- Public Consulting Group (Raleigh, NC)
- …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 (Raleigh, NC)
- …make health care more personal, convenient and affordable. **Position Summary** The Lead Director, Network Management - Medicaid /North Carolina is accountable ... for designing conceptual models, initiative planning, and negotiating Medicaid value based agreements with North Carolina providers, including health systems,… more
- Humana (Raleigh, NC)
- …risk, compliance , regulatory or related experience). + Regulatory or Medicare/ Medicaid compliance experience. + Auditing experience working with auditing ... first** Humana Healthy Horizons in Virginia is seeking a Compliance Professional 2 who will lead incoming...as Health and Human Services' Centers for Medicare and Medicaid Services (CMS) and EQROs. + Supports compliance… more
- Sumitomo Pharma (Raleigh, NC)
- …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
- American Institutes for Research (Chapel Hill, NC)
- …full-time **Researcher** with a strong background in Medicare and Medicaid policyto join AIR'sHealth Division (https://www.air.org/our-work/health) . The Researcher ... support to evaluation and analytical support for Centers for Medicare & Medicaid Services (CMS), states, and foundations. Candidates hired for the position may… more
- Highlights Healthcare (Raleigh, NC)
- … and Federal specific laws, Tricare/Governmental programs, Medical Insurance Providers, Medicaid Waiver Programs and ensure compliance with regulations. + ... Behavior Analyst (BCBA) to work as needed as a LEAD BCBA for our locations & learners in the...We specialize in serving young learners and families with Medicaid benefits. We believe every child can achieve great… more
- Humana (Raleigh, NC)
- …responsibility for all of Insurance IT to improve productivity and efficiency. The Lead DevOps engineer will be a key investment towards that productivity gain and ... to improve DevOps maturity overall. The Lead engineer will enable Insurance IT expedite access remediation, certified template migration, and improving standards… more
- HealthEdge Software Inc (Raleigh, NC)
- …(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 (Raleigh, NC)
- …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
- Humana (Raleigh, NC)
- …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
- Humana (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 ... authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. **Some weekend work may be required.** **Required… more
- UNC Health Care (Durham, NC)
- …as management of resources in a cost-effective manner, and participates in compliance and quality performance improvement efforts to ensure that nutrition care is ... liaison between other medical specialties and ancillary services. 3. Assists in achieving compliance with the Joint Commission, Centers for Medicare and Medicaid … more
- CAI (Raleigh, NC)
- …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
- American Institutes for Research (Chapel Hill, NC)
- …Reauthorization Act (MACRA) and the Quality Payment Program (QPP). The policy analyst will lead tasks related to AIR Health's work with the Centers for Medicare & ... Medicaid Services (CMS). In addition, the candidate will be...participate in business development opportunities at the federal and state levels and mentor more junior policy analysts. Candidates… more
- Humana (Raleigh, NC)
- …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
- HealthEdge Software Inc (Raleigh, NC)
- …**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
- Humana (Raleigh, NC)
- …to use your expertise in data analysis and problem solving to ensure compliance with state and federal regulations. Responsibilities include: + Subject matter ... audits and compliance mock audits + Ensure compliance with all Federal and state requirements....update and maintain various reports and policy/procedure documents. + Lead projects with internal/external areas related to required process… more
- Humana (Raleigh, NC)
- …in Virginia is seeking an Associate Director, Care Management (LTSS/ABD) who will lead teams of healthcare professionals responsible for care management. They will ... lead and guide others in providing integrated services for...and requirements to achieve and/or maintain an optimal wellness state by guiding members/families toward and facilitate interaction with… more