Curative HR LLC

This senior director role is accountable for the end-to-end performance of the claims function, encompassing adjudication accuracy, operational efficiency, compliance, vendor management, and technology optimization. The leader will drive operational excellence, implement strategic transformation initiatives using AI and automation, and ensure claims operations effectively support rapid company growth.

This role involves formulating and implementing management policies and operational practices to enhance organizational efficiency, while also leading major assignments impacting the organization's operations. The analyst will provide expert consultation to management and be actively involved in strategic planning and resolving significant operational issues.

The Staff Physician will provide high-quality, evidence-based care to members via telehealth by independently assessing, diagnosing, and treating acute conditions using an advanced AI-assisted clinical framework. Responsibilities also include providing clinical feedback to refine workflows and collaborating to ensure seamless member transitions into other health plan programs.

The Staff Clinician will provide high-quality, evidence-based care to members via telehealth, independently assessing, diagnosing, and treating acute conditions using an AI-assisted clinical framework. They will also play a vital role in refining workflows by providing clinical feedback as the service line scales.

The Lead Physician will act as the clinical anchor for the Virtual Urgent Care service, overseeing the clinical adoption of AI frameworks and monitoring quality metrics while serving as the liaison between technology and medical staff. This role involves independently assessing, diagnosing, treating, and managing acute conditions for members via telehealth, ensuring high-quality, member-centered virtual care.

The Claims Resolution Specialist ensures the accurate, timely, and compliant resolution of medical claims, balance billing issues, and reimbursement requests by reviewing and adjudicating claims based on benefits and regulations. This role involves investigating and resolving member balance billing disputes while ensuring compliance with the No Surprises Act and educating providers on proper billing practices.

This pivotal role involves overseeing and performing utilization reviews, prior authorizations, and making crucial medical necessity determinations for healthcare services. The Medical Director will act as a key clinical expert, ensuring appropriate resource utilization, promoting evidence-based care, and leading peer-to-peer discussions with practitioners.

The specialist manages contract negotiations with physicians and physician groups, simultaneously conducting multiple negotiations to meet growth demands while nurturing provider partnerships. Responsibilities include meeting unit cost targets, improving medical cost and quality, and analyzing the financial impact of complex provider contracts.

The Director Network Development oversees the development and management of insurance networks, focusing on improving affordability and quality outcomes while managing provider relationships and negotiation strategies in the NorthEast Region. Responsibilities include managing contract negotiations with large physician groups, meeting unit cost targets, and identifying initiatives to improve total medical cost and quality.

This role is responsible for leading negotiations with physicians and physician groups to meet growth demands while managing unit cost targets and preserving an adequate network. Key duties include nurturing provider partnerships, communicating with matrix partners, and identifying initiatives to improve total medical cost and quality.