• Wipfli LLP (Milwaukee, WI)
    …a career-defining opportunity. Job Summary Under the direction of the Partner/Senior Manager leading the respective service area, region or industry, the Manager ... reviewing skilled nursing Medicare cost reports, understanding the skilled nursing Medicaid reimbursement systems for assigned states, assisting clients with cost… more
    DirectEmployers Association (10/31/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …interest and demonstrated capabilities. The position will report to the LTSS Program Manager . Reporting to the Manager , LTSS Program, this position supports the ... with members of group with the oversight of the Manager , LTSS Program o Schedule regular check in meetings/calls...- Roster Reporting and Reconciliation o Partner with CCA's Eligibility Team to obtain and perform data entry on… more
    DirectEmployers Association (10/17/25)
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  • Care Manager Specialist ( Remote

    CVS Health (Columbus, OH)
    …an essential member of our Special Needs Plan (SNP) care team, the telephonic Care Manager Specialist (CMS) plays a key role in coordinating the care of our members, ... conditions. The CMS collaborates closely with the Registered Nurse Care Manager , Care Coordinator, Social Worker, and other interdisciplinary care team participants… more
    CVS Health (12/12/25)
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  • Case Manager , Registered Nurse…

    CVS Health (Columbus, OH)
    …we do it all with heart, each and every day. **Job Summary** The Care Manager -Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible ... them with appropriate resources and support services. The Care Manager provides education and guidance to members and their...learn the role of care management within Medicare and Medicaid managed care. + Familiarity with community resources and… more
    CVS Health (12/03/25)
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  • Care Manager , Registered Nurse…

    CVS Health (Columbus, OH)
    …we do it all with heart, each and every day. Job Summary: The Care Manager -Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible ... chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress,… more
    CVS Health (12/12/25)
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  • Care Manager - Behavioral Health…

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE** : This Behavioral Health Care Manager will support the Maryland Dual Eligible Special Needs Plan (MD DSNP). Under minimal ... supervision, the Care Manager researches and analyzes a member's medical and behavioral...or other direct patient care experience. Previous experience with Medicaid , Medicare Advantage and/or DSNP patient populations with multiple… more
    CareFirst (10/18/25)
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  • Clinical Case Manager Behavioral Health…

    CVS Health (Springfield, IL)
    …can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With ... delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements,… more
    CVS Health (12/05/25)
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  • Account Manager

    NTT America, Inc. (San Juan, PR)
    …of this RFP. + Minimum of two (2) years of experience in Medicaid eligibility processes, including policy, determinations, and enrollment. + Bachelor's degree ... organization, apply now. We are currently seeking a Account Manager to join our team in San Juan, Puerto...to the Puerto Rican population. + Strong knowledge of Medicaid eligibility processes, including policy, determinations, and… more
    NTT America, Inc. (10/29/25)
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  • Manager , Compliance (Duals & D-SNP…

    Centene Corporation (Austin, TX)
    …benefits including a fresh perspective on workplace flexibility. **_**Fully Remote Opportunity**_** **_The ideal candidate will have:_** + **_Knowledge of ... Dual contract requirements (eg, Medicare- Medicaid plans)_** + **_Experience managing external audits and communicating...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
    Centene Corporation (12/14/25)
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  • Temporary/Contract Prior Authorization Nurse…

    Fallon Health (Worcester, MA)
    …be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the Elderly)- in ... psychosocial information from the medical records on site, through remote electronic access, telephonically or by fax in a...Keeps records and submits reports as assigned by the Manager * Refers high-risk cases to the appropriate FH… more
    Fallon Health (12/14/25)
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  • Clinical Care Manager - Pediatric

    WellSense (NH)
    …our members, no matter their circumstances. **Job Summary** The Clinical Care Manager provides holistic medical care management services for members throughout the ... data, motivational interviewing techniques and evidence-based practices, the Clinical Care Manager engages with the member and the multidisciplinary team to develop… more
    WellSense (12/06/25)
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  • Research Admin Specialist II-CTMS, US…

