- CVS Health (Harrisburg, PA)
- …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
- Prime Therapeutics (Harrisburg, PA)
- …our passion and drives every decision we make. **Job Posting Title** North Carolina Medicaid Account Manager - Remote Raleigh, NC **Job Description** The Senior ... Account Manager is responsible for providing complex level support for...for providing complex level support for the North Carolina Medicaid business by driving communications, client-facing initiatives, and product… more
- Humana (Harrisburg, PA)
- …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
- CVS Health (Harrisburg, PA)
- …the process for identifying, evaluating, and completing contracting with Specialty and Medicaid provider partners. . Developing relationships with leaders of ... chronic kidney, oncology, polychronic/complex care, and emerging specialty types) or Medicaid provider organizations to design and execute on strategies… more
- Penn Medicine (Lancaster, PA)
- …related clinical field. + One 1 year of leadership experience. + A health care provider in good standing with Medicare, Medicaid , and other federal and state ... Position Summary: + Under the direction of the Nurse Manager , the Assistant Nurse Manager assesses, plans,...of clinical nursing needs of patients. + Collects objective data with regard to the clinical performance, attitude and… more
- Penn Medicine (Lancaster, PA)
- …AHA Basic Life Support, required within 30 days of hire. + A health care provider in good standing with Medicare, Medicaid , and other federal and state health ... **Position Summary:** + Under the direction of the Nurse Manager , the Assistant Nurse Manager assesses, plans,...of clinical nursing needs of patients. + Collects objective data with regard to the clinical performance, attitude and… more
- CVS Health (Harrisburg, PA)
- …of business systems, applications, and tools supporting network management, contracting, and provider data systems + Experience in related business environment ... audits out of QNXT and PRMS systems to support Medicaid SOC and SOX controls + Coordinate with applicable...with exposure to provider data , processes, etc. **Education** Bachelor's degree… more
- Humana (Harrisburg, PA)
- …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 (Harrisburg, PA)
- …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
- Humana (Harrisburg, PA)
- …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
- Humana (Harrisburg, PA)
- …at the center of everything it does. We are seeking a Lead Product Manager to drive the vision, strategy, and execution of our Sales and Marketing Technology ... our sales and marketing teams to achieve growth targets. The Lead Product Manager Conceives of, develops, delivers, and manages products for customer use. The Lead… more
- Datavant (Harrisburg, PA)
- …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 (Harrisburg, PA)
- …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
- Penn Medicine (Lancaster, PA)
- …years of clinical experience + One 1 year supervisory experience + A health care provider in good standing with Medicare, Medicaid , and other federal and state ... FR 730-2 Summary: + Position Summary: This position will provide support to a primary care region of practices,...One 1 year supervisory experience + A health care provider in good standing with Medicare, Medicaid ,… more
- Elevance Health (Harrisburg, PA)
- …NAH, Organ Acquisition and all cost based principles + Analyze and interpret data per a provider 's trial balance, financial statements, financial documents or ... Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs. The **Audit...will make an impact** : + Analyzes and interprets data and makes recommendations for change based on judgment… more
- Penn Medicine (Lancaster, PA)
- …an economically, racially, and culturally diverse population with a greater than 50% Medicaid population. Our scope of practice is full spectrum family medicine from ... and development of staff. + In collaboration with Managing Physician, and or Manager , interviews and selects candidates for vacant positions. + Serves as a patient… more
- Penn Medicine (Lititz, PA)
- …+ Completes quality assurance checks for staff and department as directed by supervisor/ manager . Assists with reviews of authorization denial data . + Provides ... Epic (or equivalent Electronic Medical Record) experience preferred. + Req A health care provider in good standing with Medicare, Medicaid , and other federal and… more
- CenterWell (Harrisburg, PA)
- …Internal Medicine, or Geriatric Medicine . Active and unrestricted DEA license . Medicare Provider Number . Medicaid Provider Number . Excellent verbal and ... Primary Care, Humana's Primary Care Organization. This group will provide virtual wraparound services to support patients when they...to act as a resource for the advanced practice provider to ensure exceptional patient care. . Follow policy… more
- Public Consulting Group (Harrisburg, PA)
- …administrative tasks and the entire claim process. The independent contractor will provide contract support through data entry, report extract and analysis, ... needed. Ensures accurate system support through review and updating reference data , contractual metrics, and compliance metrics. Ensures accurate RMC support through… more
- CenterWell (Harrisburg, PA)
- …diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Program Management Lead, Offshore ... needed. + Participate in Payer calls/chart reviews. + May participate in provider education programs on coding compliance. + Exercises independent judgment and… more