- CVS Health (Hartford, CT)
- …and monitoring of Medicaid network compliance requirements, focused first on Medicaid credentialing and provider data tasks. The role will collaborate cross ... over time. + Medicaid network compliance of Medicaid credentialing and provider data tasks. +...business interpretation of compliance requirements and consistently across business operations. + Lead department and cross… more
- Leidos (VA)
- …and key stakeholders in the Medicaid industry. The BD/Sales State Medicaid Lead will be responsible for driving business growth and expansion within the ... are seeking a highly motivated and experienced **BD/Sales State Medicaid Lead ** to join our team. The...will have a strong background in State and Local Business Development, with specific exposure to the Medicaid… more
- CVS Health (Hartford, CT)
- … LTSS RFP submissions and provide strategic guidance supporting initiatives across the national Medicaid LTSS line of business including but not limited to UM, ... determined by the plan leadership for NCQA and audits.* Lead the Medicaid markets national SAI ideation,...care industry. Preferred industry depth in a Medicare and/or Medicaid line of business * Strategic thinking with… more
- Humana (Richmond, VA)
- …of diverse scope and complexity ranging from moderate to substantial. The Medicaid Lead , Technology Solutions builds strategic partnerships and manages ... an effective strategy for executing and delivering on IT business initiatives. The Lead , Technology Solutions works...Humana IT's development timelines. + Serves as the 'Senior Business Architect' for Medicaid , with a strong… more
- Abt Global Inc. (Atlanta, GA)
- …The successful candidate will have extensive experience in Medicaid program operations, data , and policies. You will design and lead research projects and ... implement analyses using Medicaid claims and administrative data to meet project needs. + Lead ... development relationships with clients and external partners. + Lead business development activities including proposal writing… more
- Mathematica (Princeton, NJ)
- …of quantitative data , most commonly leveraging Medicaid and CHIP administrative data * Direct business development efforts and lead proposals for new ... In particular, we are looking for individuals who can lead current and emerging analytic work across several areas...analytic work on topics related to state and federal Medicaid and CHIP policy and data systems,… more
- Humana (Richmond, VA)
- …in Virginia is seeking a Workforce Development Administrator (Workforce Management Lead ) who will be responsible for coordinating and overseeing workforce ... development activities for Humana Healthy Horizons in Virginia Medicaid plan. Through collaboration with Virginia DMAS, providers, and other key community… more
- Sumitomo Pharma (Marlborough, MA)
- …role 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 ... other similar industry standard software. + Investigate, analyze information, and resolve business questions by applying information from various data sources, … more
- CareOregon (Portland, OR)
- …Job Summary This position is responsible for managing actuarial analysis related to Medicaid and Medicare Advantage lines of business with a focus on ... goals for actuarial analysis of the financial performance of Medicaid and Medicare lines of business in...analysis, and drivers of revenues and expenses. + Provide Medicaid rate setting support through data analysis,… more
- CVS Health (Northbrook, IL)
- …Engagement , the Manager will work closely with cross-functional leadership across the Medicaid business to establish and champion local market culture committed ... an outstanding opportunity for an enthusiastic team player to lead local market Medicaid Provider Engagement risk...with supporting material to successfully align on strategy objectives. Data Analysis & Reporting 25% + Work closely with… more
- Humana (Louisville, KY)
- …Strategy Organization in order to support the strategic direction and growth of the Medicaid and Duals lines of business . This is a unique opportunity for ... services that meet the needs of Humana's customers while aligning with its business objectives. The ** Medicaid Senior Insurance Product Manager** plays a… more
- Public Consulting Group (Columbus, OH)
- …looking for an experienced Medicaid Consultant to join our team and help lead our growth efforts. Deep Medicaid experience is critical, as well as experience ... the public sector. To learn more, visit www.publicconsultinggroup.com. **Responsibilities** The Medicaid marketplace is changing, and PCG is at the forefront. We… more
- CVS Health (Hartford, CT)
- …Medicaid Risk Adjustment will work closely with cross-functional leadership across the Medicaid business to establish and champion a local market culture ... an outstanding opportunity for an enthusiastic team player to lead a suite of market focused Risk Adjustment Programs...preferred. - Deep knowledge of local markets across Aetna Medicaid . Extensive data analytics experience RN, AAPC,… more
- PruittHealth (Norcross, GA)
- …knowledge of business processes and enabling technologies, specifically in a Medicaid Claims function * Ability to comprehend and retain information that can be ... **JOB PURPOSE:** Supports the delivery of all Medicaid billing services by final/higher level auditing, correcting,...and help foster an environment where continuous improvement in business processes and services is welcomed and recognized to… more
- Highmark Health (Columbus, OH)
- …teams on cross-functional efforts, in this role the incumbent should also act as a business data subject matter expert hands on where possible, and guide, ... lead and educate staff knowledge and growth. Responsible for...collaboration with engineering and quality teams, testing of core data platforms, and delivering solutions to solve business… more
- NORC (Bethesda, MD)
- …using relevant administrative data sets such as Medicare Advantage, Medicare Part D, Medicaid data + Expertise in data mining and application of ... and qualitative research studies, evaluations and analyses of health care administrative data ; and lead stakeholder interviews + Independently draft and manage… more
- Humana (Columbus, OH)
- …involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Staff Geriatrician or ... Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease...behavioral and social health needs. + Provide support to Medicaid markets within the region, aiding in case review,… more
- Mathematica (Columbus, OH)
- … analytics, visualization, and development of analytics products such as interactive dashboards and data driven applications. * Lead the design of data ... involving large secondary data sources such as Medicaid (T-MSIS, TAF) administrative claims data to...project risk. * Contribute to the growth of the business through significant proposal contributions (expressions of interest, planning… more
- CVS Health (Albany, NY)
- …ways to increase membership.Prepare/conduct effective data driven presentations to lead in depth quarterly business reviews to evaluate growth trends ... of all related processesResponsible for special projects to drive growth and retention. Lead and/or assist in marketing and business development activities to… more
- Humana (Indianapolis, IN)
- …in the State of Indiana. + Proficiency in analyzing and interpreting data trends. + Progressive business consulting and/or operational leadership experience. ... in Indiana is seeking a Manager, Care Coordination to lead teams of nurses and behavior health professionals responsible...care for elderly or special needs populations, or in Medicaid and/or Medicare. + 2+ years of management or… more