• Follow security policies and procedures to protect PHI, PII, and company intellectual property
• Participate in identity verification during hiring and onboarding

Senior Data Analyst

Pharmacist

• Lead efforts to improve HEDIS medication adherence and pharmacy quality measures
• Analyze medication adherence data, identify care gaps, and implement targeted interventions
• Collaborate with healthcare providers, care managers, and stakeholders on adherence strategies
• Conduct medication therapy management (MTM) sessions and provide patient education
• Identify and resolve medication adherence barriers including cost, side effects, and complex dosing schedules
• Use motivational interviewing techniques to encourage adherence
• Monitor and track HEDIS performance metrics and generate effectiveness reports
• Use EHR and pharmacy data to identify patients at risk of non-adherence and develop action plans
• Provide leadership with progress updates and improvement recommendations
• Serve as the organization’s medication adherence subject matter expert
• Train and support pharmacists, care managers, and clinical staff on medication adherence best practices
• Participate in cross-functional quality improvement, population health management, and value-based care initiatives
• Follow security policies and procedures to protect patient and company data
• Be accessible during stated working hours and participate in virtual meetings with cameras on

Clinical Pharmacist – HEDIS Medication Adherence

• Lead efforts to improve HEDIS medication adherence and pharmacy quality measures
• Analyze medication adherence data, identify care gaps, and implement targeted interventions
• Collaborate with providers, care managers, and stakeholders on adherence strategies
• Conduct medication therapy management sessions and provide patient education
• Identify and resolve adherence barriers such as cost, side effects, and complex dosing
• Use motivational interviewing to encourage adherence
• Monitor HEDIS performance metrics and generate effectiveness reports
• Use EHR and pharmacy data to identify at-risk patients and develop action plans
• Report progress toward HEDIS goals to leadership and recommend improvements
• Serve as the organization's medication adherence subject matter expert
• Train and support pharmacists, care managers, and clinical staff
• Participate in quality improvement, population health management, and value-based care initiatives
• Follow security policies to protect PHI, PII, and company intellectual property

• Lead efforts to improve HEDIS medication adherence and pharmacy quality measures
• Analyze medication adherence data, identify care gaps, and implement targeted interventions
• Collaborate with healthcare providers, care managers, and stakeholders on adherence strategies
• Conduct medication therapy management sessions and provide patient education
• Identify and resolve adherence barriers including cost, side effects, and complex dosing schedules
• Use motivational interviewing to encourage adherence
• Monitor HEDIS performance metrics and generate effectiveness reports
• Use EHR and pharmacy data to identify patients at risk of non-adherence and develop action plans
• Provide leadership with progress updates and improvement recommendations
• Serve as the medication adherence subject matter expert
• Train and support pharmacists, care managers, and clinical staff
• Participate in quality improvement, population health management, and value-based care teams
• Follow security policies protecting PHI, PII, and company intellectual property
• Disclose any secondary employment

• Lead efforts to improve HEDIS medication adherence and pharmacy quality measures
• Analyze medication adherence data, identify care gaps, and implement targeted interventions
• Collaborate with providers, care managers, and stakeholders on adherence strategies
• Conduct medication therapy management sessions and provide patient education
• Identify and resolve adherence barriers such as cost, side effects, and complex dosing schedules
• Use motivational interviewing to encourage adherence
• Monitor HEDIS performance metrics and generate effectiveness reports
• Use EHR and pharmacy data to identify patients at risk of non-adherence and create action plans
• Provide leadership with progress updates and improvement recommendations
• Serve as the medication adherence subject matter expert
• Train and support pharmacists, care managers, and clinical staff
• Participate in quality improvement, population health, and value-based care initiatives
• Follow security policies to protect PHI, PII, and company intellectual property
• Disclose secondary employment and remain accessible during stated working hours

• Lead efforts to improve HEDIS medication adherence and pharmacy quality measures
• Analyze medication adherence data, identify care gaps, and implement targeted interventions
• Collaborate with healthcare providers, care managers, and stakeholders on adherence strategies
• Conduct medication therapy management (MTM) sessions
• Provide patient education and address cost, side-effect, and dosing barriers
• Use motivational interviewing to encourage medication adherence
• Monitor and track HEDIS performance metrics
• Generate reports assessing intervention and program effectiveness
• Use EHR and pharmacy data to identify patients at risk of non-adherence and develop action plans
• Provide leadership with progress updates and improvement recommendations
• Serve as the organization's medication adherence subject matter expert
• Train and support pharmacists, care managers, and clinical staff
• Participate in cross-functional quality improvement, population health management, and value-based care initiatives
• Follow security policies and procedures to protect patient and company data

• Lead efforts to improve HEDIS medication adherence and pharmacy quality measures
• Analyze medication adherence data, identify care gaps, and implement targeted interventions
• Collaborate with healthcare providers, care managers, and stakeholders on adherence strategies
• Conduct medication therapy management sessions and provide patient education
• Identify and resolve adherence barriers including cost, side effects, and complex dosing schedules
• Use motivational interviewing to encourage medication adherence
• Monitor and track HEDIS performance metrics
• Generate reports evaluating intervention and program effectiveness
• Use EHR and pharmacy data to identify patients at risk of non-adherence and develop action plans
• Provide leadership with updates and recommendations toward HEDIS goals
• Serve as the organization’s medication adherence subject matter expert
• Train and support pharmacists, care managers, and clinical staff
• Participate in quality improvement, population health management, and value-based care initiatives
• Follow security policies and procedures to protect PHI, PII, and company intellectual property

