- City of New York (New York, NY)
- …is recruiting for one (1) Principal Administrative Associate II, to function as a Medicaid Consultant within the Central Intake Unit, who will: - Interpret ... TITLE. The Home Care Services Program (HCSP) is a Medicaid funded program that provides long term care to...Medicaid policies and procedures for assigned cases for individuals… more
- Public Consulting Group (Trenton, NJ)
- …is changing, and PCG is at the forefront. We are looking for an experienced Medicaid Consultant to join our team and help lead our growth efforts. Deep ... new streamlined modular certification (SMC) and outcomes-based certification (OBC). Our ideal Medicaid Consultant will provide oversight and direction for scope,… more
- VNS Health (Manhattan, NY)
- …analysis and interpretation designed to improve clinical outcomes. . Serves as consultant for unusual and difficult medical cases. Participates in the QARR/HEDIS ... Investigation Unit on issues related to Fraud, Waste, and Abuse of Medicare/ Medicaid services. + Collaborates with pharmacy services to review PBM activities and… more
- HealthEdge Software Inc (Trenton, NJ)
- **Overview** **Overview:** The Business Consultant leads and mentors the Service Delivery team in all Tier 1 (Basic) and Tier 2 (Intermediate) consulting ... products (from basic to advanced features/functionality), payment methodologies/policies (Medicare, Medicaid , and commercial), payment integrity, and healthcare plan operations… more
- Deloitte (Princeton, NJ)
- …Human Capital practice. Work you'll do As a Government Health Actuary - Consultant in Deloitte's Human Capital Actuarial and Insurance Solutions Practice, you will ... health plan/insurance company experience + 1 + years' experience with Medicaid managed care capitation rate development and/or fee-for-service rate development +… more
- City of New York (New York, NY)
- …with essential benefits such as Cash, Food and Rental Assistance as well as Medicaid . The Office of the Medical Director aims to improve the health and well-being ... one (1) City Medical Specialist (Per Diem) to function as a Medical Consultant who will: - Indirectly supervise contracted clinical staff, share policies and… more
- Highmark Health (Trenton, NJ)
- …share models and will be implemented for the Organization's Medicare Advantage, Medicaid , ACA, and commercial populations with the goal of maximizing quality while ... key provider partners. + Collaborate with and support the senior Strategic Partners Consultant role as needed + Other duties as assigned or requested. **EDUCATION**… more
- Public Consulting Group (Trenton, NJ)
- …intersection and overlap between our Special Education/Case Management and school-based Medicaid services work within a state; regularly engage with counterparts + ... clients + Understand and continually monitor Federal, state, and local Medicaid School-Based program policies and guidance, collaborating with PCG subject matter… more
- Public Consulting Group (Trenton, NJ)
- …setting and payment reform initiatives, including for federal entitlement programs including Medicaid and Title IV-E + Conducting financial and data analysis using ... with government and/or nonprofit finance office, accounting firm, consulting firm, Medicaid or other policy office + Bachelor's degree required, preferably with… more
- Molina Healthcare (New York, NY)
- …urgency, communication and follow through to closure. * Knowledgeable of State Medicaid contract Service Level Agreements. Demonstrates SME knowledge of MCO contract ... compliance requirements that impact processes. * Facilitates and leads processes and activities to complete deliverables impacting assigned healthplans including, but not limited to, RFP Responses, audit response/coordination, and evaluation of new contract… more
- Prime Therapeutics (Trenton, NJ)
- …management. Enforces teamwork across all internal departments, as well as with Medicaid Clients, and an in-depth understanding of all rebate programs, trends, and ... state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each...discussion for these periodic meetings. + Acts as a consultant to Rebate Director for RFPs and implementations when… more
- Daiichi Sankyo Inc. (Basking Ridge, NJ)
- …not limited to, areas of GPO/PBM and trade/distribution agreements, Medicare, Medicaid , product pricing, and government price reporting. Coordination with, and ... **Responsibilities** - Lead drafting and negotiating contracts for commercial, Medicaid and Medicare coverage, as well as other government...support functions in an in-house capacity, as a legal consultant , and/or at a law firm in a practice… more
- Prime Therapeutics (Trenton, NJ)
- …role modeling Prime's employee and leadership expectations. + Serves as a consultant to management on major matters pertaining to laws and regulations, policies, ... Management organization, or within a highly regulated industry, including experience with Medicare, Medicaid , and the Affordable Care Act (ACA) + Must be eligible to… more
- Molina Healthcare (New York, NY)
- …assuming technical and project leadership roles. * May function as a technical consultant or researcher. * Considered a SQL GURU. * Leads in gathering requirements, ... background * 3-plus years managed care experience, preferably working with the Medicaid product * Knowledge of state encounter submission process. * Knowledge of… more
- VNS Health (Manhattan, NY)
- …and ensure compliance. + Abstracts medical data from medical records assigned to consultant in a precise and proficient manner + Accesses scanned copies of medical ... required + Minimum of one year quality improvement experience in Medicare, Medicaid or Commercial Health Plan Knowledge of HEDIS/QARR standards, medical terminology,… more