- Sumitomo Pharma (Frankfort, KY)
- …language clauses. + Keep current on regulatory and industry changes that may impact Medicaid operations . + Oversee the Medicaid Dispute Resolution process. + ... with 2-3 days a week required in office. **Job Duties and Responsibilities** + Lead operations person for all Medicaid decisions as it relates to Model N… more
- Public Consulting Group (Frankfort, KY)
- …Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies ... the public sector. To learn more, visit www.publicconsultinggroup.com. **Responsibilities** The Medicaid marketplace is changing, and PCG is at the forefront. We… more
- Mathematica (Frankfort, KY)
- …self-motivated professional with a passion for solving clients' pressing problems and improving operations , and a strong interest in our Medicaid project area. ... managers, or deputy project directors on complex, fast-paced projects focused on Medicaid policy, oversight, and program operations * Developing and maintaining… more
- Mathematica (Frankfort, KY)
- …successfully improving state Home- and community-based services within the state's Medicaid or HCBS administrative agencies such as health, human services, area ... workforce, and quality monitoring is also preferred. Understanding of dual Medicare- Medicaid eligibility and coordination is preferred, but not required. * Duties… more
- Humana (Frankfort, KY)
- …practice management. + Utilization management experience in a medical management review organization , such as Medicare Advantage, managed Medicaid , or Commercial ... procedures, processes, productivity targets, and new delivery models. Maintains efficient operations while ensuring attainment of quality of care and financial… more
- Humana (Frankfort, KY)
- …and data integrity as required by CMS, The Ohio Department of Medicaid , and Humana internal reporting compliance. This role will support network optimization ... of governance tools, processes, and polices for the OH Medicaid Network Optimization team. This role will work closely...Dual Eligible products + Strong knowledge of provider network operations tools, processes, and best practices + Ability to… more
- Humana (Frankfort, KY)
- …**Preferred Qualifications** + Medicaid knowledge, including experience with interpreting Medicaid contracts. + Operations content design and facilitation + ... and analyzes learning needs and partner with subject matter experts across the organization to provide input for course curriculum. + Ensures course materials are… more
- Public Consulting Group (Frankfort, KY)
- …Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies ... support to management and consultants in compliance areas including Medicaid regulations. + Take a lead role in compliance...remote, work from home position. PCG is a remote-friendly organization and is committed to creating a culture where… more
- Humana (Frankfort, KY)
- …innovation, as well as reduction in risk, complexity, and total cost of operations . + Collaborate with technical teams and leadership to define and maintain ... robust, integrated and aligned with the strategy and long-term objectives of the organization . + Mentor the application teams with enterprise data use standards and… more
- Humana (Frankfort, KY)
- …(HCPR) function. The role's responsibility will include compliance reporting (Medicare & Medicaid ), operations reporting, and expert consultation around new data ... skills + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** +… more
- Humana (Frankfort, KY)
- …us put health first** The Delaware Valley ACO (DVACO) is an accountable care organization that participates in the Centers for Medicare and Medicaid Services' ... move projects forward. + Works with Vice Presidents, Medical Directors, Clinical Operations , Finance, Network Contracting, IT and other departments or stakeholders +… more
- Humana (Frankfort, KY)
- …dual focus: * Production Control: Leading a team responsible for the day-to-day operations and administration of our mainframe environment. * Turn Center: Leading a ... on the deployment and management of code changes on the mainframe platform. * Operations Support: Leading a team focused on the technical support for all teams… more
- HealthEdge Software Inc (Frankfort, KY)
- …ideal candidate will have a strong background in software development, operations , and automation, with a proventrack recordof successfully implementing DevOps ... to meet a health plan's needs today and extensible to grow with their organization over time-bringing disparate parts of a payer's organization together for… more
- Humana (Frankfort, KY)
- …needs to drive complex projects that across multiple departments with the Operations organization , including commissions, contracting, and data and reporting. ... Senior Project Manager to join the growing and dynamic Operations team. This is a nationwide remote role. IFG...meet deadlines + Ability to work in a matrixed organization with a virtual team, experience in large corporate… more
- Humana (Frankfort, KY)
- …will provide subject matter expertise on categories including construction, operations facilities management, fleet, furniture, security to meet pressing demand ... schedules and fulfill needs of our scaling operations . + Develop multi-year category strategy, build procurement processes with delivery strategies to run processes… more
- Humana (Frankfort, KY)
- …from moderate to substantial. CPSS Data and Analytics is an Enterprise Operations Enablement team focused on data, reporting and data science supporting Humana's ... Service Operations . The team is focused on converting data to...team, part of the broader CPSS Data and Analytics organization . This team is focused on analyzing technology, process… more
- Humana (Frankfort, KY)
- …reporting and analytics, as well as internal data management and Network Operations . The Senior Market Finance Professional works with Actuary, MRA, Corporate ... optimization inclusive of activities spanning decisions required for day-to-day operations to strategic planning and addressing specific business performance issues… more
- Humana (Frankfort, KY)
- …end-to-end experience by leveraging journey analytics, collaborating with marketing and operations teams, and ensuring improvements and innovations are tested early ... and socialize key member experience opportunities with leaders across our organization . Working with our data and technology partners, explore, define and… more
- Humana (Frankfort, KY)
- …the development of data-driven platforms, products, and services that streamline and enhance operations across the entire organization . At the heart of this ... to the development of a more efficient, secure, and data-centric organization . **Key Responsibilities** + Lead, design, and develop API based system-to-system… more
- Prime Therapeutics (Frankfort, KY)
- …planning, coordinating and leading audit support across all levels of the organization for assigned business unit. **Responsibilities** + Act as Prime's primary ... and relevant business unit systems (eg RxClaims in Clinical Operations ) + Ability to meet tight time frames and...+ Knowledge of, or experience with Medicare Part D, Medicaid , Commercial or HIM lines of business + Experience… more