- National Health Care Associates (Stafford Springs, CT)
- …We invite you to join our team! **-** **What You'll Do:** As a Medicaid Specialist, you will support the center's business office in processing Medicaid ... to the financial stability of our organization, ensuring resources are optimized to provide the best care for our residents. **Key Responsibilities:** + Process and… more
- NORC (Washington, DC)
- …design, methodology, data analysis, and interpretation for Medicare and Medicaid demonstration evaluations and health services research. + Leading teams ... of health care payment and delivery interventions on outcomes and cost using data files derived from Medicare, Medicaid , and commercial payer administrative … more
- Commonwealth Care Alliance (Boston, MA)
- …teams as needed. Performance and Data Insight - Analyze and interpret provider data related to utilization, cost, quality, and outcomes to identify ... performance. - Develop and execute annual provider engagement plans informed by provider data , feedback, and CCA priorities. - Follow through on performance… more
- Commonwealth Care Alliance (Boston, MA)
- … provider performance, identify opportunities for improvement, and facilitate data -driven action plans. + Collaborate with Contracting, Quality Analytics, and ... quality performance data into actionable insights and communicate findings to provider partners to drive improvement. + Support the development and oversight of … more
- Commonwealth Care Alliance (Boston, MA)
- …for escalated provider matters. This position partners closely with provider engagement, delegation partnerships, provider services , contracting, ... systems, large medical groups, and specialty care networks. - Experience supporting provider data integrity, onboarding, and credentialing processes. - Proven… more
- Commonwealth Care Alliance (Boston, MA)
- …executing communication strategies that foster strong, collaborative relationships with provider partners serving dual-eligible (Medicare- Medicaid ) members. This ... trends to the committee + Develop and manage annual provider communications schedule + Provide guidance and...brand standards, and provider -friendly + Work with provider network and data management to influence… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- …structured and unstructured data ) and analytics, data management, and data visualization. Understanding of Medicaid programs and related health policy is ... each year. From primary to complex critical care, more than 350 programs and services are offered, each one specially designed for children. The CHLA of the future… more
- Commonwealth Care Alliance (Boston, MA)
- …with cross-functional teams (eg, Claims, Credentialing, Clinical Care Management, Member Services , Provider Services , Regulatory Affairs, Marketing) to ... provider engagement strategy, focused on delivering a best-in-class provider experience. + Utilize strategic planning and data -driven insights… more
- Commonwealth Care Alliance (Boston, MA)
- …3-5 years + Managed Care experience + Experience in health plan provider relations. **Experience (Desired)** + Medicare/ Medicaid experience preferred. + ... 011230 CA- Provider Engagement & Performance **Position Summary** The ...orient providers on CCA's policies related to: Claims and service recovery; Program benefits; Clinical initiatives; Referral and authorization;… more
- NORC (Chicago, IL)
- …+ Expertise with analyzing pharmaceutical utilization and quality outcomes using healthcare data for payor programs including Medicare, Medicaid , and commercial ... care delivery, from private marketplaces and employer-sponsored insurance to Medicare and Medicaid ; from large health care systems to small clinics; and from the… more
- DESC (Seattle, WA)
- …no person is abandoned, ignored, or experiencing homelessness. As the region's leading provider of services to multiply disabled adults who have experienced ... member of a multi-disciplinary team that will support DESC's mission by using data queries, creating reports, and providing administrative services for programs… more
- Abt Global Inc. (Rockville, MD)
- …the Information Technology Lead, you will support a large-scale Center for Medicare & Medicaid Services (CMS) project. This role will be contracted through TSPi, ... a subsidiary of Abt Global that provides digital services and solutions to clients. **Core Responsibilities** ** Data...stakeholders to align IT systems with program goals. + Provide technical leadership to ensure IT solutions meet both… more
- Commonwealth Care Alliance (Boston, MA)
- …as mid-year and annual reviews and program-wide performance summaries. - Support delegated provider staff in using data tools effectively and understanding ... 011230 CA- Provider Engagement & Performance Position Summary: The ...leads performance evaluation and improvement efforts, including reporting and data analysis, to ensure delegated entities meet contractual, regulatory,… more
- Commonwealth Care Alliance (Boston, MA)
- …for relationship management with the contracted community-based organizations (CBOs) that provide service coordination and other supports for CCA members. ... evaluation of the appropriateness, efficiency and quality of the services provided. The LTSS Program Specialist will have a...Agency, GSSC and LTSC, among other details o Coordinate Provider Rosters with the Provider Data… more
- Human Development Services of Westchester, Inc (Port Chester, NY)
- …(HUD) approved Local Housing Counseling Agency in 2006, the NPC has expanded services to provide housing counseling to residents throughout Westchester County, ... to meet funding requirements in completing reports and collecting data as required, and to represent the agency as...in client, financial, and quality metrics. The attorney will provide legal services for eviction proceedings, serving… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …Maintain ongoing education with provider office staff regarding products and Medicaid services + Discuss availability and accessibility of specialists with ... to the appropriate staff for further handling + Perform data entry of authorization details into systems and communicate...Member Services regarding authorization questions, issues, or service provider capabilities + Guide and educate… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …rules for managing member complaints and appeals + Experience with managed care, Medicaid programs, call center support tools, customer service practices, and ... parties involved + Monitors real-time queues and adherence reports to maintain service levels and response expectations and manages real-time escalations as needed +… more
- Caris Life Sciences (Irving, TX)
- …applications, ensuring compliance with enrollment requirements, and maintaining accurate records and data . As a Senior Specialist this role serves as a primary ... enrollment, revalidation, and demographic changes. + Regularly update and manage data in the credentialing database, spreadsheets, and folders, while maintaining … more
- Molina Healthcare (Milwaukee, WI)
- …Then TMG wants to hear from you! We're currently looking for someone with a social services or human services background to join our team. This is a remote ... most out of the Wisconsin IRIS program - a Medicaid long-term care option for older adults and people...the IRIS program on the Wisconsin Department of Health Services website here . Together, you will identify the… more
- Stanford Health Care (Palo Alto, CA)
- …communication skills + Remain abreast of current Centers for Medicare and Medicaid Services (CMS) requirements, NCCI edits, National Coverage Determinations ... advanced coder position responsible for reviewing clinical documentation to extract data and assign appropriate International Classification of Diseases 10th Edition… more
