- Abt Global Inc. (Durham, NC)
- …to inform strategic decision-making. + Leverage deep functional expertise in digital operations to effectively engage key customers and stakeholders across ... Solutions Principal focused on the Centers for Medicare and Medicaid Services (CMS), you will be responsible for developing...share across the CMS organization. Specifically, you work with stakeholders across the enterprise to lead the design and… more
- COOLSOFT (Raleigh, NC)
- Stakeholders Medicaid Operations Experience Analyst (Jobs in Raleigh, NC) Requirement id 155875 Job title Analyst Job location in Raleigh, NC Skills ... required Application Systems Analyst, Data Exchange, Trouble Shooting PC, Stakeholders Medicaid Operations Experie Open Date 07-Nov-2025 Close Date Job type… more
- Humana (Raleigh, NC)
- …work experience + 2+ years of experience in product management, operations , or process improvement - Preferably in Medicaid or healthcare delivery. + ... caring community and help us put health first** The Medicaid Clinical Operations Intake Product Manager applies...and visibility of intake status and decision outcomes across stakeholders . **Use your skills to make an impact** **REQUIRED… more
- Humana (Raleigh, NC)
- …either now or in the future + Minimum of three years of work experience prior to beginning graduate school + Demonstrated leadership experience through ... showcasing the ability to lead teams, drive cross-functional initiatives, influence stakeholders , and deliver measurable results in a dynamic environment **Preferred… more
- Humana (Raleigh, NC)
- … Resource Team, you'll be at the heart of our rapidly evolving Medicaid and Medicare operations , driving meaningful change in a fast-paced, collaborative ... interruptions to protect member PHI / HIPAA information **Preferred Qualifications** + Experience with Medicare/ Medicaid state regulations and guidelines + … more
- Humana (Raleigh, NC)
- …of experience in the healthcare industry. + Minimum 3 years of experience in data analytics, clinical operations , care management, quality improvement, or ... **Preferred Qualifications** + Advanced Degree (such as MSN, MBA, MHA, MPH). + Experience in managed care, health plan operations , or Medicare Advantage programs… more
- Prime Therapeutics (Raleigh, NC)
- …and support collaborative or independent problem solving **Preferred Qualifications** + PBM/health experience + Medicare, Medicaid , CMS background + Desire to be ... for a Principal Solution Strategist to help lead the Medicare and Medicaid migrations for the JUDI program.** **Job Description** The Principal Solution Strategist… more
- Humana (Raleigh, NC)
- …and communicate clearly to multiple functional teams across digital portfolio and operations , technical, and business stakeholders . They will need to understand ... and work with stakeholders across the brokerage business lines, including Agent CRM,...**Genesys Cloud CX** or similar enterprise telephony platforms. + Experience working with **Medicare sales operations ** ,… more
- Sumitomo Pharma (Raleigh, NC)
- …Pharma Co., Ltd., is a global pharmaceutical company based in Japan with operations in the US (Sumitomo Pharma America, Inc.), focused on addressing patient needs ... collaborative relationships and communicate information across many different internal/external stakeholders to drive alignment on decisions and help remove barriers… more
- Humana (Raleigh, NC)
- …standards, and embracing modern analytic capabilities. A great candidate will have experience consulting with business stakeholders , setting priorities, and work ... stakeholders /SME, project managers, developers, system architects, quality assurance, operations , etc. by written word and presentations **Use your skills to… more
- Elevance Health (Durham, NC)
- …_We are partnering with North Carolina DHHS to operationalize a statewide Medicaid Plan designed to support Medicaid -enrolled infants, children, youth, young ... by law. The **IDD Specialty Care Manager** is responsible for coordinating operations and workflows related to Intellectual, Developmental & Disability - IDD case… more
- Humana (Raleigh, NC)
- …or experience with clinical care delivery and interventions and/or care management operations . + Prior experience or exposure to Medicare Stars Program. + ... Experience leading cross-functional group of stakeholders /teams and initiatives. **Additional information** + **Workstyle:** remote, work from home. + **Travel:**… more
- Evolent (Raleigh, NC)
- …oncology space with participation in national forums related to oncology care + Experience in health plan operations highly desirable. + Proficiency creating and ... national oncology programs with deep regulatory expertise in Medicare, Medicaid , and Commercial + 5+ years as a national... experience + 5+ years of senior level experience leading clinical operations in a health… more
- Humana (Raleigh, NC)
- …problems by bringing your own contributions while partnering with other key stakeholders from across the enterprise (clinical, quality, operations , analytics, ... for enhanced clinical outcomes, cost control, quality, and member experience . **_Responsibilities include the following:_** + Drive initiatives to analyze… more
- Prime Therapeutics (Raleigh, NC)
- …roles for a healthcare or PBM organization, or other highly regulated industry, including experience with Medicare, Medicaid , and the Affordable Care Act (ACA) + ... initiatives within their designated areas. This role partners with key internal stakeholders to monitor aspects of compliance and validate policies, procedures, and… more
- Cardinal Health (Raleigh, NC)
- …evaluating strategic opportunities for all lines of business including Medicare, Medicaid , and various commercial markets. Key responsibilities include managing the ... to identify pricing issues, ensuring regulatory compliance, maintaining communication with stakeholders like pharmacies and PSAO leadership, and improving the MAC… more
- Baylor Scott & White Health (Raleigh, NC)
- …vendor or contractor management in support of clinical denial management operations . Identifies, analyzes and reports on significant denial trends and patterns ... to key stakeholders . This will include close partnership with the BSWH...aligned to BSWH overall business objectives. + Directs daily operations of clinical denial management, including the development and… more
- Public Consulting Group (Raleigh, NC)
- …Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies ... is a member of a family of companies with experience in all 50 states, and clients in three...and Billing Services + Applied Technology + Outsourcing and Operations + Strategy + Project and Grants Management +… more
- Public Consulting Group (Raleigh, NC)
- … Experience in the areas of information technology, finance/business operations , k-12 education, and special education is highly desirable. **Supervisory ... (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and...is a member of a family of companies with experience in all 50 states, and clients in three… more
- CVS Health (Raleigh, NC)
- …and effectiveness in project execution. **Required Qualifications** + 5+ years of progressive experience in health plan clinical operations with a focus on ... from conception to implementation + Conducts routine collaboration with stakeholders to define project objectives, requirements, and deliverables, ensuring alignment… more