General

• Serve as the technical point of contact for external and internal stakeholders during onboarding and implementation
• Manage, coordinate, and execute data integration and technical integration projects
• Implement EMR integrations, third-party vendor integrations, data retrievals, API connections, and SFTP data feeds
• Facilitate discussions between internal and external technical and business stakeholders
• Design, document, and present data flow diagrams
• Project-manage integrations to ensure successful delivery
• Translate clinical and operational requirements into technical configurations and workflows
• Create and maintain technical specifications, workflow and process diagrams, implementation guides, and SOPs
• Perform data QA and validation, including scripts and manual checks for format, completeness, and accuracy
• Troubleshoot and resolve integration issues with engineering, vendor, and client teams
• Manage go-live planning, execution, maintenance, and post-implementation support
• Support onboarding of clinical data from new practices and claims data from new payers
• Manage technical implementation projects with healthcare vendors
• Support deployment and successful go-live of AI- and data-driven healthcare solutions
• Follow security policies and procedures to protect PHI, PII, and Guidehealth intellectual property
• Disclose any secondary employment and remain available during stated working hours

Senior Technical Integration Specialist

• Serve as the technical point of contact for external and internal stakeholders during onboarding and implementation
• Manage, coordinate, and execute data integration and technical integration projects
• Implement EMR integrations, third-party vendor integrations, data retrievals, API connections, and SFTP data feeds
• Facilitate discussions between technical and business stakeholders
• Design, document, and present data flow diagrams
• Project-manage integrations to ensure successful delivery
• Translate clinical and operational requirements into technical configurations and workflows
• Create and maintain technical specifications, workflow and process diagrams, implementation guides, and SOPs
• Perform data QA and validation through scripts and manual checks for format, completeness, and accuracy
• Troubleshoot and resolve integration issues with engineering, vendor, and client teams
• Manage go-live planning, execution, maintenance, and post-implementation support
• Support onboarding of clinical data from new practices and claims data from new payers
• Manage technical implementation projects with healthcare vendors
• Support successful deployment and go-live of AI and data-driven healthcare solutions
• Follow security policies to protect PHI, PII, and company intellectual property

• Serve as the technical point of contact for internal and external stakeholders during onboarding and implementation
• Manage, coordinate, and execute data and technical integration projects
• Implement EMR integrations, third-party vendor integrations, data retrievals, API connections, and SFTP data feeds
• Facilitate discussions between technical and business stakeholders
• Design, document, and present data flow diagrams
• Project-manage integrations through successful delivery
• Translate clinical and operational requirements into technical configurations and workflows
• Create and maintain technical specifications, workflow and process diagrams, implementation guides, and SOPs
• Perform data QA and validation using scripts and manual checks for format, completeness, and accuracy
• Troubleshoot and resolve integration issues with engineering, vendor, and client teams
• Manage go-live planning, execution, and maintenance
• Provide post-implementation support
• Follow security policies to protect patient and company data
• Participate in virtual meetings with cameras on during working hours

• Act as the technical point of contact for external and internal stakeholders during onboarding and implementation
• Manage, coordinate, and execute data integration and technical integration projects
• Integrate EMR systems, third-party vendors, data retrievals, APIs, and SFTP data feeds
• Facilitate discussions between technical and business stakeholders
• Design, document, and present data flow diagrams
• Project-manage integrations to ensure smooth delivery
• Translate clinical and operational requirements into technical configurations and workflows
• Create and maintain technical specifications, workflow and process diagrams, implementation guides, and SOPs
• Perform data QA and validation through scripts and manual checks for format, completeness, and accuracy
• Troubleshoot and resolve integration issues with engineering, vendor, and client teams
• Manage go-live planning, execution, maintenance, and post-implementation support
• Follow security policies and procedures to protect patient and company data
• Verify candidate identity at multiple hiring and onboarding stages

• Serve as the technical point of contact for external and internal stakeholders during onboarding and implementation
• Manage, coordinate, and execute data integration and technical integration projects
• Implement EMR integrations, third-party vendor integrations, data retrievals, API connections, and SFTP data feeds
• Facilitate discussions between technical and business stakeholders
• Design, document, and present data flow diagrams
• Project-manage integrations to ensure successful delivery
• Translate clinical and operational requirements into technical configurations and workflows
• Create and maintain technical specifications, workflow and process diagrams, implementation guides, and SOPs
• Perform data QA and validation through scripts and manual checks for format, completeness, and accuracy
• Troubleshoot and resolve integration issues with engineering, vendor, and client teams
• Manage go-live planning, execution, and maintenance
• Provide post-implementation support

• Act as the technical point of contact for external and internal stakeholders during onboarding and implementation
• Manage, coordinate, and execute data integration and technical integration projects
• Work on EMR integrations, third-party vendor integrations, data retrievals, API connections, and SFTP data feeds
• Facilitate discussions between internal and external technical and business stakeholders
• Design, document, and present data flow diagrams
• Project-manage integrations to ensure successful delivery
• Translate clinical and operational requirements into technical configurations and workflows
• Create and maintain technical specifications, workflow and process diagrams, implementation guides, and SOPs
• Perform data QA and validation through scripts and manual checks for format, completeness, and accuracy
• Troubleshoot and resolve integration issues with engineering, vendor, and client teams
• Manage go-live planning, execution, maintenance, and post-implementation support
• Support onboarding of clinical data from new practices and claims data from new payers
• Manage technical implementation projects with healthcare vendors