- Marion County (Salem, OR)
- …opportunities. Model to supervisors and support supervisors to prioritize, assign, review , and give feedback to employees about their work; provide guidance ... skills and confidence that enhances the program and organizational culture. Review supervisors work for completeness, accuracy, quality, and quantity. Provide… more
- Comunilife (Bronx, NY)
- Utilization Review Analyst Job Details...by NYS Office of Mental Health (OMH) to bill Medicaid for certain services. The program is designed to assist ... - Social Services Description Comunilife Inc.is looking for aUtilization Review Analystfor its newRehabilitation and Tenancy Support Services Program… more
- MyFlorida (Tallahassee, FL)
- …rules, coverage policies, managed care plan contracts, bill analyses, drug utilization review boards, preferred drug lists, supplemental rebate contracts, ... 68064844 - MEDICAL/HEALTH CARE PROGRAM ANALYST Date: May 7, 2024 Location: TALLAHASSEE, FL,...entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000… more
- New York State Civil Service (Albany, NY)
- …Agency Health, Department of Title Associate Health Care Management Systems Analyst (NY HELPS) - 60286 Occupational Category Financial, Accounting, Auditing Salary ... independently. The candidate should have knowledge of the NYS Medicaid program and have the ability to interact and...and support services. The Associate Health Care Management Systems Analyst will lead the Operating Rates unit within the… more
- HCA Healthcare (Earth City, MO)
- …you want to join an organization that invests in you as a Consulting Product Analyst ? At Parallon, you come first. HCA Healthcare has committed up to $300 million in ... difference. We are looking for a dedicated Consulting Product Analyst like you to be a part of our...processes to recommend opportunities for optimizing business process through utilization of technology.** + **Works with IT and Operations… more
- CareOregon (Portland, OR)
- …Nevada, Texas, Montana, or Wisconsin. Job Title IS System Configuration Analyst II Exemption Status Exempt Department Operations Manager Title IS Development ... and data integrity of multiple systems: + QNXT, including claims, utilization management, benefits, contracts, member, call tracking, fees and code modules… more
- Healthfirst (New York, NY)
- The Sr Clinical Policy Analyst is responsible for promoting compliance and regulatory requirements within Healthfirst's Clinical areas. The role supports several ... organizational governance committees, assists the Healthfirst Medical Directors and Utilization Management business units and aids with the development and oversight… more
- University of Washington (Seattle, WA)
- …and an understanding of Epic applications, data/business intelligence tools and utilization **PRIMARY JOB RESPONSIBILITIES** + Review , Remediation, and Educate ... Medicine Revenue Integrity** has an outstanding opportunity for a **TEMPORARY REVENUE INTEGRITY ANALYST ** **Work Schedule** + 100% FTE - POSITION IS EXPECTED TO LAST… more
- CVS Health (Charleston, WV)
- …experience + Foster care experience + Crisis intervention skills + Managed care/ utilization review experience + Case management and discharge planning experience ... 26+ year history of partnering with the State to provide West Virginia's Medicaid population with top notch health care coordination and service. The plan also… more
- CommonSpirit Health (Englewood, CO)
- …and out in the community. **Responsibilities** **Job Summary** The Senior Analyst , Contract Compliance will leverage knowledge of revenue cycle functions to ... Payment Integrity Compass, EPSI, EPIC) and external sources (eg, Medicare/ Medicaid website) to assess contract performance and contract compliance opportunities.… more
- Trinity Health (Syracuse, NY)
- …litigation, and health plan denials Compare evaluation and management code utilization by provider, with comparison to national benchmarking, to identify potential ... enterprise Policy & Procedure. Performs accurate resolve of assigned auditing charge review and claim edits WQs in defined timeframe. Develops, collaborates, and… more
- CVS Health (Charleston, WV)
- …experience + Foster care experience + Crisis intervention skills + Managed care/ utilization review experience + Case management and discharge planning experience ... + Through the use of care management tools and information/data review , conducts comprehensive evaluation of referred member's needs/eligibility and recommends an… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …medical terminology and experience in the analysis and processing of claims, utilization review , quality assurance procedures, payment methodologies and Part D ... security guidelines + Works in collaboration with the Coding Analyst assigned to the Operations area, as well as...to BSN or higher prepared nurses with recent medical review experience in Medicare and/or Medicaid reviews… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …HIPAA regulations according to minimum necessary rules. + Oversight of quarterly utilization review and other record auditing related to regulatory requirements, ... of Health Regulations outlined in NYCRR 10 section 763, Medicare and Medicaid billing rules and other governmental oversight and that services provided meet… more
- Elevance Health (Denison, TX)
- …documents to convey the determination. + Responsibilities exclude conducting any utilization or medical management review activities that require the ... contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs. **Pay/Location:** the pay for this… more
- Highlights Healthcare (Mooresville, NC)
- …who will lead the development, management, and implementation of our trainee/student analyst program and our BCBA mentor program. This position ensures the delivery ... We specialize in serving young learners and families with Medicaid benefits. We believe every child can achieve great...for students if needed + Coordinates or implements the review and signing off on all student session notes,… more
