- Guidehouse (Arlington, VA)
- …seeking Consultants with experience and knowledge of validating, loading, processing and analyzing Medicaid data and detailed member data across various ... analyses will be leveraged to help inform work with state Medicaid , public health or state...stay abreast of states' healthcare transformation efforts + Perform data and qualitative research activities to address state… more
- New York State Civil Service (Albany, NY)
- …City Albany State NY Zip Code 12206 Duties Description The Medicaid Redesign Analyst will be engaged in the development, implementation, management, oversight ... NY HELP Yes Agency Health, Department of Title Medicaid Redesign Analyst 2 (NY HELPS) - 62213 Occupational Category Administrative or General Management Salary Grade… more
- CVS Health (Salem, OR)
- …Qualifications** + Exposure to Lean Six Sigma or Agile methodology. + Experience with Medicaid and Duals process and data . + Experience with QNXT. **Education** ... it all with heart, each and every day. **Position Summary** The Senior Manager Data Consultant plays a crucial role in the overall planning and execution of… more
- Sumitomo Pharma (Marlborough, MA)
- …Manager, Medicaid Contract Administration. This position is responsible for managing the Medicaid rebate team in receiving, processing, validating, ... trouble-shooting Medicaid claims and dispute resolution with state agencies. This position requires a detailed understanding of the life science industry… more
- Highmark Health (Indianapolis, IN)
- …leadership role ensures the organization's robust compliance with all applicable federal and state Medicaid and CHIP regulations, including the growing number of ... laws and regulations governing managed care organizations. The Manager, Medicaid Compliance & Operations acts as a trusted business partner, providing expert advice… more
- Commonwealth Care Alliance (Boston, MA)
- …requests, providing solutioning options and documentation, developing new policies based on State and Federal requirements, host meetings, and managing projects ... applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for...and report outcome results on edits implemented. + Utilize data to examine large claims data sets… more
- Humana (Sterling Heights, MI)
- …report to the Plan Chief Executive Officer (CEO). The HIDE-SNP Program Medicaid Liaison (Strategy Advancement Advisor) will support Humana's Highly Integrated Dual ... link between Humana, MDHHS, and Centers for Medicare & Medicaid Services (CMS). + Supports all priority health plan...a minimum of five (5) years of progressive experience managing large scale projects **OR** equivalent work experience with… more
- Molina Healthcare (Scottsdale, AZ)
- …in managing multiple complex priorities simultaneously. * Experience with Medicaid Proposals and/or business development and requires demonstrated Medicaid ... The AVP Proposal Strategy is dedicated to maximizing Molina's likelihood of winning Medicaid RFPs. The AVP must have the executive presence and communication skills… more
- Centene Corporation (Cheyenne, WY)
- …This position will serve as a key actuarial leader for the **Coordinated Care Medicaid health plan in Washington State ** . The Manager, Actuarial Services is ... model submission, managing a cross functional team from Actuarial, Finance, Data & Analytics, and Accounting + Lead annual MLR submissions + Support analysis… more
- CVS Health (Hartford, CT)
- …Experience managing Medical Directors Demonstrated knowledge and skills making data driven decisions Ability to effectively manage multiple priorities and meet ... experience with CMS and / or MCG guidelines as well as state specific Medicaid contracts. Previous experience with NCQA accreditation **Education:** MD or DO,… more
- Deloitte (Tempe, AZ)
- …our people, ideas, technology and outcomes-is designed for impact. Serving federal, state , & local government clients as well as public higher education ... Operate offering provides key aspects of our clients' businesses with technology, data , and deep technical and human capabilities. Innovates and delivers creative,… more
- Commonwealth Care Alliance (Boston, MA)
- …The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial payment methodologies and supports audit, compliance, and ... provider engagement initiatives. This role also provides support in managing provider disputes and escalations requiring detailed pricing and reimbursement… more
- Centene Corporation (Austin, TX)
- …techniques to determine competitive strategy. + Oversees preparation and interpretation of data for rate and formula filings for state insurance departments. ... experience including responsibilities for hiring, training, assigning work and managing performance of staff. **License/Certification:** Associate or Fellow of the… more
- State of Colorado (Denver, CO)
- …mapping and transmissions of the interface files and APIs to ensure Medicaid data is mapped according to the State and Federal regulatory policies and rules. ... + Manage data integration business process changes, Medicaid data modeling changes, recommending changes to... long term goals, complex problem solving, understanding and managing data interface files, vendor management, writing… more
- New York State Civil Service (Schenectady, NY)
- …skills. Ability to work independently and in a team-based setting. Experience analyzing and managing data using SAS (or SPSS) and visualizing data using ... and services to over 8,000 recipients across New York State . The Data Analyst 1 is within...for full and unconditional participation in the Medicare and Medicaid programs. Continued employment will depend on maintaining eligibility.*… more
- Humana (Salem, OR)
- …the data exchange between Humana and its trading partners, Medicare and Medicaid . The Senior Encounter Data Management Professional will work with department ... caring community and help us put health first** The Senior Encounter Data Management Professional develops business processes to ensure successful submission and… more
- New York State Civil Service (Schenectady, NY)
- …of state operated supports and services to over 8,000 recipients across New York State . The Data Analyst 2 is within DSO's Bureau of Business Analytics and ... NY HELP No Agency People With Developmental Disabilities, Office for Title Data Analyst 2 Occupational Category Other Professional Careers Salary Grade 23 Bargaining… more
- New York State Civil Service (Albany, NY)
- …The Research Scientist 4 will serve as the Assistant Director of the Bureau of Medicaid Data Reporting and Analysis. Under guidance from the Director, they will ... Data Strategy and Management (DSM) as well as managing the day-to-day activities of the Bureau. Specific duties... sources may include, but are not limited to: Medicaid data , enrollment data , fiscal… more
- New York State Civil Service (Albany, NY)
- …Description The Research Scientist 5 will serve as the Director of the Bureau of Medicaid Data Reporting and Analysis. They will supervise and conduct a broad ... including ensuring proper allocation of resources.* Supervising, training, and managing the execution of complex data extracts,... sources may include, but are not limited to: Medicaid data , enrollment data , fiscal… more
- New York State Civil Service (Albany, NY)
- …12208 Duties Description The Research Scientist 2 position will work within the Bureau of Medicaid Data Reporting and Analysis and will assist in a broad range ... sources may include, but are not limited to, Medicaid data , enrollment data , case...Comments * If you are currently a New York State employee serving in a permanent competitive qualifying title… more