    Huron Consulting Group (Chicago, IL)
    …interpret and apply clinical guidelines including Centers for Medicare and Medicaid , Federal Drug Administration, National Comprehensive Cancer Network. + Highly ... to no errors. + Intermediate Excel competency + This is a full time US- REMOTE role. This salaried position may require working additional hours at times, depending… more
    Huron Consulting Group (12/08/25)
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  • Social Work Care Manager

    WellSense (NH)
    …our members, no matter their circumstances. **Job Summary** The Social Work Care Manager (SWCM) works collaboratively with the patient centered care team. The SWCM ... a recent incarceration. Our Investment in You: + Full-time remote work + Competitive salaries + Excellent benefits **Key...knowledge of the most common conditions presented in the Medicaid population and is able to assess, manage and… more
    WellSense (11/20/25)
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  • Product Owner, Health Sciences - Consulting…

    Cognizant (Phoenix, AZ)
    **Product Owner Health Sciences, Consulting Manager ** **About the Role:** As a Product Owner for Sales & Enrollment Platforms, you will make an impact by leading the ... features. * Drive improvements in digital quoting, application intake, eligibility verification, and member onboarding for individual, group, and… more
    Cognizant (11/15/25)
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  • Care Manager

    LIFEPlan CCO NY (Ithaca, NY)
    Care Manager Job Details Job Location Ithaca - Ithaca, NY Position Type Full Time Education Level 4 Year Degree Salary Range $25.75 - $27.81 Hourly Travel Percentage ... Up to 50% Description Job Summary: The Care Manager provides services within the Care Management programs, including Health Home Care Comprehensive Care Management,… more
    LIFEPlan CCO NY (11/06/25)
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  • Manager Provider Network Management (Health…

    AmeriHealth Caritas (Washington, DC)
    …is consistent with claim payment methodologies. + Maintains familiarity with State Medicaid fee schedules and analyzes comparable Plan pricing guidelines. + Resolves ... for facilitating the department on system upgrades, regulatory directives (ie, Medicaid Bulletins, etc.) and assigned corporate initiatives. + Monitors capitation,… more
    AmeriHealth Caritas (10/30/25)
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  • Physician Manager 20 - Medical Director

    State of Michigan (MI)
    Physician Manager 20 - Medical Director Print (https://www.governmentjobs.com/careers/michigan/jobs/newprint/4848644) Apply  Physician Manager 20 - Medical ... enjoy better lives. Many State of Michigan jobs offer alternate work schedules and remote -work options that can help give the flexibility you need. The State of… more
    State of Michigan (10/01/25)
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  • Child Health Home Care Manager

    Northern Rivers Family Services (Schenectady, NY)
    Child Health Home Care Manager Job Details Job Location Schenectady-Genium-PCFC - Schenectady, NY Position Type Full Time Salary Range $23.00 - $23.00 Hourly Travel ... Over 50% Description As a Children's Health Home Care Manager , you will engage youth and families through outreach...a hybrid model. Work will involve a combination of remote , office, and community-based settings. Local travel and personal… more
    Northern Rivers Family Services (10/09/25)
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  • Sr Manager Clinical Compliance Reg…

    HCA Healthcare (Nashville, TN)
    …you want to join an organization that invests in you as a Senior Manager Clinical Compliance and Regulatory Accreditation? At HCA Healthcare, you come first. HCA ... on income. Learn more about Employee Benefits (https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards) **_Note: Eligibility for benefits may vary by location._** You contribute… more
    HCA Healthcare (11/04/25)
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  • Intake Case Manager

    GMHC (New York, NY)
    Intake Case Manager WFH Flexible * New York, NY (http://maps.google.com/maps?q=New+York+NY+USA+10018) * Supportive Housing Job Type Full-time Description TheIntake ... caseload of up to 25 clients, the Intake Case Manager serves as a consistent advocate and point of...& Assessment: + Collaborate with HRA to verify client eligibility and ensure enrollment in GMHC services. + Conduct… more
    GMHC (10/21/25)
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