Corewell Health

Role Description The Principal, Risk Adjustment, is a director-level strategic leader responsible for cross-functional collaboration to drive enterprise risk adjustment performance, supporting new market acquisition and expansion, and leading high-impact, scalable program initiatives from concept through execution. This role provides leadership across risk adjustment strategy, trend management, provider engagement, operational execution, compliance, vendor oversight & technology enablement. The role will drive cost saving measures, improve operational efficiencies, and increase provider engagement and regulatory compliance. Essential Functions - Strategic Leadership & Market Expansion: - Lead risk adjustment strategy for new market acquisition, expansion, and operational readiness. - Assess market-specific risk adjustment opportunities, operational gaps, provider capabilities, and technology requirements. - Develop & execute scalable risk adjustment playbooks for new & existing markets. - Partner with executive leadership & cross-functional stakeholders to align risk adjustment strategies with enterprise growth, revenue integrity, quality & value-based care objectives. - Ensure department policies, programs, and plans are consistent with and support Priority Health’s core values and mission. - Program Development & Execution: - Lead risk adjustment initiatives from ideation & business case development through implementation, monitoring & continuous improvement. - Define program objectives, success metrics, timelines, resource needs, risks, and operational dependencies. - Oversee & support implementation of prospective, concurrent & retrospective risk adjustment programs. - Drive process standardization across markets and vendors. - Monitor initiative performance & develop corrective action plans to close gaps in execution or outcomes. - Trend Management & Performance Oversight: - Lead trend management for all risk adjustment initiatives, including development, implementation, monitoring, reporting, and optimization. - Analyze trends and financial impacts and make recommendations for gap closure. - Partner with Analytics & Actuary teams to forecast performance, identify improvement opportunities, and quantify revenue impact. - Develop executive-level reporting & dashboards to track performance against targets. - Identify emerging risks, market variation, provider performance issues, data gaps, and operational barriers impacting risk adjustment outcomes. - Provider Engagement & Technical Enablement: - Lead implementation of provider-facing technical applications and workflows that support risk adjustment accuracy and documentation improvement. - Partner with IDA/DS, Analytics, Clinical Operations, and external vendors and providers to integrate risk adjustment tools into EMR/EHR platforms and provider workflows. - Ensure provider facing tools are scalable across markets. - Collaborate with Provider Network and external providers to support adoption, training, workflow redesign and performance accountability. - Operational Governance & Compliance: - Establish governance, controls, and monitoring processes for risk adjustment initiatives & technology-enabled workflows. - Ensure risk adjustment activities comply with CMS requirements, coding guidelines, documentation standards, HIPAA, and internal compliance policies. - Partner with Compliance and Audit teams to support RADV readiness, internal audits, chart review governance, and remediation plans. - Develop policies, procedures, operating models, and controls to support sustainable & compliant risk adjustment operations. - Cross-Functional Leadership: - Partner with market leadership, provider engagement, clinical operations, finance, actuarial, analytics, compliance, IDA/DS, product and vendor partners. - Influence stakeholders across a matrixed organization to drive alignment, accountability, and execution. - Lead steering committee updates, executive briefings, and cross-functional workgroups. - Translate complex risk adjustment insights into actionable business strategies & operational priorities. - Provide leadership, coaching, and direction to project teams, analysts, market partners, and operational stakeholders. - Vendor & Partner Management: - Lead and participate in evaluating, selecting and managing vendors supporting risk adjustment. - Support defining vendor performance expectations, service-level metrics, implementation timelines, and quality standards. - Monitor vendor outcomes, resolve issues, and ensure alignment with enterprise objectives and compliance requirements. - Partner with procurement, legal, compliance, and finance on contracting, performance reviews, and ongoing governance. Qualifications - Bachelor's Degree in business, health care administration or related clinical field. (Required) - Master's Degree in business, health care administration or related clinical field. (Preferred) - 12 years of relevant experience. - Strong Risk Adjustment and Project Management experience with a detailed understanding of Enterprise Risk Management & Risk Adjustment for MA & ACA LOB. (Required) - CRT-ScrumMaster, Certified (CSM) - Required. - CRT-Lean Six Sigma Black Belt Certification (CSSBB) - Preferred. - CRT-Project Management Professional (PMP) - PMI - Preferred. Physical Demands - Pallet to Waist (6" from floor) > 5 lbs: Seldom - Waist to Waist > 5 lbs: Seldom - Waist to Chest (below shoulder) > 5 lbs: Seldom - Waist to Overhead > 5 lbs: Seldom - Bilateral Carry > 5 lbs: Seldom - Unilateral Carry > 5 lbs: Seldom - Pushing Force > 5 lbs: Seldom - Pulling Force > 5 lbs: Seldom - Sitting: Frequently - Standing: Occasionally - Walking: Occasionally - Forward Bend - Standing: Seldom - Forward Bend - Sitting: Occasionally - Trunk Rotation - Standing: Seldom - Trunk Rotation - Sitting: Occasionally - Reach - Above Shoulder: Seldom - Reach - at Shoulder or Below: Seldom - Handling: Occasionally - Forceful Grip > 5 lbs: Seldom - Forceful Pinch > 2 lbs: Seldom - Finger/Hand Dexterity: Frequently Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.

