- CVS Health (Columbus, OH)
- …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
- Humana (Columbus, OH)
- …Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing ... be primarily responsible for implementation, maintenance and support of Medicaid provider reimbursement for hospitals and facilities....EAPG + 2+ years of experience with Optum Rate Manager + 2+ years of experience with Optum WebStrat… more
- Molina Healthcare (Cincinnati, OH)
- …as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes + Provide data driven analytics to Finance, ... **JOB DESCRIPTION** **Job Summary** The Manager , Medical Economics provides support and consultation to...utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard reports to monitor health plan performance… more
- Humana (Columbus, OH)
- …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 (Columbus, OH)
- …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
- CenterWell (Columbus, OH)
- …part of our caring community and help us put health first** The Manager of Pre-Bill Audit provides strategic leadership and operational oversight for the ... improvements in unbilled rates, revenue cycle performance, and compliance. The Manager leads a team of Pre-Bill Specialists, partners with senior leadership,… more
- Capgemini (Cincinnati, OH)
- **About the job:** Job role responsibilities of **Program Manager / Sr Project Manager ** - Markets and Growth portfolio Medicare Advantage/ DSNP/ Medicaid or ... Exchange program/ product build knowledge (Enrollment, Eligibility, Claims, Provider network, encounters etc) (Highly Recommended having exposure to one or many… more
- CVS Health (Columbus, OH)
- …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 (Columbus, OH)
- …health first** Humana Healthy Horizons in Ohio is seeking a RN Field Care Manager 2 with Maternity, L&D, Mother Baby expertise. They will assess and evaluate ... member's needs to achieve and/or maintain optimal wellness. The Field Care Manager will connect members/families with resources appropriate for their care and… more
- Elevance Health (Columbus, OH)
- **Project Manager - Project Liaison** **About the Role:** We are seeking an experienced and proactive Project Liaison to join our team. This critical role involves ... and handling related reporting to the Ohio Department of Medicaid (ODM). The ideal candidate will have a strong...accommodation is granted as required by law. The **Project Manager ** is responsible for working with business partners to… more
- Pfizer (Columbus, OH)
- …Pfizer vaccines and programs. This includes a clear understanding of the commercial, Medicaid and Medicare landscape as it relates to the availability of Pfizer ... opportunities and projects to maximize impact; leveraging all available data sets and stakeholder maps input to optimize decision...to educate colleagues across Pfizer on insights gained. * Provide the marketing and strategy teams with key local… more
- Humana (Columbus, OH)
- …telephony, data systems, and enterprise architecture. The Senior Product Manager will serve as a key interface between business and technology, driving ... and help us put health first** The Senior Product Manager Conceives of, develops, delivers, and manages products for...to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Senior… more
- Humana (Columbus, OH)
- …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 (Columbus, OH)
- …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 (Columbus, OH)
- …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
- CVS Health (Columbus, OH)
- …the bold vision to deliver the "Next Generation" of managed care in Ohio Medicaid , OhioRISE will help struggling children and their families by focusing on the ... in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with… more
- Philips (Orange Village, OH)
- **Territory Manager - RespirTech (Baltimore, ME, Annapolis, ME, Wilmington, ME)** RespirTech's Territory Manager represents the InCourage airway clearance ... evidence to physicians. + Being an expert on Medicare, Medicaid and private insurance coverage-criteria for InCourage vest therapy,...in order for coverage to be obtained. + Analyzing data to effectively target priority healthcare teams and create… more
- Datavant (Columbus, OH)
- …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 (Columbus, OH)
- …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
- Elevance Health (Mason, OH)
- …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