- Elevance Health (Nashville, TN)
- ** Medicaid Contract / Implementation Management Director** **Location:** 22 Century Blvd., Suite 310, Nashville, TN 37214. This position will take part in ... model with PulsePoint sites used for collaboration, community, and connection. The ** Medicaid Contract / Implementation Management Director** is… more
- Prime Therapeutics (Nashville, TN)
- …+ Experience with analyzing state and federal regulations + Experience using Contract Management software including maintaining and managing databases **Minimum ... fuels our passion and drives every decision we make. **Job Posting Title** PBM Contract Representative Sr - LA Medicaid **Job Description** The Senior … more
- Humana (Nashville, TN)
- …support to assigned health plan and/or specialty companies relative to Medicare/ Medicaid /TRICARE/Employer Group product implementation , operations, contract ... of diverse scope and complexity ranging from moderate to substantial. The Medicaid Market Development Advisor serves as the primary resource on regulations for… more
- CVS Health (Nashville, TN)
- …Medicare and/or Medicaid Delegation + Delegation / capitation and associated contract and performance oversight + PMP Certification + Key concepts (high level) ... (clinical, operations, Medicare segment). **Required Qualifications** + Successful project management experience in health operations or similar disciplines with… more
- Prime Therapeutics (Nashville, TN)
- …the Medicaid Drug Rebate Program. + Ensures compliance with each State Medicaid contract . + Maintains rebate records in accordance with all applicable state ... Operations **Job Description Summary** This position provides administrative oversight and management of rebate operations team and is responsible for directing day… more
- HealthEdge Software Inc (Nashville, TN)
- …cycle/workflow, network contracting, payment/policy configuration, provider relations, medical management , medical economics, audit, compliance) related to ... and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities… more
- Prime Therapeutics (Nashville, TN)
- …data management and overall healthcare trends specific to the Medicaid population. **Job Description** + Partners with appropriate staff in the identification, ... 8+ years of pharmacy experience. + 5+ years of experience in Pharmacy Benefits Management (PBM), Health plan or Medicaid clinical customer service. + Working… more
- Public Consulting Group (Nashville, TN)
- …the important points of intersection and overlap between our Special Education/Case Management and school-based Medicaid services work within a state; regularly ... Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human… more
- Public Consulting Group (Nashville, TN)
- …+ **_Job Requirements:_** + Provide legal and practical guidance and support to management and consultants in compliance areas including Medicaid regulations. + ... as assigned. + **_Job Qualifications:_** + Specialized knowledge and experience in Medicaid , contract , and other relevant compliance areas. + Employment… more
- Public Consulting Group (Nashville, TN)
- Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human ... support the delivery of health-related services by helping schools access critical Medicaid reimbursement. Client Success Partners (CSP) are key members of the… more
- HCA Healthcare (Brentwood, TN)
- … contract language and negotiations. + Significant Revenue Cycle management experience, specifically in the areas of accounts receivable, denials, and ... of the RVP of Operations: Collaborate with IRC, Case Management / URS, Parallon, PCA, Legal and other HUB...in the Managed Commercial, Exchange, Managed Medicare and Managed Medicaid books of business that consists of 3700 contracts… more
- Elevance Health (Nashville, TN)
- …week** The **LTSS Service Coordinator - RN Clinician** is responsible for overall management of member's case within the scope of licensure; provides supervision and ... participating in the member's case in accordance with applicable state law and contract ; develops, monitors, evaluates, and revises the member's care plan to meet… more
- HealthEdge Software Inc (Nashville, TN)
- …and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities ... senior level role in analyzing claims data, as well as translating contract terms, policies, and regulatory guidelines into actionable requirements for our… more