Role Description The Financial Counselor assists patients and family members in financial interactions related to their health care expenses. By establishing relationships, they serve as a patient advocate and educator in order to assist in navigating through available resources to fund their health care expenses. The Financial Counselor works closely with clinical providers (i.e. physicians, case managers, executive administrators) to provide financial guidance that will support the clinical needs of our patients throughout the Spectrum Health delivery system. - Conducts in-person interviews and consults with patients and their families, which may include travel to multiple locations or home visits. - Acts as the liaison between the patient and intake, registration or clinical staff, as well as outside organizations, on matters related to assisting the patient with securing a funding source. - Investigates and makes recommendations on complex cases to secure third party funding sources including, but not limited to Medicaid, Medicare, auto, workers' compensation, COBRA, crime victims compensation, access to insurance exchange, liability coverage and grants. - Participates in continuing education in order to stay current on relevant patient funding sources, Financial Assistance Policies, and Patient Financial Interaction Best Practices. - Acts as the liaison between the price estimator and the patient. - Responds to patient inquiries and provides on-site consultation and support as a liaison for billing, collections and denial management questions as needed, which may include collecting patient deposits or setting up payment arrangements if requested by the patient. - Communicates and collaborates with patients and their families to resolve financial barriers to care. - Evaluates qualification for financial assistance which may include Propensity to Pay evaluation and/or completion of the application process. Qualifications - High School Diploma or equivalent - 2 years of relevant experience in health care revenue cycle or equivalent, customer service, medical billing/third party payers, Microsoft Office, financial/mathematical skills, or business office experience - Associate's degree in customer service, health services, health care administration, information technology, business or accounting (preferred) - CRT-Application Counselor (CAC) - CMC Centers for Medicare & Medicaid Services 60 Days (preferred) Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status. Company Description As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

Role Description This is a fully remote position with set working hours of 8:00 AM to 5:00 PM Eastern Standard Time. The Medicare Quality - Pharmacy Specialist is responsible for conducting high-volume outbound member outreach calls to support Medicare Stars programs. This position is primarily phone-based, with the majority of the workday dedicated to making and receiving calls with Medicare members, pharmacies, and healthcare providers. The Specialist plays a key role in improving medication adherence, closing care gaps, and supporting CMS quality initiatives through member education and care coordination with clinical pharmacists. Success in this role requires strong communication skills, attention to detail, and the ability to meet daily productivity and quality performance standards in a structured call center environment. Essential Functions - Conduct high-volume outbound member outreach calls to address medication adherence gaps and improve Medicare Star measure performance (e.g., diabetes, hypertension, statin). - Educate members on the importance of medication adherence and assist in overcoming barriers (e.g., transportation concerns, setting up refill reminders). - Assist members in understanding their pharmacy benefits and refer to appropriate internal teams when needed (e.g., Care Management, Mail Order Pharmacy). - Identify and assist in resolving pharmacy billing issues or access barriers impacting adherence outcomes. - Process medication refill requests and coordinate communication between members, pharmacies, and providers. - Identify and transfer members to a licensed clinical pharmacist to resolve medication-related issues and improve member outcomes. - Assist in the administration of the Medication Therapy Management (MTM) program which includes scheduling CMRs, processing opt-outs, and other activities assigned to support the program. - Document all outreach activities accurately and in accordance with departmental standards. - Meet or exceed daily productivity, call volume, quality, and documentation accuracy targets. - Ensure compliance with CMS requirements, HIPAA regulations, and organizational requirements. - Participate in team meetings and quality improvement initiatives aimed at enhancing Medicare Star Ratings and member experience. - Support special projects and organizational initiatives as assigned. Qualifications - 2+ years of pharmacy technician experience (retail, managed care, PBM, mail order, specialty, or call center). - Strong verbal communication skills with the ability to effectively engage Medicare beneficiaries. - Ability to work in a high-volume, production-driven call environment with extended time on the phone. - Demonstrated ability to meet productivity and quality performance expectations. - Strong organizational skills and attention to detail. - Basic proficiency in Microsoft Office applications. Preferred - Bachelor's degree or equivalent. - Active Michigan pharmacy technician license and NABP Certified Pharmacy Technician (CPhT) certificate. - Experience supporting Medicare Stars medication adherence measures. - Experience in Medicare Advantage programs. - Call center or outbound outreach experience. - Knowledge of CMS Stars, CAHPS, and adherence-related quality metrics. Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status. Company Description As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members, and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders, and innovators that continue to build on one shared mission statement - to improve health, instill humanity, and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

