- CVS Health (St. Paul, MN)
- …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 (Albany, NY)
- …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
- CVS Health (Annapolis, MD)
- … Manager of Claims Management is responsible for overseeing Medicaid claims operations, inventory management, quality assurance, and compliance monitoring. This ... federal regulations, contractual requirements, and organizational performance standards. The manager partners cross-functionally with Provider Relations, Configuration,… more
- NTT DATA North America (Montgomery, AL)
- …an inclusive, adaptable, and forward-thinking organization, apply now. We are currently seeking a Medicaid Project Manager - PMP Certified to join our team in ... **Req ID:** 349933 NTT DATA strives to hire exceptional, innovative and passionate...organization, apply now. We are currently seeking a Project Manager to join our team in Montgomery Alabama. This… more
- Humana (Tallahassee, FL)
- …Consumer Service Operations is responsible for the daily activities for Florida Medicaid Contact Center Operations. The Manager , Consumer Service Operations ... up to 200+ associates and leaders supporting the Florida Medicaid plan. The manager will oversee strategic...guarantee prompt resolution of inquiries, follow ups, and calls. Provide education and details about benefits provided by the… more
- CVS Health (Hartford, CT)
- …Medicaid plans. Responsibilities may include: Querying and analysis of complex provider claim, financial and other data to support VBC ... and every day. **Position Summary** Aetna is recruiting for a Manger on the Medicaid VBC Analytics team to support VBC partnerships throughout Aetna's Medicaid … more
- Molina Healthcare (ID)
- …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
- MyFlorida (West Palm Beach, FL)
- …needed regarding new/ongoing policies. Provides feedback on Waiver Support Coordinator and Medicaid Waiver provider scorecards as requested. Ensures current and ... MEDICAID WAIVER SUPERVISOR - 67013921 Date: Dec 15,...processes by ensuring submissions made to the Regional Operations Manager and Deputy ROM for approval follow the Agency… more
- Teva Pharmaceuticals (Parsippany, NJ)
- …selected. **How you'll spend your day** + Work with assigned states to get Medicaid Summary invoice, summary data file and Claim Level Invoice each quarter ... and review to ensure completeness of information received. Upload data into Medicaid systems and authorize transactions....for key findings and changes to state programs. + Provide backup for Medicaid team members in… more
- CVS Health (Baton Rouge, LA)
- …day. **Position Summary** Coordinate effective resolution of member and/or provider /practitioner appeals, complaints and grievances. Responsible for the day-to-day ... management of staff to ensure effective resolution of member or provider /practitioner appeals, complaints and grievances for all products, which may contain multiple… more
- NTT DATA North America (Montgomery, AL)
- …processes and performance metrics + Analyzes source systems and identifies potential data gaps + Provide project management support, including: + Scope ... **Req ID:** 349932 NTT DATA strives to hire exceptional, innovative and passionate...forward-thinking organization, apply now. We are currently seeking a Medicaid Senior BA to join our team in montgomery,… more
- Fallon Health (Worcester, MA)
- …improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and ... in core system accurately and timely. This is to be completed through review of data integrity reports, and working closely with Provider Partners, Provider … more
- Point32Health (Canton, MA)
- …engagement and consultation activities supporting the complete and accurate capture of risk adjustment data . To be successful, the Manager will need to rely on ... and programs (internal and vendor-driven) that optimize performance across our provider networks serving Point32Health's Medicare, Medicaid , Duals and Commercial… more
- Commonwealth Care Alliance (Boston, MA)
- …account manager , relationship manager , and performance partner - using data , provider feedback, and system collaboration to enhance provider ... Engagement & Performance Position Summary: The Behavioral Health (BH) Provider Engagement Program Manager is responsible for...and Data Insight * Analyze and interpret provider data related to utilization, cost, quality,… more
- Commonwealth Care Alliance (Boston, MA)
- 011230 CA- Provider Engagement & Performance **Position Summary:** The Provider Communications Manager is a key contributor responsible for building and ... executing communication strategies that foster strong, collaborative relationships with provider partners serving dual-eligible (Medicare- Medicaid ) members. This… more
- Commonwealth Care Alliance (Boston, MA)
- 011230 CA- Provider Engagement & Performance **Position Summary** The Program Manager , in collaboration with the Sr Director of Delegation Partnerships and ... and Systems (CAHPS), and social determinants of health (SDOH) measures. The Program Manager will work collaboratively with our provider network and Quality teams… more
- Humana (Baton Rouge, LA)
- …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
- AmeriHealth Caritas (Washington, DC)
- …Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication. This position is also responsible ... for all provider network recruiting and contracting management activities as it...with claim payment methodologies. + Maintains familiarity with State Medicaid fee schedules and analyzes comparable Plan pricing guidelines.… 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
- State of Colorado (Pueblo, CO)
- Nurse Manager - Mid Level Provider - CMHHIP Nursing- Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5171266) Apply Nurse Manager ... as indicated in this announcement and if the hiring manager chooses to extend a job offer to you,...Standards, Environment of Care Manual, Centers for Medicare and Medicaid Services, Safety Data Sheets, Colorado State… more