- Humana (Richmond, VA)
- …the Enterprise; leverage these relationships in helping to drive innovation and effective operations for Humana Medicaid . **Use your skills to make an impact** ... Time Zone** + Bachelor's Degree or 5+ years of Medicaid managed care, network contracting, network/provider operations ,...leadership success. + Ability to identify, structure and solve business problems. + Experience working with Medicaid … more
- Humana (Richmond, VA)
- …conflict with Humana IT's development timelines. + Serves as the 'Senior Business Architect' for Medicaid , with a strong understanding of how the industry's ... Solutions devises an effective strategy for executing and delivering on IT business initiatives. The Lead, Technology Solutions works on problems of diverse scope… more
- Humana (Richmond, VA)
- …Improvement (HQRI) organization as Senior Vice President (SVP), Risk Adjustment Operations and Interoperability. This key leadership position plays a crucial role ... optimize risk adjustment and interoperability solutions that deliver quality outcomes and business value. This role will impact our overall Medicare and Medicaid… more
- HealthEdge Software Inc (Richmond, VA)
- …issues and client impacts. + Partner withappropriate Source Teams(BA, PM, Development , Account Management, Sales/ Business Development , Product, Content, ... Medicaid , and commercial), payment integrity, and healthcare plan operations (eg, claim life cycle/workflow, network contracting, payment/policy configuration,… more
- Mathematica (Richmond, VA)
- …and family support to nutrition, employment, disability, and international development . Mathematica offers our employees competitive salaries, and a comprehensive ... improving state Home- and community-based services within the state's Medicaid or HCBS administrative agencies such as health, human...consulting services to state and local clients, support the development of new health policies, assist with the … more
- Humana (Richmond, VA)
- …of our caring community and help us put health first** The Associate Director, Business Systems Analysis performs analysis of business , process and user needs, ... and translation into proper system requirement specifications. The Associate Director, Business Systems Analysis requires a solid understanding of how organization… more
- Humana (Richmond, VA)
- …priorities on a regular basis. + Embrace a service mentality to collaborate with Operations , Business Intelligence teams, Database teams, and IT to assure data ... our caring community and help us put health first** The Associate Director, Business Intelligence for CPSS Data and Analytics will support the account services,… more
- Prime Therapeutics (Richmond, VA)
- …overall administration of the programs. Activities address impact on customers, operations , program integrity, pricing, quality and satisfaction. Develops and tracks ... expertise with data management and overall healthcare trends specific to the Medicaid population. **Job Description** + Partners with appropriate staff in the… more
- Mathematica (Richmond, VA)
- …to the collection and interpretation of quantitative and qualitative data * Direct business development efforts and lead proposals for new projects * Author ... and family support to nutrition, employment, disability, and international development . Mathematica offers our employees competitive salaries, and a comprehensive… more
- Humana (Richmond, VA)
- …will be responsible for leading the beginning-to-end operational support of specialty Medicaid value based payment (VBP) models in alignment with segment strategy ... + Analyze utilization data to reconcile provider disputes + Contribute to development and support of provider reporting packages to help providers understand their… more
- Mathematica (Richmond, VA)
- …and family support to nutrition, employment, disability, and international development . Mathematica offers our employees competitive salaries, and a comprehensive ... improving state behavioral health programs within or in conjunction with Medicaid programs and state, local, and private providers. Experience managing public… more
- Option Care Health (Richmond, VA)
- …action policies and procedures. Reporting to the VP, Compliance & Privacy Operations , this individual will also assist Compliance leadership with: * Developing and ... and adhere to legal and regulatory requirements, the Company's Code of Business Conduct and Company policies and procedures. * Assessing the effectiveness of… more
- Humana (Richmond, VA)
- …+ 2+ years of project leadership and consulting experience. + Health Care Business Domains - Medicare, Medicaid , Group, Specialty etc. **Additional Information** ... help us put health first** Are you interested in leveraging technology and business strategy to deliver improved member experiences and health outcomes to Humana's… more
- Humana (Richmond, VA)
- …looking for an experience Senior ADA Compliance Professional to join the Marketing Operations - Strategy, Compliance & Reporting team working remote in the state of ... members with disabilities and limited English. You will analyze operations and critically assess compliance to identify and review...met based on the Code of Federal Regulations for Medicaid states + Collaborate with the communication team on… more
- Humana (Richmond, VA)
- …+ Advanced certifications in software and/or process improvement + Experience with Medicaid + Experience in provider networks/provider operations + Advanced ... Adequacy tests the overall network in each county of operations to ensure the network is strong enough to...matching program + Network Resource Groups (NRGs) + Career development opportunities **Use your skills to make an impact**… more
- Elevance Health (Richmond, VA)
- …Amerigroup, is a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative services ... to Medicaid plans in partnership with blue cross blue shield...consultation and serve as clinical/strategic advisor to enhance clinical operations . May identify cost of care opportunities. May serve… more
- CVS Health (Richmond, VA)
- …SUMMARY The BH Clinical Liaison is a clinical leader in the Medicaid plan focusing on utilization management, integrating member care, clinical coordination, leading ... the development , implementation and ongoing monitoring of program and quality...and to ensure adherence to performance targets of the business area.Fundamental Components: + Clinically manage non-traditional mental health… more
- Humana (Richmond, VA)
- …to assigned business partners + Conduct periodic compliance reviews of business partner operations + Develop and monitor metrics and other oversight ... focusing on marketing, agents, sales, as well as product offerings, development , and filings. The Senior Compliance Professional works assignments involving… more
- Humana (Richmond, VA)
- …our multi-channel call center operations . Analyze forecast, manage data, real-time operations and project staffing to achieve call business unit goals and ... our multi-channel call center operations . Analyze forecast, manage data, real-time operations and project staffing to achieve call business unit goals and… more
- Cardinal Health (Richmond, VA)
- …legal advice and services in order to protect the organization's assets, operations and image. This function provides legal counsel related to commercial, corporate ... all company legal matters, manages outside counsel and manages legal operations . Commercial Transaction provides legal advice, counsel and services to domestic… more