Role Description This is a part-time (20 hours/week), 14-week fall internship that will run either from: - Aug 31 - Nov 30 - Sept 8 - Dec 7 Want real-world experience supporting Microsoft 365 in a large enterprise environment? Join our Digital Workspace team and help keep the tools running that thousands of employees rely on every day. You’ll get hands-on experience with platforms like Microsoft Teams, Outlook, SharePoint, and Copilot. A large part of the role will focus on troubleshooting issues and supporting users through ServiceNow, while also getting exposure to how new tools and features are tested and rolled out. Through this internship, you will gain: - Experience working with ServiceNow in a real enterprise support environment. - Hands-on experience supporting Microsoft 365 tools. - Practical problem-solving and troubleshooting skills. - Exposure to how new technology is introduced and supported. - Experience that translates directly into entry-level IT roles. Qualifications - Must be Sophomore or Junior standing at college or university (graduating May 2027 or later) - Interested in IT support, systems, or end user technology - Strong problem-solving skills and attention to detail - Willingness to learn and work through real-world issues - Comfortable working independently and as part of a team Requirements - Support users by troubleshooting Microsoft 365 issues through ServiceNow - Work tickets and tasks to resolve user-reported problems - Assist with testing and rollout of new Microsoft 365 apps and features - Document issues and solutions to improve team knowledge - Learn how enterprise IT systems and support models operate at scale Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance - Traditional and Roth retirement options with service contribution and match savings - Eligibility for benefits is determined by employment type and status

Role Description - Develop and deploy ELT/ETL processes across multiple sources, targets, and tools. - Communicate with data consumers to improve processes connecting to data. - Develop and deploy self-service reporting assets to provide data exploration capabilities to end users. - Develop, create, and modify data ingestion pipelines and workflows that align with technical specifications. - Provide support for incidents related to data warehouses, datasets, and data pipelines. Qualifications - Bachelor's or foreign equivalent in Information Systems, Business Administration, or related field. - 60 months of experience as a Data Engineer, Software Developer, or related role. - 3 years of experience in the health care industry, including: - Developing ETL/ELT workflows with Informatica & Python. - Building & managing data warehouses/marts using SQL plus Azure Synapse or Snowflake. - Creating insights using tools including Power BI, Crystal, Dundas, or Tableau. - Working with Azure portal, Unix scripting, Jira, Agile, and Waterfall. Requirements - Telecommuting permitted from within the US. Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on restaurants, phone plans, spas, and more. - Optional identity theft protection, home and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.

