- RELI GROUP INC (Windsor Mill, MD)
- …in achieving the mission and vision of the organization Will serve as the Health Policy SME for the program and stakeholders for value-based payment models, Fraud, ... waste and abuse analytics, quality measures reporting and other clinical or patient safety...the schedule, technology, methodology, tolls, solutions components, and financial management of the project. Monitors conflict of interest compliance… more
- RELI GROUP INC (Baltimore, MD)
- …We partner with government agencies to solve complex challenges, improve public health , strengthen national security, and make government services more effective and ... Privacy Support Services (MSSPSS) contract for the Centers for Medicare & Medicaid Services (CMS), Center for Consumer Information and Insurance Oversight (CCIIO).… more
- RELI GROUP INC (Baltimore, MD)
- …We partner with government agencies to solve complex challenges, improve public health , strengthen national security, and make government services more effective and ... Security and Privacy Support Services (MSSPSS) contract for the Centers for Medicare & Medicaid Services (CMS). This role supports Task 7 and plays a key part in… more
- Executive Care (Leesburg, VA)
- …healthcare or related field. Experience working with healthcare/home healthcare standards and quality assurance or risk management . Working knowledge of Virginia ... HCO (Home Care Organization) and CMS (Centers for Medicare & Medicaid Services) documentation standards a plus Excellent organizational, communication, and… more
- Elevance Health (Washington, DC)
- …coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan. Responsible ... for working with the regional head of quality management to direct the clinical ...quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements **Required Qualifications:** +… more
- CVS Health (Annapolis, MD)
- …complex contracting options, financial/contracting arrangements and regulatory requirements. + Medicaid Network Management experience, preferably Maryland ... At CVS Health , we're building a world of health...and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives. **Responsibilities** **include:**… more
- Humana (Washington, DC)
- …Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other ... a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines… more
- Humana (Washington, DC)
- …they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service ... part of our caring community and help us put health first** The Associate Vice President (AVP) of Medicare...first** The Associate Vice President (AVP) of Medicare and Medicaid Encounter Submissions is responsible for the integrity, accuracy,… more
- Humana (Washington, DC)
- …Professional initiates, negotiates, and executes physician, hospital, and/or other Behavioral Health contracts and agreements within the Virginia Medicaid space. ... and reimbursement rates to providers in building and maintaining Medicaid Behavioral Health provider networks. Analyzes the...need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid… more
- Humana (Washington, DC)
- **Become a part of our caring community and help us put health first** Design and maintain Medicaid claims analytics dataset using Databricks. Conduct in-depth ... skills for technical and non-technical audiences + Demonstrated project management skills with the ability to drive work independently...need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid… more
- Prime Therapeutics (Washington, DC)
- … plan and/or managed care with a minimum of 8 years in Medicare and/or Medicaid in a health plan, healthcare consulting firm, PBM, or other government ... we make. **Job Posting Title** VP Government Programs - Medicare & Managed Medicaid (REMOTE) **Job Description** The Vice President Government Programs - Medicare &… more
- Prime Therapeutics (Washington, DC)
- …passion and drives every decision we make. **Job Posting Title** North Carolina Medicaid Account Manager - Remote Raleigh, NC **Job Description** The Senior Account ... responsible for providing complex level support for the North Carolina Medicaid business by driving communications, client-facing initiatives, and product and… more
- CareFirst (Baltimore, MD)
- …analyses to improve awareness and understanding of risk adjustment results and quality , accuracy and identification of member health conditions. Update, create ... **Resp & Qualifications** **PURPOSE:** The Senior Medicaid Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity of… more
- CVS Health (Annapolis, MD)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...each and every day. **Position Summary** Responsible for performing quality inter-rater review audits of medical records coded by… more
- Huntington Ingalls Industries (Woodlawn, MD)
- …and ensure contract objectives are met. + Maintain a strong understanding of supplier quality management processes and Supply Chain Risk Management industry ... vital role in supporting our Centers for Medicare and Medicaid and Health and Human Services (HHS)...Health and Human Services (HHS) Supply Chain Risk Management (SCRM) efforts. This role requires exceptional research and… more
- CVS Health (Annapolis, MD)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment… more
- CVS Health (Annapolis, MD)
- …from the National Health Care Anti-Fraud Association (AHFI) + Experience In Medicaid Compliance, Medicaid Investigations, MCO Medicaid FWA Unit in the ... At CVS Health , we're building a world of health...comply with state regulations mandating fraud plans and reporting; Medicaid experience is preferred. Leads a team in the… more
- NTT America, Inc. (Baltimore, MD)
- …elicitation and verification of business requirements + Minimum of 5 years Medicaid Management Information System (MMIS) APD development and maintenance ... The ideal candidate will possess comprehensive understanding of administration, management , and APD processes, procedures, and best practices. It...as a business analyst with, or consultant to, State Health Programs (eg Medicaid ) + Minimum 3… more
- Cardinal Health (Washington, DC)
- …medical billing practices, payer guidelines, and reimbursement methodologies (commercial, Medicare, Medicaid ). + Proven leadership and team management abilities. ... **Job Summary:** The Manager, Revenue Cycle Management , is responsible for overseeing the insurance collection...operations of the insurance follow-up team, ensuring productivity and quality standards are met. + Monitor aging reports and… more
- Humana (Washington, DC)
- **Become a part of our caring community and help us put health first** The Quality Assurance Professional 2 develops and implements programs to establish and ... and improve same. Trains and/or coaches staff and management in areas such as quality improvement,...need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid… more
