- Lundbeck (Dallas, TX)
- …navigating access via medical and pharmacy benefit reimbursement process Serve as a deep subject matter expert on the local market access expertise including ... boundaries with access to a major airport. Territory boundaries include: Texas ( subject to change) SUMMARY: The Lundbeck Field Access Specialist is a field-based… more
- Molina Healthcare (Fremont, NE)
- …CBOs to refer clients who may be eligible for other Molina products. Viewed as a " subject matter expert " (SME) by community and influencers on the health ... Responsibilities: Drive membership growth and retention for Molina Healthcare Medicaid . Build and maintain relationships with community-based organizations and… more
- Humana (Trenton, NJ)
- …requires an in-depth evaluation of variable factors. This position serves as a subject matter expert for Humana's strategies supporting physician practice ... and approaches to assignments. Position will serve as a subject matter expert (SME) for...Recognition programs across multiple lines of business (Medicare and Medicaid ). Utilizes complex SQL, SAS, and other technical skills… more
- Prime Therapeutics (Nashville, TN)
- …maintenance of regulatory requirements throughout the enterprise. This position acts as the subject matter expert on applicable regulations, training, and ... customer needs with business goals. Consults with business areas and other subject matter experts to identify compliance requirements, assess risks, and… more
- CVS Health (Frankfort, KY)
- …As the Manager of Pharmacy Communications, you will serve as the main liaison and subject matter expert for all pharmacy communication needs for Elevance ... of Elevance Health/CarelonRx across all lines of business (Commercial, Medicaid , Medicare Part D, etc.). In addition, the manager...team members and other business partners and serve as subject matter expert on Pharmacy… more
- CVS Health (Atlanta, GA)
- …and every day. Position Summary The individual in this role will serve as the subject matter expert for Aetna's Medicare Advantage Special Needs Plans (SNP) ... all Aetna geographies, Medicare Advantage market actuaries, and associated Medicaid actuaries. Establish best practices, ensure consistency, and provide guidance… more
- Public Consulting Group (Salt Lake City, UT)
- …for OCM Plan, and execution of the plan as lead advisor Operate independently as a lead and Subject Matter Expert Lead a team of OCM, and non SME team to ... Business Enablement Business Solutions Project Assurance An OCM consultant will provide expert support and guidance to clients ensuring projects meet objectives by… more
- Molina Healthcare (Tampa, FL)
- …keeping other variables as constant that are not of focus. Develop oneself as HEDIS subject matter expert to help health plan improve performance on ... automated analytical as well as Reporting modules related to Quality/HEDIS for Medicaid , Marketplace and Medicare/MMP. Analysis and reporting related to Managed care… more
- Houston Methodist (Katy, TX)
- …environment Demonstrates flexibility and adaptability in the workplace Ability to serve as a subject matter expert in assigned area to provide support for ... billing compliance with government/regulatory agencies and the Medicare and Medicaid programs. Ensures optimization of timely cash collections and minimizes… more
- Humana (Salem, OR)
- …responsible for supporting the Stars strategy within Insurance Operations, serving as a subject matter expert for Stars-related initiatives, and ensuring ... Principal coordinates, implements, and manages oversight of the company's Medicare/ Medicaid Stars Program for aligned areas. The Stars Improvement Principal… more
- UnitedHealth Group (Dublin, OH)
- …and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin ... local and state government, community-based organizations, the Ohio Department of Medicaid (ODM), and other ODM-contracted managed care entities to impact population… more
- CVS Health (Pittsburgh, PA)
- …meet the organizational and marketplace needs. The role will consult as a subject matter expert facilitating formulary decision-making process and continual ... possess demonstrated working knowledge of Formulary Management in Commercial and Medicaid environments; Drug File and Adjudication knowledge; and the Pharmacy and… more
- Waystar (Atlanta, GA)
- …data Design new payer edits based on a new client's payer mix and facility types Subject matter expert in claim edits and payer policies Advise onboarding ... and stabilization. The Consultant will leverage billing and coding subject matter expertise and industry experience to...systems, and is connected to over 5K commercial and Medicaid /Medicare payers. We are deeply committed to living out… more
- Molina Healthcare (Buffalo, NY)
- …issues that may cross departmental lines and involve Senior Leadership. Serves as a subject matter expert for other departments. Trains other Provider ... familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited… more
- Molina Healthcare (Everett, WA)
- …staff and matrixed resources with oversight from AVP and VP as needed Serves as industry Subject Matter Expert in the functional area and leads programs to ... internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process… more
- Molina Healthcare (Omaha, NE)
- …CSST resolution support, and National Contract Management support services. Serves as a subject matter expert for other departments. Conducts regular ... Nebraska, requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage complex providers, including… more
- UnitedHealth Group (Mount Clemens, MI)
- …coordination, offer training, and drive provider-level quality improvement Serve as a clinical subject matter expert to internal teams, leadership, and ... and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin… more
- Molina Healthcare (Green Bay, WI)
- …issues that may cross departmental lines and involve Senior Leadership. Serves as a subject matter expert for other departments. Conducts regular provider ... position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage high priority providers,… more
- UnitedHealth Group (Hartford, CT)
- …policies within the claim adjudication process through medical records review Serve as a Subject Matter Expert (SME), performing medical record reviews to ... 2+ years of experience using Facets claims platforms with Medicaid , Medicare, and Commercial lines of business 2+ years...equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where… more
- UnitedHealth Group (Tampa, FL)
- …Friday, 8:00 AM - 4:30 PM EST Preferred Qualifications: 1+ years of experience as a subject matter expert or in a team training capacity Experience working ... programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us,… more
