• Business Process Analyst

    IQVIA (Milwaukee, WI)
    …and Eligibility determinations o Prescription Rebate Processing o Pharmacy Benefit Management o Managed Health Care o Medicaid Drug Rebate Program IQVIA is a ... your clients. Those skills are pertinent because as an analyst , you will be responsible for multiple accounts and...tasks and assignments without detailed direction. o Complies with contract requirements, business unit rules and related and legal… more
    IQVIA (12/14/24)
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  • Claims Configuration Analyst

    Healthfirst (FL)
    …+ High school diploma or GED from an accredited institution. + Previous managed care /health plan experience in an operations department where you have ... to understand manner to other staff. As the SME, the Claims Configuration Analyst will need to effectively communicate with all levels of the organization, including… more
    Healthfirst (11/09/24)
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  • Senior Analyst - Strategic Pricing…

    Novo Nordisk (Plainsboro, NJ)
    …monitoring and evaluation of contract performance for all customer segments (eg, Managed Care , Non-Federal Hospitals, Long-Term Care , Medicare Part D, ... more accurate customer profitability assessment and decision-making + Supports contract profitability forecasting. Contributes to continuous improvement of methodologies… more
    Novo Nordisk (01/30/25)
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  • Cost Containment Analyst

    VNS Health (Manhattan, NY)
    …What You Will Do + Assists the Manager in analyzing and validating managed care claims and comp grids against provider contracts, member eligibility, ... Science, Mathematics or statistics required Work Experience: + Minimum of two years managed care claims analysis experience required + Experience in financial or… more
    VNS Health (01/22/25)
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  • Financial Analyst II

    University of Rochester (Rochester, NY)
    …prepare and manage the life cycle of clinical trial budgets and trial specific contract terms for the Clinical Trials Office of the Wilmot Cancer Institute. Plans, ... other hospital departments. - Post award management activities, including: amendments, contract end dates, review charge reports, categorize services in relation to… more
    University of Rochester (12/17/24)
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  • Senior Analyst , Network Relations

    CVS Health (Springfield, IL)
    …* Strong communication and presentation skills * 3+ years' experience in Medicaid Managed Care business segment environment with exposure to benefits and/or ... purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our...growth, and efficiency targets. Duties: + Research and handle contract related issues (ability to research and deep dive).… more
    CVS Health (01/31/25)
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  • Appeals Analyst Nurse

    US Tech Solutions (Columbia, SC)
    …Ability to work independently, prioritize effectively, and make sound decisions. Working knowledge of managed care and various forms of health care delivery ... **Job Description:** + Monday Friday, 8:30am-5pm contract to hire onsite interview panel interviews with...including reviews of clinical information to identify quality of care issues. **Experience:** + 2 years clinical experience plus… more
    US Tech Solutions (02/01/25)
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  • Appeal Analyst RN

    US Tech Solutions (Hopewell, NJ)
    …and/or in person striving for continuity and efficiency as the member is managed along the continuum of care . + Understands fiscal accountability and ... **Location: New Jersey (Remote/ Tri State)** **Duration: 3+ Months Contract with possible extension** **Job Summary:** + This position is responsible for performing… more
    US Tech Solutions (01/22/25)
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  • Patient Financial Services Reimbursement…

    Nuvance Health (Danbury, CT)
    …ie, registration. 6. Follows through with education of rules and regulations in the managed care system, as well as, State & Federal guidelines. 7. Adjusts ... inquiries, denials, correspondence & telephone inquires. 4. Maintains all reports ( contract management) files and records as needed; ie, medical records, referrals,… more
    Nuvance Health (02/01/25)
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  • Healthcare Analyst (Provider Reporting)

    Healthfirst (NY)
    …Claims and/or reimbursement preferred. Preferred Qualifications: + Understanding of key managed care concepts and provider reimbursement principles such as ... communicate to internal leadership and external stakeholders. + Support contract analytics and fee schedule modeling to aid in... analytics and fee schedule modeling to aid in contract negotiations and budget development. + Respond to ad-hoc… more
    Healthfirst (01/17/25)
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  • Patient Financial Services Reimbursement…

