- The Cigna Group (Nashville, TN)
- **Summary** The Directory Data Steward is an Advisor level role within the Provider Data Quality & Accuracy team, responsible for maintaining data ... project. They will help to drive improvements in the provider data domain to ensure we meet...assisting with improved claims auto-adjudication. + Work within the Data Quality management process to champion incremental… more
- The Cigna Group (Nashville, TN)
- **Summary** The Medicare Advantage Data Science team's mission is to provide data science and analytical support to our partners, promote sustained ... collaboration with our Cigna matrix partners. This role will provide Medicare Advantage clinical and member experience...development programs and on a project-by-project basis + Ensure quality and integrity of data collected, analyses… more
- The Cigna Group (Nashville, TN)
- …critical processes + Develop reporting in collaboration with analytics partners to monitor data quality + Work effectively and efficiently on multiple tasks and ... **Summary** The Medicare Risk Adjustment Advanced Analytics team is searching...while producing high quality results + Ensure quality and integrity of data and follow… more
- The Cigna Group (Nashville, TN)
- …experience in healthcare analytics; value-based care experience preferred + Experience with government medicare data highly desired + Data extraction and ... quality of care of our members by our provider groups. In addition, this person will be responsible...collaboratively with key technical and non-technical matrix partners to provide analytical reporting for use in evaluation of our… more
- The Cigna Group (Nashville, TN)
- …an individual contributor responsible for supporting the analytics strategy for Medicare Health Services, performing research and analysis within the Clinical ... team. This role will help us accomplish this through data -driven analytics, strategic insights, and collaboration with our internal...to meet our goal of reducing costs and increasing quality of care to our members. This individual will… more
- Humana (Nashville, TN)
- …of our caring community and help us put health first** The Encounter Data Management Professional 2 develops business processes to ensure successful submission and ... reconciliation of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance...meet or exceed all compliance standards via analysis of data , and develops tools to enhance the encounter acceptance… more
- Humana (Nashville, TN)
- …community and help us put health first** CPSS Business Intelligence is a Consumer & Provider Services and Solutions team focused on data , reporting and data ... cause analysis + Demonstrated ability to problem solve and provide solutions for business or data issues...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- Humana (Nashville, TN)
- …the company's data governance program and applies seasoned knowledge to ensure data quality . The Senior Enterprise Data Governance Professional work ... oversight, data usage, system analysis and data retention to assure data quality...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- Humana (Nashville, TN)
- … assets, enterprise-wide governance processes and tools, sensitive data management, data literacy and data quality . This individual will collaborate ... data governance, data lineage and mapping, data enrichment, data quality , ...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- Humana (Nashville, TN)
- …they need, when they need it. These efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service ... services using technology and analytics. We are looking for a Senior Data Scientist who will utilize cutting-edge AI, NLP, GenAI techniques, build predictive… more
- Humana (Nashville, TN)
- …they need, when they need it. These efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service ... caring community and help us put health first** The Data and Reporting Professional 2 generates ad hoc reports...age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our… more
- Elevance Health (Nashville, TN)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... federal health programs._ The **Audit and Reimbursement Senior** will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for… more
- CenterWell (Nashville, TN)
- …Internal Medicine or Geriatric Medicine preferred + Active and unrestricted DEA license + Medicare Provider Number + Medicaid Provider Number + Minimum of ... team-based care environment. We are a value based care provider focused on quality of care for...unmatched experience for seniors. Our model is positioned to provide higher quality care and better outcomes… more
- Humana (Nashville, TN)
- …market Provider Engagement, MRA, Clinical, & Contracting leadership to provide support through complex analytics and reporting. The Senior Financial Analyst role ... will also provide insights for financial opportunities for our ...DRG codes + Exposure to healthcare either from the provider or payer side + Understanding of Medicare… more
- The Cigna Group (Nashville, TN)
- …members of health care team to ensure outstanding patient care is delivered + Provider must be able to interpret laboratory data and diagnostic testing when ... Our focus is comprehensive care at home to improve quality of life, increase understanding and management of serious...within the continuum of serious and complex illness; we provide the right level of care at the right… more
- Elevance Health (Nashville, TN)
- **JR130960 Business Change Director ( Quality Control Test Architect, PBM systems)** CarelonRx's Business Operations org is looking to hire a PBM Test Program Manager ... / Quality Control Test Architect. This high-performing individual contributor will...status as defined in the test plan with supporting data . + Manages both onshore and offshore test execution… more
- Humana (Nashville, TN)
- …+ Contribute to moving the team towards cloud-based analytical platforms + Ensure solutions provide the highest quality of data + Consults with internal ... first** The Senior Software Engineer solves complex business problems and issues using data from internal and external sources to provide insights to… more
- The Cigna Group (Nashville, TN)
- …our success. **Role Details** As an enabler of Enterprise Strategic Priority for Medicare Advantage Growth, the Dedicated Medicare Operating Model (DMOM) program ... be leveraged within the program and post-program operations to ensure a high quality of system performance. This individual will work with business, technology, and… more
- Humana (Nashville, TN)
- …they need, when they need it. These efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service ... impact on underwriting margin. They will work collaboratively with peers across Medicare Risk Adjustment, Membership Growth Analytics, Medicare Finance, and… more
- The Cigna Group (Nashville, TN)
- MIRS is the Medicare Issue Remediation System, where the organization logs and tracks issues that are systemic and have a compliance implication. The **MIRS Issue ... working with Compliance partners, functional leaders and SMEs across Medicare Advantage to ensure MIRS issues are worked timely...ensure MIRS issues are worked timely and with high quality . The MIRS Issue Project Manager is expected to… more