• PBM Contract Representative Sr - LA…

    Prime Therapeutics (St. Paul, MN)
    …make. **Job Posting Title** PBM Contract Representative Sr - LA Medicaid **Job Description** The Senior Contract Representative is responsible for contract ... and ensuring process adherence in support of Prime's contracting efforts with Louisiana Medicaid PBM business . This position is responsible for supporting the… more
    Prime Therapeutics (12/19/24)
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  • Care Consultant Sr - Healthcare Provider…

    Elevance Health (Mendota Heights, MN)
    …Success** is responsible for consulting with providers (Commercial, Medicare Advantage and Medicaid Lines of Business ) to assess and deploy appropriate ... Care Consultant Sr . (Provider Success) - JR135434 **Location** : Must...continuous process of assessment, root cause analysis, strategy mapping, implementation and tracking to outcomes for each assigned provider.… more
    Elevance Health (11/27/24)
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  • Sr . Compliance Analyst (Regulatory…

    Prime Therapeutics (St. Paul, MN)
    …Compliance Analyst (Regulatory Intelligence and Assessment) - Remote **Job Description** The Senior Compliance Analyst assists in the implementation of Prime's ... of regulatory releases and identify the applicable key stakeholders responsible for implementation + Timely communicate new regulatory guidance to the applicable key… more
    Prime Therapeutics (12/17/24)
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  • Medicaid Children's Behavioral Health…

    Public Consulting Group (St. Paul, MN)
    …and Grants Management + Assessments and Feasibility Studies PCG is looking for a Senior Consultant in Medicaid policy and funding as it relates to children's ... Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health,...children's behavioral health services. PCG is looking for a Senior Consultant in Medicaid policy and funding… more
    Public Consulting Group (10/23/24)
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  • Provider Delegation Implementation

    CVS Health (St. Paul, MN)
    …role requires effective partnering within network as well as other business areas (clinical, operations, Medicare segment). **Required Qualifications** + Successful ... + Oral and written presentations to internal/external customers, constituents and business partners, strong business acumen and can perform reasonability… more
    CVS Health (12/18/24)
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  • Senior Compliance Analyst (Interpretation…

    Prime Therapeutics (St. Paul, MN)
    … Compliance Analyst (Interpretation and Advising) - Remote **Job Description** The Senior Compliance Analyst assists in the implementation of Prime's compliance ... depth perception and ability to adjust focus **Reporting Structure** + Reports to Sr Professional, Manager, Director or Senior Director in the Compliance… more
    Prime Therapeutics (12/17/24)
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  • Senior Compliance Professional

    Humana (St. Paul, MN)
    …evaluation of variable factors. **Regulatory Compliance - State Enterprise Intake and Implementation - Senior Compliance Professional** The Senior Compliance ... guidance issued by state and federal regulators across the enterprise. Coordinates business partner engagement and implementation of rules. Researches compliance… more
    Humana (12/19/24)
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  • Senior Network Engineer

    Humana (St. Paul, MN)
    …analyzes, plans and modifies network components supporting customer communication implementation activities. The Senior Network Engineer work assignments ... situations or data requires an in-depth evaluation of variable factors. The Senior Network Engineer will be responsible for providing engineering and operational… more
    Humana (12/06/24)
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  • Senior Cloud Security Engineer(remote)

    Humana (St. Paul, MN)
    …a part of our caring community and help us put health first** The Senior Cloud Security Engineer ensures that cybersecurity policies are engineered and deployed in ... minimize and reduce threats, vulnerabilities, and risks. They ensure that cross-functional business processes are in place for cloud security control engineering and… more
    Humana (11/06/24)
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  • Senior Payment Integrity Analyst

    HealthEdge Software Inc (St. Paul, MN)
    **Overview** **Position Overview:** We are seeking a Senior Payment Integrity Specialist to play a key role in building and implementing proprietary healthcare edits ... in claims processing. The successful candidate will be responsible for taking a senior level role in analyzing claims data, as well as translating contract terms,… more
    HealthEdge Software Inc (12/18/24)
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  • Senior Research Scientist, Humana…

