- Molina Healthcare (New York, NY)
- **Job Description** **Job Summary** Molina Medicare Stars Sr Program Manager function supports program governance, plans, leads and implements ... initiatives to improve Star Ratings. * Serves as the Medicare Stars subject matter expert to Program Managers and in functional areas; leads programs to meet… more
- Gilead Sciences, Inc. (Newark, NJ)
- …that will improve the lives of patients with life-threatening illnesses worldwide. The ** Sr .** **Field Reimbursement Manager - HIV Prevention (** ** Sr . ... in navigating the complexities of the healthcare system. The Sr . FRM HIV Prevention will provide in-person and virtual...and reimbursement outcomes. + Assist the internal patient support program team in enhancing hub and FRM processes, such… more
- Elevance Health (Woodbridge, NJ)
- …Medicaid Services to transform federal health programs._ The **Audit and Reimbursement Senior ** will support our Medicare Administrative Contract (MAC) with the ... of the Department of Health and Human Services). The Audit and Reimbursement Senior will support contractual workload involving complex Medicare cost reports and… more
- Stryker (Mahwah, NJ)
- …**What you will do:** As the Senior Manager of Reimbursement and ... attending marketing/sales meetings. + Develop and maintain relationships with Medicare contractors and commercial payors (including Medical Directors, Policy… more
- CVS Health (New York, NY)
- …and affordable. **Position Summary** CVS Health is looking for a technical product manager to join the Multi-Carrier Solutions team, an exciting and fast-paced new ... growth area within the organization. As a technical Product Manager & Adobe Target Developer, you will lead the...every day * MBA or other relevant graduate degree Medicare experience is a plus, not required **Education** Bachelor's… more
- Molina Healthcare (New York, NY)
- …Please include this experience on your resume.** **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist, Quality Interventions / QI Compliance contributes to one ... + Acts as a lead specialist to provide project-, program -, and / or initiative-related direction and guidance for...results to identify opportunities for improvement. + Surfaces to Manager and Director any gaps in processes that may… more
- Molina Healthcare (Yonkers, NY)
- **Knowledge/Skills/Abilities** * Responsible for program development, implementation, and management of process improvement initiatives. * Coordinates, directs, and ... Conduct meetings and disseminates communication related to process improvement activities to senior leadership and staff as needed. * Knowledge of HEDIS measurement… more
- The Cigna Group (Morris Plains, NJ)
- **Job Summary:** + Lead a team of Senior Advisors and Advisors responsible for the development and management of the Medicare Prescription Payment Plan (M3P) ... client facing products, broad-based knowledge of Regulated Markets/Pharmacy Benefit Manager (PBM) operations, experience leading people, a strategic mindset, and… more
- Teva Pharmaceuticals (Parsippany, NJ)
- Senior Manager Patient Services Hub Operations Date: Dec 24, 2024 Location: Parsippany, United States, New Jersey, 07054 Company: Teva Pharmaceuticals Job Id: ... people to make a difference with. **The opportunity** The Senior Manager , Patient Services Hub Operations seeks...among Insurers, PBMs, and Specialty Pharmacies including Medicaid and Medicare . + Ability to work with senior … more
- VNS Health (Manhattan, NY)
- …CFEEC scheduled dates and outcomes as needed. + Offers assignment of Medicare assistance as needed. + Responds to inquiries regarding pre-enrollment issues, ... eligibility and program information to ensure service satisfaction. Works with our...for new enrollees start of care authorizations and care manager assignment. + Assists in the monitoring and updating… more
- VNS Health (Manhattan, NY)
- …moderately complex issues from other departments. + Escalates issues to manager as needed. Performs various administrative support functions (eg, generating/sending ... an institution, Home Care or Managed Long Term Care Program required + Knowledge of federal and state health...of federal and state health care regulations related to Medicare , Medicaid, managed care, and long term care preferred… more
- Molina Healthcare (Bronx, NY)
- …of illness and the site of service. **This position will support our Senior Whole Health business.** **_Senior Whole Health by Molina_** **is a Managed Long-Term ... or disabled people who are eligible for Medicaid and Medicare .** **We are looking for Case Managers with a...preferred. Strong organizational and time management skills. The Case Manager must have the ability and be comfortable to… more
- VNS Health (Manhattan, NY)
- …includes management policies, procedures and operational systems for the Medicare /Dual eligible population. + Interfaces/collaborates with Plan staff to monitor ... regional needs assessments and identifying potential Providers for recruitment into program . Manages or assists with department or plans special projects. +… more
- Atlantic Health System (Morristown, NJ)
- Responsible for leading and implementation program that supports non-physician clinical staff with orientation and competency assessment in order to promote ... measure the effectiveness of patient care. 4. Works with senior leadership, interdisciplinary teams and other stakeholders in order...of AllSpire Health Partners. We have received awards and recognition for the services we have provided to our… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity ... documentation e. Target DRGs Reviews f. Use of case manager as a resource + Uses guidelines to evaluate...on length of stay, level of care requirements and Medicare regulations, and Major Complications or Comorbidities (MCC) /… more
- Hackensack Meridian Health (Hackensack, NJ)
- …ambiguous or conflicting documentation** **iv. Target DRGs Reviews** **v. Use of case manager as a resource** **4. Uses guidelines to evaluate patient status based ... on length of stay, level of care requirements** **and** ** Medicare regulations, and Major Complications or Comorbidities (MCC) / Complications or** **Comorbidities**… more
- Mount Sinai Health System (New York, NY)
- …risk adjustment for all populations served, especially our patients covered under a Medicare arrangement (MSSP or MA). The MD will report to Vice President, Clinical ... Health Practice Optimization Lead (working collaboratively with a Population Health Manager (PHM)) for 6-10 high priority primary care/multispecialty practices. *… more