• Medicaid State Technology Lead

    Humana (Lincoln, NE)
    …caring community and help us put health first** The State Technology Lead understands departmental and IT organizational strategy and operating objectives, including ... their assigned state, supporting the business goals of the Medicaid IT program. + Identifies and implements best practice...transitioned smoothly to markets. + Works with the Test Lead to develop plans of action for testing new… more
    Humana (09/03/25)
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  • Executive Director, Digital Product Management-…

    CVS Health (Hartford, CT)
    …innovation? Aetna, a CVS Health company, is seeking an Executive Director, Digital Medicaid Capabilities to lead the vision, strategy, and execution of our ... digital Medicaid portfolio. Reporting to the VP, Digital Aetna Product,...ensuring alignment with business objectives and member needs. + Lead the end-to-end delivery of features and experiences, focusing… more
    CVS Health (09/17/25)
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  • Technical Lead

    Cognizant (Everett, WA)
    …+ Ensure compliance with industry standards and regulations related to Medicare and Medicaid Claims. + Lead the troubleshooting and resolution of complex ... **Job Summary** The Technical Lead role is pivotal in managing and optimizing...iSeries/AS400 systems ensuring seamless operations within the Medicare and Medicaid Claims domain. With a hybrid work model and… more
    Cognizant (10/01/25)
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  • Vice President, Population Health & Clinical…

    Centene Corporation (Columbus, OH)
    …improves member health outcomes, and aligns with Centene and the Ohio Department of Medicaid . + Lead population health initiatives with a strong focus on ... the direction of Centene and the Ohio Department of Medicaid . While the primary focus is on Medicaid...the VP will also collaborate with organizational partners who lead Medicare and Marketplace initiatives to ensure alignment and… more
    Centene Corporation (09/18/25)
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  • VP Government Strategy & Programs

    Highmark Health (Camp Hill, PA)
    …navigating the complexities of state-level regulations and contracting processes. + ** Medicaid Strategy & Execution:** Lead the development and implementation ... relations and contracting efforts. This encompasses a broad portfolio including Medicaid , TRICARE Dental Program (TDP), and Active Duty Program (ADDP) contracts.… more
    Highmark Health (09/04/25)
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  • Dir Net Revenue & Reimb

    Covenant Health Inc. (Knoxville, TN)
    …and financial performance. Recruiter: Suzie Mcguinn || ###@covhlth.com Responsibilities Medicare & Medicaid Reimbursement Oversight + Lead all phases of Medicare ... Covenant Health's reimbursement strategy across all payors, including Medicare, Medicaid /TennCare, and commercial insurers. This role ensures accurate regulatory… more
    Covenant Health Inc. (08/28/25)
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  • Manager, Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    …* Maintain up-to-date knowledge of and compliance with CMS, NCQA and state Medicaid requirements. * Lead preparation for internal and external audits (eg ... (eg InterQual, CMS NCDS & LCDs) medical necessity guideline development. * Ability to lead audit readiness efforts and ensure compliance with CMS, NCQA and state … more
    Commonwealth Care Alliance (10/02/25)
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  • Product Manager

    Staffing Solutions Organization (Albany, NY)
    …Program needs and Policy changes to ensure reporting requirements, performance goals and Medicaid compliance. e. Lead the collaboration required to develop and ... including internal and external customers, data engineers, analysts, developers, and Medicaid Program stakeholders to ensure the creation of high quality, accessible… more
    Staffing Solutions Organization (08/19/25)
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  • Medicaid Waiver Liaison

    MyFlorida (Fort Myers, FL)
    MEDICAID WAIVER LIAISON - 67014883 Date: Oct 3,...the qualities of being humble, hungry, and smart and lead others to embody the same. This entails lacking ... Requisition No: 862471 Agency: Agency for Persons with Disabilities Working Title: MEDICAID WAIVER LIAISON - 67014883 Pay Plan: Career Service Position Number:… more
    MyFlorida (10/04/25)
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  • Director of Medicaid Reimbursement

    AdventHealth (Altamonte Springs, FL)
    …adjusting or adapting messaging for different stakeholders. + Participates in and/or lead special projects as assigned. DIRECT REPORTS Medicaid Team **The ... Springs, FL **The role you will contribute:** This position leads AdventHealth's Medicaid reimbursement process across the entire company focusing on supplemental … more
    AdventHealth (10/02/25)
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  • Attorney: Prosecute Medicaid Fraud/Nursing…