    Humana (St. Paul, MN)
    …caring community and help us put health first** Through the design and implementation of various types of research studies and the strategic interpretation of data, ... Health Services Research Team in HHR is seeking a Senior Research Scientist to join a team of multi-disciplinary...health services and outcomes research studies: + Understand policy, business and clinical issues and map them into quantitative… more
    Humana (11/20/24)
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  • Clinical Program Manager - Remote

    Prime Therapeutics (St. Paul, MN)
    …for the client including, client specific Pharmacy &Therapeutics (P&T) or business committee decision making and implementation , oversight of formulary ... management experience + Knowledge of the applicable line of business (eg, Medicare, Medicaid , Exchange, Commercial, Employer...ability to adjust focus **Reporting Structure** + Reports to Sr Principal or Sr Director in the… more
    Prime Therapeutics (12/18/24)
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  • AVP, IT Service Management

    Humana (St. Paul, MN)
    …use of ServiceNow, JSM, or other platforms as necessary. + Collaborate with senior leadership to integrate ITSM into business process operations, ensure IT ... exceptional stability and performance for our IT infrastructure. Leads design, implementation , and optimization of ITSM processes for the cloud environment, DevOps,… more
    Humana (11/23/24)
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  • Director, Health Economics & Reimbursement

    Edwards Lifesciences (Minneapolis, MN)
    …without the need for open heart surgery. Our Transcatheter Heart Valve (THV) business unit continues to partner with cardiologists and clinical teams to transform ... Center for Medicare Services (CMS) and/or Medicare Administrative Contractors (MAC), Medicaid , Veteran Affairs (VA) and commercial payers. **The Director, Global… more
    Edwards Lifesciences (12/18/24)
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  • Director, Clinical Product Development/RPh…

    Prime Therapeutics (St. Paul, MN)
    …product domain and may align activities around a specific line of business (MedD, Medicaid , Health Insurance Marketplace, Commercial). **Responsibilities** + ... departmental strategy and new clinical product offerings (ie project representation across business units) + Represent the domain in partnership with key internal… more
    Prime Therapeutics (12/20/24)
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  • Vice President, Insurance Strategy and Segment…

    Humana (St. Paul, MN)
    …includes strategic oversight across Medicare Advantage (Individual and Group), Medicaid , Medicare Supplement, Specialty, and Prescription Drug Plans. Additionally, ... Process Improvement, Learning, and Change. These teams collaborate closely with senior leaders within the Insurance segment and across the enterprise, addressing… more
    Humana (12/21/24)
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  • Insurance Strategy Consultant

    Humana (St. Paul, MN)
    …organizations in the country. The Healthcare Strategy team supports Humana's Medicare and Medicaid business unit. This business unit, Humana's largest, ... total revenue and earnings. Team members partner with the senior leaders of the business unit, and...sound, logical solutions and recommendations. You will also shape implementation considerations, and work with business owners… more
    Humana (11/05/24)
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  • Director, Insurance Strategy

    Humana (St. Paul, MN)
    …the country. **Location:** remote The Insurance Strategy team supports Humana's Medicare and Medicaid lines of business . This business unit, Humana's ... total revenue and earnings. Team members partner with the senior leaders of the business unit, and...sound, logical solutions and recommendations. You will also shape implementation considerations, and work with business owners… more
    Humana (12/21/24)
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  • Insurance Segment Strategy Lead

    Humana (St. Paul, MN)
    …majority of the company's total revenue and earnings. Team members partner with the senior leaders of the business unit, and more broadly with leaders throughout ... and craft sound, logical solutions and recommendations. You will also shape implementation considerations, and work with business owners as appropriate to… more
    Humana (11/13/24)
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  • Financial Analytics Lead

    Humana (St. Paul, MN)
    …strong relationships with key stakeholders discussing financial performance and incorporate business insights into the financial models. + Implementation and ... home-based care and post-acute value-based services. The Home Health Business Unit is one of the largest providers in...Financial Analytics Lead. The position will work directly with senior management, including the Segment President, Senior more
    Humana (12/21/24)
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