• Perform medical necessity reviews and authorization determinations to ensure members receive appropriate, high-quality behavioral health services • Performs a clinical review and assesses care related to mental health and substance abuse • Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate • Evaluates member’s treatment for mental health and substance abuse before, during, and after services • Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria • Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning • Analyzes BH member data to improve quality and appropriate utilization of services • Provides education to providers members and their families regarding BH utilization process • Interacts with BH healthcare providers as appropriate to discuss level of care and/or services • Engages with medical directors and leadership to improve the quality and efficiency of care • Formulates and presents cases in staffing and integrated rounds • Performs other duties as assigned and complies with all policies and standards.

• Manage the day-to-day operations of the HRIS, including data entry, system updates, and user support, to ensure the accuracy and integrity of employee data. • Maintain employee records, including personal information, employment history, compensation details, and benefits enrollment, in compliance with data privacy regulations and company policies. • Assist in the configuration, customization, and testing of the HRIS to support HR processes, workflows, and reporting requirements, in collaboration with HR stakeholders and IT partners. • Generate regular and ad-hoc reports, dashboards, and data analysis to support HR decision-making, workforce planning, and compliance reporting, utilizing HRIS reporting tools and Excel. • Identify opportunities to streamline HR processes, improve data accuracy and efficiency, and enhance user experience within the HRIS platform, through automation, standardization, and best practices. • Provide training and technical support to HR team members and end-users on HRIS functionality, processes, and best practices, ensuring effective utilization and adoption of the system. • Ensure compliance with data privacy regulations, company policies, and industry standards in HR data management, and support internal and external audits as needed. • Liaise with HRIS vendors, consultants, and service providers to resolve system issues, implement upgrades, and stay informed about system enhancements and industry trends.

• Oversee and address capacity-related concerns for all company projects, ensuring efficient resource allocation • Provide strategic guidance on developing tailored business models for diverse clients • Collaborate closely with various departments to accurately assess project capacity needs • Analyze capacity requirements across all projects to align with monthly demand forecasts • Develop proactive strategies with your team to anticipate and prepare for various capacity scenarios • Maintain comprehensive records of activities, actions, and impacts; prepare detailed departmental reports on a daily, weekly, monthly, and yearly basis • Coordinate with Workforce teams to provide in-depth analysis from a capacity perspective • Drive strategic initiatives focused on standardization and identifying improvement opportunities for the business • Contribute to the design and execution of operational initiatives and projects to optimize staffing and meet Service Levels and KPIs • Manage forecasting models, analyze trends, and maintain accurate data to support decision-making • Assess workforce shrinkage, make recommendations for reductions, and establish shrinkage targets and vacation allowances as needed • Foster open communication and feedback loops within the team and across the organization to maximize insights and learning • Effectively communicate with Senior Management and leaders to clarify priorities and guide strategic direction • Ad hoc tasks as required

• Manage the development, operations, and results of the Gulf South Region market performance • Maintain key provider relationships and track innovative pilot programs • Support the Regional President on community, state and federal government engagement • Monitor strategic provider relationships needed for network adequacy, Stars performance, and market expansion • Track and maintain status of pilot programs proposed or deployed in the region • Monitor and track national providers with a regional footprint • Coordinate weekly regional leadership meetings and agenda • Manage Market Reviews and strategy presentations • Facilitate aspects of the bid process