Role Description This position is 100% remote and averages about 10 hours per week. While the role offers flexibility in how you structure your schedule, candidates are expected to complete most of their work during typical business hours to support team collaboration. Step into a high-impact role where your clinical expertise directly influences provider quality and patient outcomes. As an RN Provider Performance Specialist Senior, you will serve as a trusted partner to medical staff leadership, leading in-depth clinical case reviews, analyzing performance trends, and guiding physician peer review processes across the system. This role is ideal for a highly experienced RN who brings strong clinical judgment, thrives in complex problem-solving situations, and is confident navigating sensitive provider performance concerns. If you’re passionate about improving care delivery, collaborating with physician leaders, and driving meaningful change through data and insight, this is an opportunity to make a measurable difference at the forefront of healthcare quality. Job Summary - Facilitates the maintenance of physician performance monitoring and analysis, including process and outcomes measures for assigned physician specialties. - Leads and facilitates medical staff performance committees, completes case reviews, data trending, communications, and joint commission requirements with/for physician performance. - Supports the medical staff electronic review process and applications to support workflows. - Partners with all facilities to educate, evaluate, and support workflows for system peer review. Essential Functions - Understand medical staff accreditation guidelines and the bylaws and rules and regulations of the organized medical staff. - Supports processes for the evaluation and outcomes of the physicians with privileges. - Supports medical staff leadership and their responsibility in quality improvement, care of the patient, and maintenance of competency requirements through data analysis and monitoring. - Partner with all SH facilities to facilitate workflows, implement changes, and coordinate reviews and referrals. - Partners with medical staff services and quality improvement to align performance metrics for physician specialties across the hospital group. - Ensures updating of performance metrics regularly. - Completes clinical case review to support physician peer review and other Joint Commission reporting requirements. - Uses appropriate applications and tools to support data tracking and trending for hospital group specialties. - Supports focused professional performance workflows and ongoing measuring and monitoring of the medical staff. - Facilitates medical staff performance review committees, electronic workflows, and individual physician action plans. - Works to continually improve the performance management process, optimize reporting, and increase physician engagement in data and improvement. - Supports education sessions for physicians as needed. - Supports orientation of new staff. Qualifications - Required: Bachelor's Degree in nursing, health care, or health care administration (or equivalent education and experience) - LIC-Registered Nurse (RN) - State of Michigan - 5 years of inpatient hospital care or health care administration - Experience working in an organization of size and complexity comparable to Corewell Health - Clinical background - Preferred: Project management or process improvement Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance - Traditional and Roth retirement options with service contribution and match savings - Eligibility for benefits is determined by employment type and status

Role Description Provides analytics that turn data into critical information for business needs; Analyzes, designs, configures, tests, debugs, and maintains self-service reporting assets and Extract, Transform, and Load (ETL) for populating data warehouse assets; Documents business needs and translates them into technical solutions using visuals and creating data sources, metrics, and automation; Works with teams to create information solutions to support business strategies. Qualifications - Bachelor's or foreign equivalent in computer science, data science, or related field. - 36 months of experience as a Business Intelligence or Data Analyst, Application or Software Developer, or related. - Above experience must include two years in the insurance or financial industry. Requirements - BI, data warehousing, ETL, and data modeling. - Data visualization using Tableau or Power BI. - Utilizing Oracle SQL, Informatica Power Center, AWS or Snowflake, and automation tools, including Snowflake and Python scripting. Benefits - Comprehensive benefits package to meet financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on restaurants, phone plans, spas, and more. - Optional identity theft protection, home and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.

Role Description Data Engineer at Corewell Health, Grand Rapids, Michigan. - Develop and deploy ELT/ETL processes across multiple sources, targets, and tools. - Communicate with data consumers to improve processes connecting to data. - Develop and deploy self-service reporting assets to provide data exploration capabilities to end users. - Develop, create, and modify data ingestion pipelines and workflows that align with technical specifications. - Provide support for incidents related to data warehouses, datasets, and data pipelines. Qualifications - Bachelor's or foreign equivalent in Data Science, Computer Science, or related field. - 36 months as a Data Engineer, Data Analyst, or related role. - Two years of experience in the health care or health insurance industry, including: - Statistical analysis for large datasets and data modeling. - Developing ETL processes, building & managing data warehouses using Snowflake, DBT, and EPIC. - Designing and implementing dimensional and relational database management systems. - Utilizing Oracle SQL and SQL Developer, Python, Agile methodologies, and GitHub. - Data visualization using Tableau/Power BI. Requirements - Telecommuting permitted from within the US. Benefits - Comprehensive benefits package to meet financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on restaurants, phone plans, spas, and more. - Optional identity theft protection, home, and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.

