- Humana (Raleigh, NC)
- …caring community and help us put health first** Humana Healthy Horizons is seeking a Medicaid Implementation Senior Business Project Manager to manage a ... change management and project management are best suited for this role. The Medicaid Implementation Senior Business Project Manager will serve as a… more
- Prime Therapeutics (Raleigh, NC)
- … business (Employer Markets, Health Insurance Marketplace, Commercial, Medicare, Medicaid , Specialty) or with unique Prime contract requirements; drive the ... we make. **Job Posting Title** Health Plan Account Dir Sr - Remote **Job Description** The Sr ...advanced degree + Experience working within assigned line of business or market segment (Commercial, Medicare, Medicaid ,… more
- Prime Therapeutics (Raleigh, NC)
- …passion and drives every decision we make. **Job Posting Title** Regulatory Analyst Sr - Remote **Job Description** The Senior Regulatory Analyst is responsible ... and participates in committee review meetings within the Commercial, Medicare, Medicaid , and Health Insurance Marketplace for the assigned department. This position… more
- Humana (Raleigh, NC)
- …Medicaid products and capabilities to support the strategic direction and growth of the Medicaid and Duals lines of business . This is a unique opportunity for ... Care Organization **OR** 2+ years of experience in strategy consulting supporting Medicaid managed care organizations. + Experience in business development or… more
- Public Consulting Group (Raleigh, NC)
- …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
- Prime Therapeutics (Raleigh, NC)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Sr . Director, Pharmacy Network Management - Remote **Job Description** The Senior ... market leading pharmacy reimbursement methodologies that support all of Prime's business assuring coordination with performance standards and corporate goals. + Lead… more
- Humana (Raleigh, NC)
- …an in-depth evaluation of variable factors. The Senior Technology Implementation Professional gathers and documents business system and functional ... a part of our caring community and help us put health first** The Senior Technology Implementation Professional delivers new technological solutions to meet … more
- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Senior Business Systems Analysis Professional who is part of the System Optimization ... ensuring optimal performance and integration across the procurement landscape. The Senior Business Systems Analysis Professional performs analyses of systems,… more
- Humana (Raleigh, NC)
- …Coordinate business partner engagement with external regulators + Coordinate implementation and compliance with corrective action plans, as needed + Provide ... a part of our caring community and help us put health first** This Senior Compliance Professional role supports Humana's suite of Medicare and Commercial Dental and… more
- CVS Health (Raleigh, NC)
- … implementation of value-based contract relationships in support of business strategies. . Represent Aetna with high visibility constituents, including customers ... role? Join Aetna/CVS Health, a Fortune six company, as the Network Management Senior Manager. In this individual contributor role, you will negotiate with, execute… more
- HealthEdge Software Inc (Raleigh, NC)
- **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
- Humana (Raleigh, NC)
- …our caring community and help us put health first** The Service Fund Senior Value-Based Programs Analyst supports our Market and Provider partners through ensuring ... with the Market partners to ensure understanding and accuracy. The Senior Value-Based Programs Analyst work assignments involve moderately complex to complex… more
- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Senior IT Product Owner (PO) role is responsible for managing and communicating the vision ... to the team to determine the HOW. The role drives value to the business by building and maintaining a product backlog in collaboration with stakeholder and delivery… more
- Kepro (Raleigh, NC)
- …with MITA, HIPAA, and CMS standards. + Leverage expertise in state-specific Medicaid business processes and regulatory requirements to design tailored testing ... strategic direction of our SQA team. You will lead the design, implementation , and optimization of cutting-edge test strategies and frameworks, ensuring the delivery… more
- Prime Therapeutics (Raleigh, NC)
- …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
- Humana (Raleigh, NC)
- …experience. The individual in this role will lead Humana network infrastructure implementation for Google Cloud. The Lead Cloud Solutions Engineer (Network) performs ... to ensure an integrated architecture across interdependent technologies. Works with senior executives to develop and drive segment or enterprise-wide functional… more
- Highmark Health (Raleigh, NC)
- …carriers), topics (ex. technology, virtual health, industry trends), and lines of business (ex. ACA, commercial, Medicare Advantage, Medicaid ). The work can ... will support strategic initiatives and priorities for product development and implementation and/or market and competitive intelligence. Gather and analyze internal… more
- Humana (Raleigh, NC)
- …strong relationships with key stakeholders discussing financial performance and incorporate business insights into the financial models. + Implementation and ... seeking a Financial Analytics Lead. This individual will work across the business , and will be highly involved in reporting, planning, underwriting, strategic… more
- Highmark Health (Raleigh, NC)
- …integration into the overall Enterprise strategy through collaboration with Senior -level internal/external stakeholders. Ensures a high degree of development, ... development and completion of sales cycle (from model conception to implementation ) of VBR programs for key strategic accounts and/or initiatives.Support strategic… more
- Humana (Raleigh, NC)
- …us put health first** This Actuary role is a role within the Senior Products Actuarial Compliance team focused on special Medicare Advantage programs, including ... you will have a unique opportunity to provide guidance and collaborate with business partners and leadership on these growing and expanding programs. In addition to… more