- Prime Therapeutics (Frankfort, KY)
- …we make. **Job Posting Title** VP Government Programs - Medicare & Managed Medicaid ( REMOTE ) **Job Description** The Vice President Government Programs - ... Medicare & Managed Medicaid is responsible for the development, administration, and execution...development of products and services across the enterprise to support growth objectives + Oversee the expansion of PBM… more
- Prime Therapeutics (Trenton, NJ)
- …Come build the future of pharmacy with us. **Job Posting Title** Georgia Medicaid Clinical Account Manager - Remote **Job Description** Innovative business ... address unmet customer needs. + Provides clinical operations input and support of client specific claims processing programs, coordinates implementations of clinical… more
- CVS Health (Annapolis, MD)
- …- 2 years leading member/customer service team. - Experience in a Medicaid and/or Medicare setting. - Bachelor's Degree **Education** High School Diploma or ... equivalent **_We support a hybrid work environment. If selected and you...for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed… more
- Humana (Madison, WI)
- … or state partnership financial operations.** **Experience with value-based program development and administration** **.** **_Location_** ** Remote (Work** ... of our caring community and help us put health first** The Wisconsin Medicaid Market CFO provides strategic financial leadership for Humana's Medicaid operations… more
- Humana (Austin, TX)
- …efforts and network adequacy. + Participate in ongoing training related to Medicaid dental program requirements and provider network management. + Responsible ... dental providers participating in Medicaid . + Ensures providers understand Medicaid policies, compliance requirements, best practices, and program updates,… more
- General Dynamics Information Technology (Fairfax, VA)
- …**Public Trust/Other Required:** Other **Job Family:** Software Engineering **Skills:** Medicaid , Medicaid Claims, Medicaid Management Information System ... team is dedicated to improving the efficiency and effectiveness of Medicaid Management Information Systems (MMIS). We are seeking talented technical professionals… more
- Humana (Indianapolis, IN)
- …leadership regarding rate and pricing development + Provides leadership and support regarding value-based program development and administration + Ensures ... Medicaid or state partnership financial operations. + Experience with value-based program development. Travel: While this is a remote position, occasional… more
- Humana (Baton Rouge, LA)
- …Senior Market Finance Professional supports more than half of Humana's Medicaid business, providing technical financial analysis and data-driven insights to drive ... with Market CFOs, clinical teams, and provider engagement teams, focusing on Medicaid claims and premium analytics across multiple states, including established and… more
- NTT DATA North America (Montgomery, AL)
- …adaptable, and forward-thinking organization, apply now. We are currently seeking a Medicaid Project Manager - PMP Certified to join our team in Montgomery, ... our team in Montgomery Alabama. This can be a remote position with limited travel to the client's site....will actively participate in the development and delivery of program and quality management services and associated deliverables. The… more
- NTT DATA North America (Montgomery, AL)
- …focus will be the Medicaid Claims Processing System. The Senior BA will support both the current MMIS and plan for the future CPMS takeover project working with ... forward-thinking organization, apply now. We are currently seeking a Medicaid Senior BA to join our team in montgomery,...our team in Montgomery Alabama. This can be a remote position with limited travel to the client's site.… more
- Public Consulting Group (Concord, NH)
- …partners + Stay informed and rigorously track federal, state, and local Medicaid School-Based program policies, cultivating subject matter expertise through ... Services PCG helps school districts and state agencies across the country support the delivery of health-related services by helping schools access critical … more
- Highmark Health (Pittsburgh, PA)
- …solutions with seamless omni-channel handoffs. As a key leader of the Medicaid Clinical organization, role is responsible for maximizing and optimizing value of ... and cost. + **Maintain compliance:** Implement and oversee a comprehensive compliance program for clinical services, ensuring adherence to NCQA standards and all… more
- Molina Healthcare (Sterling Heights, MI)
- …and analysis to increase community engagement in key business decisions. Provides support to Molina functional areas through program management, including ... Molina Healthcare of Michigan meets it's Community Reinvestment obligations under the Medicaid and HIDE SNP contracts with the State of Michigan while supporting… more
- Magellan Health Services (Boise, ID)
- …Excel, Access, Outlook, Word, and Power Point. General Job Information Title SIU Program Integrity Investigator - Remote (In Idaho) Grade 24 Work Experience ... and facility providers, member data, contractual relationships, payment policies, Medicaid /Medicare rules and statutes, etc. + Conduct research on medical… more
- Marshfield Clinic (Marshfield, WI)
- …any time have been or be excluded from participation in any federally funded program , including Medicare and Medicaid . This is a condition of employment. ... **Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!** **Job Title:** Risk Adjustment Revenue… more
- Guidehouse (Minneapolis, MN)
- …**Travel Required** **:** None **Clearance Required** **:** None This position is fully remote **What You Will Do** **:** + Under the direction of the Director ... Revenue Integrity, the Revenue Integrity Coding Billing Specialistprovides revenue cycle support services through efficient review and timely resolution of assigned… more
- Conduent (OH)
- …noticed and valued every day. ** Remote - Call Center Customer Service Representative** ** Medicaid Member Support - Tier 1** **For The State of Iowa** **You ... point of contact for inquiries from potential and existing Iowa Medicaid Program recipients and affiliates. + Provide one-to-one telephone contact with… more
- Prime Therapeutics (Boston, MA)
- …**Job Posting Title** Compliance Analyst Principal (Performance and Oversight) - Remote **Job Description** The Compliance Principal is responsible for supporting ... identify compliance requirements, assess risks, and recommend compliant solutions that support enterprise goals + Conducts analysis to create written reports,… more
- Molina Healthcare (WI)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are ... Validation is a plus. Work hours: Monday - Friday 8:00am- 5:00pm Remote position **Essential Job Duties** * Performs clinical/medical reviews of previously denied… more
- Prime Therapeutics (Providence, RI)
- …of pharmacy with us. **Job Posting Title** Clinical Account Director - Remote **Job Description** The Clinical Account Director is responsible for the management ... member materials and communications, and product ownership for Medicare and Medicaid formularies + Provide consultation and recommendations to the client regarding… more