- Merck & Co. (North Wales, PA)
- …the entire US health care system: Pharmacy Benefit Managers, Health Plans, State Medicaid agencies, Integrated Delivery Networks, Hospital Systems, Group ... Director, US Market Access Contracting within the NCOSC Team. The Director will lead a team of Customer Managers to achieve profitable product access for all… more
- The Cigna Group (Philadelphia, PA)
- …Express Scripts Medicaid and Commercial will serve as the Express Scripts Medicaid Compliance Officer and have direct oversight of the Express Scripts ... Managing Director- Evernorth Benefits Management Compliance regarding Compliance Program matters. + Lead a team...mechanisms. + Serve as Chair of the Express Scripts Medicaid Compliance Committee. + Develop and maintain… more
- CVS Health (Princeton, NJ)
- …health care more personal, convenient and affordable. **Position Summary** The NJ Medicaid Lead Director, Network Management is accountable for designing ... conceptual models, initiative planning, and negotiating Medicaid value based agreements with New Jersey providers, including health systems, clinically integrated… more
- Public Consulting Group (Trenton, NJ)
- …and cultivate relationships with potential clients with a particular focus on state Medicaid agencies, children's behavioral health, child welfare and juvenile ... more, visit www.publicconsultinggroup.com . _Key responsibilities include:_ _Project Management_ + Lead the planning, execution, and monitoring of Medicaid … more
- CVS Health (Blue Bell, PA)
- …and lead team members to do the same. (10% time) + Assure compliance with Medicaid contract and supplemental analysis requests from market leads or the ... team supporting CVS Health and Aetna's exciting and growing Medicaid business. Support CVS Health's financial integrity with sound...OHRISE, WV, & VA). Within this role, you'll: + Lead /manage Plan and analytical support to achieve operating plan… more
- Sumitomo Pharma (Trenton, NJ)
- …the Medicaid rebate team in receiving, processing, validating, trouble-shooting Medicaid claims and dispute resolution with state agencies. This position ... role with 2-3 days a week required in office. **Job Duties and Responsibilities** + Lead operations person for all Medicaid decisions as it relates to Model N… more
- AristaCare (Manchester, NJ)
- …procedures related to billing and accounts receivable, census processing and Medicaid applications. The Business Office Manager processes facility information and ... families in regards to accounts + Collections of all payors; Hospice, Medicare, Medicaid , MLTSS, Managed Care/Managed Medicare, Private + Check claim status for all… more
- Organon & Co. (Plymouth Meeting, PA)
- …the primary or collaborative Women's Health point of contact for Organon for the following: + State Medicaid & Managed Medicaid Plans + State FQHCs ... IDN customers, the WH-AD will serve as the account lead for Women's Health in the supply chain/procurement and...Develops relations with key public health officials such as state , Medicaid , city and county health department… more
- HealthEdge Software Inc (Trenton, NJ)
- …(from basic to advanced features/functionality), payment methodologies/policies (Medicare, Medicaid , and commercial), payment integrity, and healthcare plan ... payment/policy configuration, provider relations, medical management, medical economics, audit, compliance ) related to implementation/consulting engagements, strategic user adoption initiatives,… more
- Humana (Trenton, NJ)
- …service should be authorized. All work occurs within a context of regulatory compliance and work is assisted by diverse resources which may include national clinical ... Behavioral Health Medical Directors will learn Medicare, Medicare Advantage and/or Medicaid requirements, and will understand how to operationalize this knowledge in… more
- CVS Health (Blue Bell, PA)
- …Performance Improvement Plans, provider & member enablement, regulatory and accreditation compliance . This individual will lead a cross-functional team ... and STAR ratings are achieved. + Defining and regulating a preparedness and compliance culture and discipline with federal and state laws and regulations… more
- Humana (Trenton, NJ)
- …service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national ... and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines. **Use your skills to make an impact** **Required… more
- Merck (North Wales, PA)
- …the entire US health care system: Pharmacy Benefit Managers, Health Plans, State Medicaid agencies, Integrated Delivery Networks, Hospital Systems, Group ... Access Contracting within the NCOSC Team. The Director will lead a team of Customer Managers to achieve profitable...contract strategies for the following customer segments: + Federal ( Medicaid , 340B, Apexus, DoD, VA) + GPO + Hospitals… more
- Humana (Trenton, NJ)
- …service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national ... and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines. **This is a full-time work from home opportunity.… more
- Humana (Trenton, NJ)
- …meet authorization requirements. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national ... thinking and authorship. Exercises independence in meeting enterprise expectations and compliance timelines. Completes other duties as assigned. This is a full-time… more
- Humana (Trenton, NJ)
- …service should be authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which may include national clinical ... and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. Supports the assigned work with respect to market-wide… more
- CAI (Trenton, NJ)
- …responses and create tailored solutions for complex RFP requests in the Medicaid , Medicare, Child Welfare, and/or Child Support areas. **Job Description** **Job ... create tailored solutions for complex RFP requests in the Medicaid , Medicare, Child Welfare, and/or Child Support areas. This...will be **full-time** and **remote.** **What You'll Do** + Lead the review process for RFPs to determine suitability… more
- Humana (Trenton, NJ)
- …necessity and appropriateness of services rendered by healthcare professionals in compliance with CMS guidelines, clinical coverage criteria, and quality standards. ... + Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products + Must be passionate about...Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will… more
- Bristol Myers Squibb (Princeton, NJ)
- …laws. + Possess a strong understanding of Commercial payers, Medicare plans and state Medicaid in geography. + Immunology experience (emphasis on Dermatology, ... have no direct reports and report into the Regional Lead , Derm APP Clinical Liaison. The Dermatology APP Liaison...our short and long-term goals, ensuring all legal and compliance regulations are adhered to + Serve as a… more
- HealthEdge Software Inc (Trenton, NJ)
- …**Your Impact** **: ** + Develop the product roadmap forclaimsvalue stream and lead high-level epic planning for current and futurequarters + Lead and ... and coordinate delivery of multiple product features across multiple engineeringteams + Lead engineering grooming sessions for selected epics and stories + Work… more