    Nuvance Health (Danbury, CT)
    …ie, registration. 6. Follows through with education of rules and regulations in the managed care system, as well as, State & Federal guidelines. 7. Adjusts ... inquiries, denials, correspondence & telephone inquires. 4. Maintains all reports ( contract management) files and records as needed; ie, medical records, referrals,… more
    Nuvance Health (12/11/24)
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  • Analyst , Master Data Management

    Ascension Health (Indianapolis, IN)
    …and key performance indicators, and to deliver a cost-effective, highly-efficient managed distributor model. By combining a culture of hospitality with leading ... flows + Cleanses and loads contracts into ERP system(s) + Identifies contract discrepancies and escalates as applicable **Requirements** Education: + High School… more
    Ascension Health (01/31/25)
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  • Sr Claims Configuration Analyst

    Healthfirst (NC)
    …or other claims processing systems necessary. + Comprehensive knowledge of managed care industry and product administration/implementation. + Experience creating ... terminology, medical coding (CPT4, ICD9 or ICD10, and HCPCS), provider contract concepts and common claims processing/resolution practices. + Experience working with… more
    Healthfirst (12/25/24)
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  • Healthcare Analyst

    Healthfirst (NY)
    …multiple projects in a fast-paced environment. + Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk ... creating, modifying, and updating analysis for Provider Organizations. + Responsible for contract analysis and fee schedule modeling. + Maintain current project logs… more
    Healthfirst (12/20/24)
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  • Director, Contract Monitoring…

    City of New York (New York, NY)
    …(1) Administrative Staff Analyst NM I who will function as Director, Contract Monitoring and Compliance who will: Under the general direction of the Senior ... Job Description APPLICANTS MUST BE PERMANENT IN THE ADMINISTATIVE STAFF ANALYST CIVIL SERVICE TITLE OR BE ELIGIBLE PERMANENT IN A COMPARABLE TITLE ELIGIBLE FOR 6.1.9… more
    City of New York (11/15/24)
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  • Manager, Rebates

    Amneal Pharmaceuticals (Bridgewater, NJ)
    …As a Manager, this role will be responsible for leading and supporting the Managed Care claims processing, contract maintenance, formulary and data ... meetings with various teams as changes occur, review proposed contract language for managed care ...Where disputes are identified, support and work with respective analyst to secure paybacks from customers. Communicate often with… more
    Amneal Pharmaceuticals (01/23/25)
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  • Mental Health Program Manager II / Emergency…

    The County of Los Angeles (Los Angeles, CA)
    …operational areas, clinic, or programs overseen; ensures that budget and contract allocations reflect program priorities; and takes corrective action where ... Develops and monitors revenue-generation procedures and objectives for programs managed , including achievement of revenue goals. Develops and implements reporting… more
    The County of Los Angeles (01/16/25)
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  • Director, Care Coordination - Remote…

    Magellan Health Services (Idaho Falls, ID)
    …to achieve the business and clinical outcomes for the health plan, meeting contract requirements. Directs all care coordination activities ensuring delivery is ... Education - Preferred License and Certifications - Required BCBA - Board Certified Behavior Analyst - Care Mgmt, LCMFT - Licensed Clinical Marriage and Family… more
    Magellan Health Services (01/26/25)
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  • Program Coordinator - SAGE

    DESC (Seattle, WA)
    …assist in providing routine administrative tasks related to Medicaid Integrated Managed Care (IMC), Collective Medical Technology online platform, Washington ... improvement. + Comply with all agency policies and procedures, Medicaid Integrated Managed Care (IMC), Collective Medical Technology online platform, Washington… more
    DESC (01/25/25)
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  • FP & Analytics Anlst III

    Covenant Health Inc. (Knoxville, TN)
    …limited to changes in governmental reimbursement, fee schedule and rate updates for managed care payors, costing updates, and changes in productivity data ... Overview Financial Planning & Analytics Analyst , Financial Analytics Full Time, 80 Hours Per...revenue analyses, and analyzing budget exception requests. Coordinate with Managed Care and Reimbursement to aggregate reimbursement… more
    Covenant Health Inc. (01/14/25)
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