Role Description The Medication Care Coordination Infusion (MCC) Pharmacy Team is a centralized team currently supporting 28 Infusion Departments across Corewell Health West (CHW), Corewell Health South (CHS) and Corewell Health East (CHE). Tasks within these areas of work include: - Serving as the first-line resource for infusion pharmacy, scheduling, nursing, and provider teams for patient insurance benefit investigation. - Infusion pre-authorizations, navigating site of care restrictions, externally supplied medications, and insurance formulary preferences. - Troubleshooting infusion claim payment denials. Scope of Work includes: - Coordinating educational programs and activities designed to enhance clinical drug knowledge of staff pharmacists, physicians, nurses, and other care providers. - Working with staff pharmacists to increase participation in drug monitoring, pharmacokinetics, and cost containment activities. - Providing pharmaceutical care to patients in assigned area of practice. - Implementing cost containment programs and providing drug information, education, and clinical services. - Evaluating patients and orders, taking a lead role in the ordering and interpretation of drug serum levels using pharmacokinetic principles. - Providing physicians with dosage regimen recommendations to enhance therapeutic outcomes and reduce patient risk. - Providing drug information and educational services to hospital health care professionals, patients, and families. - Assisting staff pharmacists in responding to drug information requests. - Coordinating and implementing departmental drug utilization review efforts and other process improvement activities. - Ensuring that processes and services are continuously monitored for quality, cost effectiveness, and efficiency. - Engaging in process and quality improvement activities. - Making and implementing recommendations to improve operational efficiency and to implement new services. - Facilitating applicable Pharmacy Committee activities in area of specialty. - Engaging in continuous study of the entire professional field to maintain professional competence. - Completing required continuous training and education on a timely basis. - Coordinating the development, editing, and dissemination of departmental publications for physicians and hospital staff. - Precepting pharmacy residents and students as assigned. Qualifications - Required: Bachelor's Degree in Science of Pharmacy or Doctor of Pharmacy degree from an accredited College of Pharmacy. - 2 years of relevant pharmacy experience or an American Society of Health-System Pharmacists (ASHP) Pharmacy Practice Residency Required. - 2 years of relevant hospital pharmacy experience or an ASHP Pharmacy Practice Residency Preferred. - ASHP accredited postgraduate year 2 (PGY2) residency in area of specialty Preferred. - LIC-Clinical Pharmacist - STATE_MI State of Michigan 90 Days required. - LIC-Pharmacist Controlled Substance - STATE_MI State of Michigan 90 Days required. - CRT-Basic Life Support (BLS) - AHA American Heart Association 90 Days required or CRT-Basic Life Support (BLS) - ARC American Red Cross 90 Days required. - CRT-Pediatric Adv Life Support (PALS) - AHA American Heart Association Excludes Ambulatory Sites 180 Days required or CRT-Adv Cardiovascular Life Support (ACLS) - AHA American Heart Association Excludes Ambulatory Sites 180 Days required. - CRT-Board Cert Pharmacotherapy Specialist (BC-PS) - ASHP Upon Hire preferred or CRT-Board Cert Pharmacotherapy Specialist (BC-PS) - BPS Upon Hire preferred. - Ideal candidate will be a Pharmacist possessing PharmD Degree and PGY1 or PGY2 Residency. - Prior experience in Managed Care, Medication Care Coordination, Infusion, or Specialty Pharmacy would be a great plus. Benefits - Comprehensive benefits package to meet your financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! - Optional identity theft protection, home and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status.

Role Description This is a remote position for the Imaging Lab. - Responsible for performing and assisting with 3D imaging for advanced computerized tomography (CT) and magnetic resonance imaging (MRI) applications. - In collaboration with radiology management and the applications coordinators, facilitates continuous improvement processes. - Assesses radiology employees' educational needs and requirements. Qualifications - Required Associate's Degree or equivalent. - 3 years of relevant experience in clinical settings with emphasis in CT and/or MRI. - 6 months of relevant experience in post-processing of MRI/CT images including 3D experience (Preferred). - CRT-Computerized Tomography (CT) - ARRT American Registry of Radiologic Technologist required. - Or CRT-Magnetic Resonance Imaging Technologist (MRI) - ARRT American Registry of Radiologic Technologist required. - Or CRT-American Registry Of Magnetic Resonance Imaging Technologists (MRI) - ARMRIT American Registry of Magnetic Resonance Imaging Technologists required. Benefits - Comprehensive benefits package to meet financial, health, and work/life balance goals. - On-demand pay program powered by Payactiv. - Discounts directory with deals on restaurants, phone plans, spas, and more. - Optional identity theft protection, home and auto insurance. - Traditional and Roth retirement options with service contribution and match savings. - Eligibility for benefits is determined by employment type and status. Company Description Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. We advocate for equity as we care for our patients, our communities, and each other. We invite those that share in our commitment to join our team.