- Independent Living Systems (Miami, FL)
- …the healthcare industry. Proficient knowledge of UB04 / CMS-1500 claim adjudication process , including Medicare and Medicaid reimbursement methodologies (ie Per ... is responsible for analyzing complex business processes, identifying areas for improvement , and designing effective strategies that align with healthcare regulations… more
- Argon Agency (North Palm Beach, FL)
- …our staff, and ultimately transform the lives of those we serve. Job Duties: Lead with Compassion : Supervise and mentor our clinical staff, fostering a culture of ... empathy, professionalism, and continuous improvement . Supervision of therapists, counselors, case managers, and medical...for mental health and substance use disorders. Insurance & Medicaid Requirements Understanding of Medicaid , Medicare, and… more
- NTT DATA North America (Montgomery, AL)
- …implementation of corrective/preventive actions, compliance with PMI methodology, and continual process improvement efforts + Administrative support tasks such ... inclusive, adaptable, and forward-thinking organization, apply now. We are currently seeking a Medicaid CMS Certification Lead to join our team in Montgomery,… more
- CVS Health (Downers Grove, IL)
- …other specialties such as HCBS, LTC, BH, DMEs, and others to support staff. + Process Improvement : Work with Sr. Managers and Director to develop and implement ... compliance within our network responsibilities as provided within the state Medicaid contractual requirements. This position holds a variety of functions for… more
- Molina Healthcare (Fort Worth, TX)
- …accuracy and auditing configuration and outgoing payments + Focuses on process improvement , organizational change management, program management and other ... : + 3-5 years of Program and/or Project management experience. + Operational Process Improvement experience. + Healthcare experience. + Experience with Microsoft… more
- Conduent (Honolulu, HI)
- …to ensure high performance, professional development, and employee satisfaction. ** Process Improvement :** Continuously assess and enhance service delivery ... Department of Human Services Med-QUEST Division (MQD), which is responsible for Medicaid administration. Conduent has been providing these services to Hawaii MQD for… 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 ... operational excellence/administrative cost management. This requires the incumbent to lead their team through the implementation of alternative resourcing strategies… more
- Centene Corporation (Dover, DE)
- …Purpose:** Oversee all related activities for the Quality Improvement functions. Lead and direct process improvement activities for more efficient ... of QM/QI health care experience, including HEDIS data collection, implementing rapid-cycle process improvement principles and using study design and evaluation… more
- Sanofi Group (Morristown, NJ)
- …models to more accurately forecast government prices. + Recommend and implement process improvement measures to enhance operating performance, including driving ... the development of voluntary government channel strategies and direct the State Medicaid Supplemental Program and the FSS Contracting process including strategy… more
- Humana (Frankfort, KY)
- …Power Platform (Power BI, Power Automate, & Power Apps) + Knowledgeable in process improvement and metrics development + Knowledgeable in regulations governing ... community and help us put health first** The DSNP Encounters Data Management Lead supports the Encounter Data Management team within the Healthcare Quality Reporting… more
- Humana (Springfield, IL)
- …Care Programs, specifically in Member/Consumer Experience areas. + Experience with process improvement initiatives and strategy development. **Work at Home ... is dedicated full-time to member services for the Illinois Medicaid Market. This Lead leverages the voice...much more **Interview Format** As part of our hiring process , we will be using exciting interviewing technology provided… more
- Molina Healthcare (Provo, UT)
- **Job Description** **Job Summary** Provides lead level support as a highly capable business analyst who serves as a key strategic partner in driving health plan ... Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits,… more
- Molina Healthcare (Layton, UT)
- …requirements, strong commitment to high quality, on time delivery + Previous process improvement experience + Previous experience mentoring or training peers ... **Job Description** **Job Summary** We are seeking a highly experienced Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations… more
- Humana (Richmond, VA)
- …of this evolution is Humana's Insurance Segment, which provides Medicare Advantage, Medicaid , and other health plans to millions. By integrating insurance with care ... role in defining the future of Humana's Medicare and Medicaid businesses, which generate the majority of the company's...experience to join this team. As an Insurance Strategy Lead , you will directly contribute to high-impact strategy projects,… more
- Humana (Lansing, MI)
- …and help us put health first** The Utilization Management Nurse Lead uses clinical knowledge, communication skills, and independent critical thinking skills ... treatment, care, or services for Enrollees. The Utilization Management Nurse Lead coordinates and communicates with Providers, Enrollees, or other parties to… more
- Elevance Health (NC)
- \#HealthyBlueCareTogetherCFSP ** Lead Placement Support Specialist** **$2,500 SIGN ON BONUS** _We are partnering with North Carolina DHHS to operationalize a ... statewide Medicaid Plan designed to support Medicaid -enrolled infants,...an accommodation is granted as required by law. The ** Lead Placement Support Specialist** is Responsible for coordinating operations… more
- Humana (Baton Rouge, LA)
- …delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system evaluates Medicare Advantage and ... experience, and plan operations. **Location:** Remote or if in Louisville hybrid The Lead for HEDIS Diabetes Eye Exam is responsible for the advancement of the… more
- Humana (Washington, DC)
- …properly prioritize initiatives/projects that align with strategic objectives. Develop and lead the prioritization process , articulate tradeoffs and make ... quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system...planning support for the organization. The Stars Operations Strategy Lead requires an in-depth understanding of how the Stars… more
- Humana (Boston, MA)
- …and continually improve guidelines and procedures related to Network management including process and efficiency improvement + Conduct research on emerging ... part of our caring community and help us put health first** The Lead , Cloud Network Engineer designs, analyzes, plans and modifies network components supporting… more
- Cognizant (Blaine, MN)
- **About the role** As a Lead Developer you will play a crucial role in designing, developing and implementing OnBase solutions to enhance our healthcare claims ... processing systems. With a focus on Medicare and Medicaid claims you will leverage your expertise in OnBase...work collaboratively in a dynamic environment contributing to the improvement of healthcare services. **In this role, you will:**… more