    New York State Civil Service (New York, NY)
    …HELP No Agency Attorney General, Office of the Title Attorney: Prosecute Medicaid Fraud/Nursing Home Abuse (3819) Occupational Category Legal Salary Grade NS ... New York State NY Zip Code 10005 Duties Description Criminal Justice Division Medicaid Fraud Control Unit - New York City Special Assistant Attorney General… more
    New York State Civil Service (09/11/25)
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  • Medicaid Fraud Investigator (Special Agent…

    State of Colorado (Denver, CO)
    Medicaid Fraud Investigator (Special Agent III) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5057010) Apply  Medicaid Fraud Investigator ... is seeking an experienced investigator to join the Colorado Medicaid Fraud, Abuse & Neglect Unit ("MFANU"). The MFANU...in state court. Often, the unit acts as the lead investigative agency gathering information from partnering law enforcement… more
    State of Colorado (08/27/25)
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  • Attorney: Prosecute Medicaid Fraud/Nursing…

    New York State Civil Service (Mineola, NY)
    …HELP No Agency Attorney General, Office of the Title Attorney: Prosecute Medicaid Fraud/Nursing Home Abuse (3818) Occupational Category Legal Salary Grade NS ... State NY Zip Code 11501 Duties Description Criminal Justice Division Medicaid Fraud Control Unit-Hauppauge (Suffolk County) Special Assistant Attorney General… more
    New York State Civil Service (09/11/25)
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  • Chief Medical Officer (CMO)

    UNC Health Care (Eden, NC)
    …ensure adherence to all applicable healthcare regulations and standards (HIPAA, Medicare/ Medicaid , JCAHO). Lead the development and implementation of policies ... resolve conflicts and disagreements in a constructive manner. **Leading People:** Lead people toward meeting the organization's vision, mission, and goals. Provide… more
    UNC Health Care (08/03/25)
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  • Medicaid /Marketplace Senior Strategist…

    The Cigna Group (St. Louis, MO)
    **POSITION SUMMARY** The Medicaid /Marketplace Client Strategy Senior Advisor serves as the primary contact for Medicaid /Marketplace strategic initiatives and ... market development. You will become a subject matter expert (SME) on Medicaid /Marketplace pharmacy benefits, Express Scripts Programs and Products, and State and… more
    The Cigna Group (09/30/25)
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  • Medicaid Compliance and Investigations…

    State of Minnesota (St. Paul, MN)
    **Working Title: Medicaid Compliance and Investigations Manager** **Job Class: Human Services Manager 2** **Agency: Human Services Dept** + **Job ID** : 89348 + ... location to be eligible for telework._** **_*Approximately, 10% travel._** The Medicaid Compliance and Investigations Manager is responsible for providing oversight… more
    State of Minnesota (10/03/25)
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  • Dir Ent Pharmacy Govt Programs

    Health Care Service Corporation (Chicago, IL)
    …to internal and external areas including government agencies and audit vendors. Lead enterprise Medicaid operational and clinical programs. **JOB REQUIREMENTS** ... in your professional development. This position is responsible for directing the Medicaid pharmacy operations team and responsible for analyzing and optimizing the… more
    Health Care Service Corporation (09/27/25)
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  • Senior Strategy Analyst - Medicaid (Remote)

    Highmark Health (Tallahassee, FL)
    …Business Solutions leadership in strategic activities to expand IT capabilities for Medicaid growth in the dental market by: Applying SME knowledge to analytical ... to identify business needs for growing and sustaining the Medicaid business. Apply SME knowledge and oversee multiple teams'...represent findings to stakeholders and own the outcome + Lead medium to large sized strategy work streams with… more
    Highmark Health (10/01/25)
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  • Director Medicaid Plan Marketing

    Elevance Health (Atlanta, GA)
    **Director Medicaid Plan Marketing** **Location:** 2505 N HWY 360, Grand Prairie TX. Relocation assistance offered. This role requires associates to be in-office 3 ... accommodation is granted as required by law_ The **Director Medicaid Plan Marketing** is responsible for the planning and...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
    Elevance Health (09/24/25)
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  • VP Medicaid Markets CEO

    Highmark Health (Pittsburgh, PA)
    …**Job Description :** **JOB SUMMARY** This job leads the overall performance of a Medicaid plan, for quality of care and service as well as financial performance. ... with Actuary, Finance, Executive Leadership and key business partners, lead the state contract RFP or rate renewal activities...other influential local entities in support of the state's Medicaid programs and members as well as market and… more
    Highmark Health (10/01/25)
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