- CVS Health (Lansing, MI)
- …located in MI- This position will support the several parts of the Medicaid provider management team with focus on assignment, reporting, project management, ... coordination and collaboration amongst of work for Network Operations-Intake and triage, provider data assignments, claim pend assignments.-Will be lead for work… more
- Humana (Lansing, MI)
- …on Ohio Medicaid Behavioral Health. Responsibilities will include maintaining provider relations to support customer service activities through data ... The Behavioral Health Network Operations Lead manages behavioral health provider data for health plans including but...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and… more
- Public Consulting Group (Lansing, MI)
- …new streamlined modular certification (SMC) and outcomes-based certification (OBC). Our ideal Medicaid Consultant will provide oversight and direction for scope, ... achieve strategic goals to serve the public better. We provide the full spectrum of technology consulting services to...Business Enablement + Business Solutions + Project Assurance The Medicaid marketplace is changing, and PCG is at the… more
- Humana (Lansing, MI)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... authorizations to determine the medical necessity of a given service , level of care, or medical item/supply. The Medical...to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors that… more
- Humana (Lansing, MI)
- …Medicaid Business Intelligence Engineer solves complex business problems and issues using data from internal and external sources to provide insight to ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Public Consulting Group (Lansing, MI)
- …Reviews and can be the expert in the business/project operations for service and efficiency improvements. + Evaluates projects and programs and makes recommendations ... interprets federal and state law and regulation. + Assesses best practices and provide technical assistance to clients. + Manages small projects, staff and tasks… more
- Prime Therapeutics (Lansing, MI)
- …empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members. If ... Posting Title** Documentation Management & Reporting Business Analyst - Louisiana Medicaid **Job Description Summary** Serves as liaison between departmental team… more
- Humana (Lansing, MI)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... caring community and help us put health first** The Senior Provider Reimbursement Professional performs research, analysis, documentation, and interpretation for the… more
- Humana (Lansing, MI)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP), plus other commercial and… more
- Humana (Lansing, MI)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... a medical director with utilization management process skills. This MD will provide legal representation for Humana at pre-litigation, case reviews and litigation.… more
- Humana (Lansing, MI)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... to work in optimizing testing strategies and ensuring robust data accuracy, making you the cornerstone of successful software...achieve their best health - delivering the care and service they need, when they need it. These efforts… more
- Humana (Lansing, MI)
- …solve complex business problems and issues for the Medicaid organization using data from internal and external sources to provide insight to decision-makers. ... data management, data visualization and data science supporting Humana's Service Operations. The...progress, producing adequate responses, and providing support for the Medicaid business + Analyze Medicaid data… more
- CVS Health (Lansing, MI)
- …to the State CEO, COO, and other executive team members in Medicaid driving clinical excellence, achieving measurable health outcomes, and supporting quality and ... as well as conceptualization, design, and implementation of strategic priorities for Medicaid . The State CMO will be responsible for cost containment outcomes and… more
- Sumitomo Pharma (Lansing, MI)
- …Integrated Service Networks (VISNs), Department of Defense (TRICARE), Indian Health Service (IHS) and State Medicaid PBA decision-makers to obtain and/or ... Indian Health Service + US Public Health Services + State Medicaid PBA's **Qualifications:** + 10 years of pharmaceutical experience with positions of increasing… more
- Humana (Lansing, MI)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The...services, requested level of care, and/or requested site of service should be authorized. All work occurs within a… more
- Highmark Health (Lansing, MI)
- …onboarding of new plans/providers. Translates configuration rules, fee schedules, contract terms, provider data code sets, and benefits into systems parameters ... underlying systems that support the respective business platforms for the Medicaid Business Unit market served by Highmark. Performs configuration change management… more
- Humana (Lansing, MI)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... help us put health first** The Financial Analytics Professional 2 manages data to support and influence decisions on day-to-day operations, strategic planning and… more
- Sutherland Global Services (Lansing, MI)
- …+ Status Inquiries + Interpreting Medical Benefit Grids + Verification of Provider Participation + Credentialing Inquiries + Documentation + Provider Inquiries ... provided on the phone call + Routing Pathways + Self- Service Options + Assisting providers with education on available...+ 1-2 years of experience with healthcare insurance + Medicaid experience highly favored + 1-2 years of experience… more
- Humana (Lansing, MI)
- …PowerBI experience + 5 or more years of experience working with healthcare data (claims, clinical, provider , operational, etc.) + Strong relationship building ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- CenterWell (Lansing, MI)
- … provider organization strongly preferred. + Prior Medicare and/or Medicaid , Medicare Advantage, or government oversight strongly preferred. + Healthcare ... involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. **The Role** The Senior… more