- Sun Pharmaceuticals, Inc (Washington, DC)
- …developed analytical skills with demonstrated ability to conceptualize issues and synthesize data to provide strategic direction Experience in Sun Pharmas ... Field Reimbursement Manager Overview: The Field Reimbursement Manager ...(coverage, coding & payment), specialty pharmacy and distribution processes, provider support services (eg, benefits investigation) and patient support… more
- CVS Health (Annapolis, MD)
- …all with heart, each and every day. **Position Summary** + Lead a team of Medicaid Provider Data Services Analysts responsible for loading and maintaining ... Medicaid Provider data within Aetna QNXT. + Team...Medicaid Provider data within Aetna QNXT. + Team...or Network operations. + 1+ years of experience in Medicaid provider operations. + At least 1… more
- Humana (Annapolis, MD)
- …Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing ... be primarily responsible for implementation, maintenance and support of Medicaid provider reimbursement for hospitals and facilities....EAPG + 2+ years of experience with Optum Rate Manager + 2+ years of experience with Optum WebStrat… more
- CVS Health (Annapolis, MD)
- … Manager of Claims Management is responsible for overseeing Medicaid claims operations, inventory management, quality assurance, and compliance monitoring. This ... federal regulations, contractual requirements, and organizational performance standards. The manager partners cross-functionally with Provider Relations, Configuration,… more
- Humana (Annapolis, MD)
- …providers, with full accountability from strategy to execution. The Lead Product & Strategy Manager - Provider Practice Management role is a critical member of ... first** We are looking for a dynamic Lead Product Manager to develop clinical solutions for our members and...-friendly insights. + Lead the design and refinement of provider -facing data views (dashboards, insights, performance summaries)… more
- AmeriHealth Caritas (Washington, DC)
- …Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication. This position is also responsible ... for all provider network recruiting and contracting management activities as it...with claim payment methodologies. + Maintains familiarity with State Medicaid fee schedules and analyzes comparable Plan pricing guidelines.… more
- NTT America, Inc. (Baltimore, MD)
- **Req ID:** 343399 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, ... adaptable, and forward-thinking organization, apply now. We are currently seeking a APD Manager to join our team in Baltimore, Maryland (US-MD), United States (US).… more
- CenterWell (Annapolis, MD)
- …part of our caring community and help us put health first** The Manager of Pre-Bill Audit provides strategic leadership and operational oversight for the ... improvements in unbilled rates, revenue cycle performance, and compliance. The Manager leads a team of Pre-Bill Specialists, partners with senior leadership,… more
- Johns Hopkins University (Baltimore, MD)
- …health plan functions such as claims processing, premium billing, encounter data , utilization management, risk adjustment, provider contracting, quality metrics, ... **General Summary** We are seeking an **Internal Audit Manager ,** who demonstrates subject matter expertise in operational internal auditing and the healthcare… more
- CareFirst (Baltimore, MD)
- …performance to internal stakeholders, and C-suite with a focus on coding data and analytics. + Experienced with effective physician/ provider collaborative ... **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Manager plays a critical role in the development...a dedicated resource within the organization for Medicare Advantage, Medicaid and ACA markets, coordinating and leading the end… more
- Humana (Annapolis, MD)
- …telephony, data systems, and enterprise architecture. The Senior Product Manager will serve as a key interface between business and technology, driving ... and help us put health first** The Senior Product Manager Conceives of, develops, delivers, and manages products for...to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Senior… more
- Humana (Annapolis, MD)
- …technical program management, including at least 3 years as a Technical Product Manager in data , AI/ML, or personalization platforms. + Demonstrated success in ... advanced agentic AI decision-making across our organization. As a Lead Technical Product Manager (PM-T), you will be responsible for shaping the vision, defining the… more
- Cardinal Health (Annapolis, MD)
- …conducts investigations to resolve ethics and compliance issues. **Compliance Audit Manager ** Reporting to the Compliance Director, this position supervises and ... annual enterprise risk assessment and audit and monitoring plan. The Manager has supervisory responsibility for all Compliance Audit staff. **Responsibilities** +… more
- Leidos (Baltimore, MD)
- …Modernization Sector at Leidos currently has an opening for a Senior ISSO/Security Manager to work in our Baltimore, Maryland office. This is an exciting opportunity ... to use your experience helping the Center for Medicare and Medicaid (CMS) program operate, maintain, modernize and transform its legacy system. **Primary… more
- Humana (Annapolis, MD)
- …us put health first Humana's Product organization is seeking a Lead Product Manager to drive the strategy, development, and optimization of the Adobe Experience ... translating business needs into platform capabilities that enable personalized, data -driven customer experiences. You'll work closely with cross-functional teams to… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE** : This Behavioral Health Care Manager will support the Maryland Dual Eligible Special Needs Plan (MD DSNP). Under minimal ... supervision, the Care Manager researches and analyzes a member's medical and behavioral...member's stabilization and ability to self manage. Ensures member data is documented according to CareFirst application protocol and… more
- Leidos (Baltimore, MD)
- …Leidos currently has an opening for an HHS (Health and Human Services) Program Manager to work in our Baltimore, Maryland office. This is an exciting opportunity to ... use your experience helping the Center for Medicare and Medicaid (CMS) program operate, maintain, modernize and transform its current highly visible legacy system.… more
- Philips (Baltimore, MD)
- **Territory Manager - RespirTech (Baltimore, ME, Annapolis, ME, Wilmington, ME)** RespirTech's Territory Manager represents the InCourage airway clearance ... evidence to physicians. + Being an expert on Medicare, Medicaid and private insurance coverage-criteria for InCourage vest therapy,...in order for coverage to be obtained. + Analyzing data to effectively target priority healthcare teams and create… more
- Datavant (Annapolis, MD)
- …needs, and determine the right methodology for analysis and assumptions to provide data -driven insights into program performance and partnerships + Create ... + Run various risk adjustment models for Medicare Advantage, Medicaid or ACA to forecast patient risk scores and...problem-solving skills with the ability to think critically and provide data -driven solutions + Expertise in the… more
- CVS Health (Annapolis, MD)
- …data analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate ... and data integrity. + Stay informed about changes in Medicaid policy, regulatory requirements, and FWA detection techniques to ensure ongoing compliance.… more
