- Idaho Division of Human Resources (Boise, ID)
- …AS SOON AS POSSIBLE TO BE CONSIDERED. The Department of Health and Welfare is hiring a Medicaid Utilization Review Analyst in Boise . Do you have an ... Utilization Review Analyst -... Utilization Review Analyst - MED Posting Begin...identify and deter fraud, waste and abuse in the Medicaid program. As an analyst , you will… more
- Sumitomo Pharma (Columbus, OH)
- …disputes and to clean up historical utilization that is routinely submitted with Medicaid claims. In addition, the analyst will load Medicaid claim ... the Medicaid Drug Rebate Program or program contract. This individual will review utilization by these programs to identify potential disputes and will work… more
- Teva Pharmaceuticals (Parsippany, NJ)
- Medicaid Claims Analyst Date: Oct 21, 2024 Location: Parsippany, United States, New Jersey, 07054 Company: Teva Pharmaceuticals Job Id: 57268 **Who we are** Teva ... us on our journey of growth! **The opportunity** The Medicaid Claims Analyst is responsible for ...propose recommended amounts to be paid for historical outstanding utilization that is routinely submitted with Medicaid … more
- CaroMont Health (Gastonia, NC)
- …RAC for reversal of original determination. May serve on the Medical Record/ Utilization Review Committee, providing detailed logs of denial activity and appeal ... be cross trained to work for the Commercial Resource Analyst when the need arises. Act as liaison to...NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case… more
- The Cigna Group (Bloomfield, CT)
- Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst We will depend on you to communicate some of our most critical information to the correct ... Medicare appeals and related issues, implications and decisions. The Case Management Analyst reports to the Supervisor/Manager of Appeals and will coordinate and… more
- MyFlorida (Tallahassee, FL)
- …rules, coverage policies, managed care plan contracts, bill analyses, drug utilization review boards, preferred drug lists, supplemental rebate contracts, ... 68064844 - MEDICAL/HEALTH CARE PROGRAM ANALYST Date: Nov 12, 2024 The State Personnel...entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000… more
- MyFlorida (Tallahassee, FL)
- …rules, coverage policies, managed care plan contracts, bill analyses, drug utilization review boards, preferred drug lists, supplemental rebate contracts, ... 68064814 - GOVERNMENT ANALYST II Date: Nov 8, 2024 The State...be found on the Agency's administrative rule webpage at http://ahca.myflorida.com/ medicaid / review /index.shtml. 8. Providing technical assistance to ensure… more
- Commonwealth Care Alliance (Boston, MA)
- …claims adjudication, clinical coding reviews for claims, settlement, claims auditing and/or utilization review required + 7+ years experience with Optum Claims ... research, as necessary on all new and revised coding logic, related Medicare/ Medicaid policies for review /approval through the Payment Integrity governance… more
- CVS Health (Tallahassee, FL)
- …Florida Medicaid Health system strongly preferred + Managed care experience + Utilization review experience + Claims review experience strongly preferred ... in state of Florida, position is 100% remote._** Behavior Analysis Utilization Management Clinical Consultant applies critical thinking and is knowledgeable in… more
- Premier Health (Dayton, OH)
- …related experience Prior job title or occupational experience: Case management, Utilization review Prior specific functional responsibilities: N/A Preferred ... Medicare and Medicaid guidelines, and other regulations which impact the utilization or denial of provider services. Essential Duties & Functions: 1. Responds… more
- Prime Therapeutics (Columbus, OH)
- …and analysis, external audits and accreditation processes, and participates in committee review meetings within the Commercial, Medicare, Medicaid , and Health ... fuels our passion and drives every decision we make. **Job Posting Title** Regulatory Analyst Sr - Remote **Job Description** The Senior Regulatory Analyst is… more
- Hackensack Meridian Health (Edison, NJ)
- …transform healthcare and serve as a leader of positive change. The **Pharmacy Analyst , 340B** will be responsible for ensuring 340B program compliance in HMH's 340B ... medication orders for replenishment. The role requires an in-depth review of data and analysis to ensure regulatory compliance...A day in the life of a **Pharmacy Business Analyst ** at Hackensack Meridian _Health_ includes: + Shares expertise… more
- Molina Healthcare (WI)
- **Job Description** **Job Summary** The Lead Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and ... rate tracking and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity reporting. + Lead… more
- CareOregon (Portland, OR)
- …Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Healthcare Analyst Exemption Status Exempt Department Informatics & Evaluation Manager Title Director ... information for decision makers. Analysis focus areas include cost and utilization of health services, financial trending, population health outcomes, and quality… more
- Essentia Health (Superior, WI)
- **Job Description** **Job Description:** The 340B Analyst is a remote position that reports to the Pharmacy Business Services Director. As a member of the 340B Team ... the 340B Analyst assists with providing ongoing 340B program oversight and...patient medical records, insurance plans, and hospital status + Review 340B program policies and workflows on an ongoing… more
- Prime Therapeutics (Columbus, OH)
- …licensed functions (Pharmacy Benefit Management (PBM), Third Party Administrator, Utilization Review Organization, Business, State registrations, etc); compile ... and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Interpretation and Advising) - Remote **Job Description** The Senior Compliance … more
- American Academy of Pediatrics (Itasca, IL)
- …AAP initiatives in child health financing and payment including managed care, Medicaid , medical risk/liability, fraud and abuse, and key health regulations. In ... that impact pediatric healthcare financing, particularly those related to Medicaid , Medicare, value-based care arrangements, and other government programs such… more
- Molina Healthcare (ID)
- …5+ Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among ... Medicaid , Marketplace and Medicare/MMP. + 5+ Years of experience...problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics. + 5+ Years of experience in Statistical… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Quality Review Nurse (RN) is to evaluate clinical quality and procedures within the Clinical Appeals & ... Grievance Department Government Programs (Maryland Medicare and Medicaid ). This includes auditing clinical appeals and grievance letters/documentation, reporting and… more
- The County of Los Angeles (Los Angeles, CA)
- …program administration, ensuring compliance with Federal and State Medicare and Medicaid regulations for reimbursement claiming and maximum recovery costs for ... goals. Develops and implements reporting procedures to ensure that program services utilization and revenue data are reported accurately and in a timely manner.… more