- Prime Therapeutics (Santa Fe, NM)
- …Summary** Responsible for the intake and initial handling of allegations of fraud, waste or abuse. Conducts preliminary investigation to assess the merit of an ... allegation through fact gathering and analysis of data. Uses independent judgment to conclude preliminary investigation in accordance with procedures or to present to management to recommend for audit or investigation. Serves as a corporate resource on fraud,… more
- Humana (Santa Fe, NM)
- …+ Generate reports and deliver them to the markets + Ability to become a SME in various reporting platforms (ex. Availity, PowerBI, PPCM) + Monitor program ... **Become a part of our caring community and help us put health first** Healthcare Quality Reporting & Improvement (HQRI) is an organization responsible for improving health outcomes and advancing the care experience of our members and provider partners through… more
- Ford Motor Company (Santa Fe, NM)
- …The ideal candidate will have a comprehensive background in CRM systems, API development, and Microsoft Dynamics CRM. As Dealer Portal Anchor, you will play a key ... role in leading the development, migration, and maintenance of our CRM dealer portal platform. + Serve as the technical anchor for the CRM Dealer Portal product team + Lead effort to migrate Dealer Portal from GCCT (existing USD application) to CX-Hub (newly… more
- Highmark Health (Santa Fe, NM)
- …:** **JOB SUMMARY** CANDIDATE MUST BE US Citizen (due to contractual/access requirements) This job turns data into information, information into insight, and insight ... into business decisions. More specifically, this job drives and supports all activities related to collecting, analyzing, and reporting on the Organization's key performance indicators including developing dashboards, scorecards, forecasting, trending,… more
- Confluent (Santa Fe, NM)
- …We have a purpose that drivesexperience, and work location. In addition, Confluent offers a wide range of employee benefits. To learn more about our benefits click HERE ... (https://confluentbenefits.com/) . Click HERE (https://www.confluent.io/legal/confluent-candidate-privacy-notice/) to review our Candidate Privacy Notice which describes how and when Confluent, Inc., and its group companies, collects, uses, and shares certain… more
- Pearson (Santa Fe, NM)
- …Provide administrative and logistical support of high-volume recruitment Create and send offer letters to selected candidates Assist with onboarding tasks Other ... We are the world's learning company with more than 24,000 employees operating in 70 countries. We combine world-class educational content and assessment, powered by services and technology, to enable more effective teaching and personalized learning at scale.… more
- J&J Family of Companies (Santa Fe, NM)
- …Johnson & Johnson is recruiting for a Manager Cybersecurity, J&J Innovative Medicines Research & Development. This role can be fully remote in the United States or ... onsite at one our locations in New Jersey or Pennsylvania. Johnson & Johnson is the world's most comprehensive and broadly-based manufacturer of health care products and related services, for the pharmaceutical and medical devices markets. Johnson & Johnson… more
- Jacobs (Santa Fe, NM)
- …will focus upon providing advisory and design solutions for geothermal project development and technical delivery as part of the geothermal team, along with other ... **Your Impact:** Our People & Places Solutions business - reinforces our drive to improve the lives of people everywhere and epitomizes the "why" of what we do - the tremendous positive impact and value our solutions bring to our communities and society as a… more
- Humana (Santa Fe, NM)
- …+ Bachelor's degree + Must have one of the following Ohio licensures: Licensed Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Licensed ... Professional Counselor (LPC), or other professional license. + One or more years of post-degree clinical experience in private practice or other patient care + Must be passionate about contributing to an organization focused on continuously improving consumer… more
- SMX (Santa Fe, NM)
- …+ Prepares Requests for Proposals to include statements of work, terms and conditions, flow-down terms and conditions, bid or performance evaluation factors, and ... Senior Subcontract Administrator (3509)at SMX(View all jobs) (https://www.smxtech.com/careers/) United States SMX is seeking a Senior Subcontract Administrator who will compile, award, and execute subcontracts within policy guidelines in a dynamic contractual… more
- Ensono (Santa Fe, NM)
- …+ Selects and develops staff to ensure all go-live timelines are met and post-live objectives are being met. + Maintain accurate and thorough documentation of client ... environments and support procedures. + Determine appropriate performance expectations and manage across all staff. + Drive team to achieve all KPI's and associated metrics. + Responsible for directing and executing day-to-day operations including managing… more
- Prime Therapeutics (Santa Fe, NM)
- …Purpose: The Account Install Analyst provides research support and interpretation of benefit requirements necessary to support new and existing benefits and product ... development. This position performs analytical tasks related to benefit design enhancements, maintenance of documents, feasibility testing, and quality audit. Responsibilities: Partner with Clinical Pharmacists and provide analysis and support for benefit… more
- Prime Therapeutics (Santa Fe, NM)
- …Summary** Plays a key role in various multi-functional projects critical to the company achieving clinical and operational goals and objectives. Responsible to ... develop, implement and monitor clinical specialty programs in the field. Primarily responsible to serve as the clinical liaison for assigned contract(s). Manages overall client relationship. Participates in the development of clinical management products and… more
- Highmark Health (Santa Fe, NM)
- …:** **JOB SUMMARY** This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage ... (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and… more
- Humana (Santa Fe, NM)
- …+ Serves as subject matter expert on NCQA Health Plan Accreditation Long-Term Services and Supports (LTSS) requirements, advising stakeholders on compliance, and ... facilitating NCQA LTSS file universe preparation and LTSS file reviews. + Works closely with operational areas to prepare documentation and files for presentation to NCQA. + Advises operational leaders and frontline associates in developing functional… more
- Jacobs (Santa Fe, NM)
- **Your Impact:** Our People & Places Solutions business - reinforces our drive to improve the lives of people everywhere and epitomizes the "why" of what we do - the ... tremendous positive impact and value our solutions bring to our communities and society as a whole. From facilities delivering life-saving therapies and ensuring clean water to enabling the connection of people through all modes of transportation and providing… more
- Humana (Santa Fe, NM)
- …+ Provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS ... requirements, Humana policies, clinical standards, and (in some cases) contracts. + Completes computer-based reviews of moderately complex to complex clinical scenarios, review of all submitted clinical records and communication of decisions to internal… more
- Ford Motor Company (Santa Fe, NM)
- …for selected vehicle lines, including: + Coordinate and schedule US Fleet orders to support the Ford Pro sales team. + Analyze scheduling previews and make necessary ... adjustments required due to supplier/assembly plant constraints, engineering stop ships/builds, schedule based on Fleet segment requirements and customer requested build weeks to fill weekly fleet allocation. + Develop monthly optimization preference patterns… more
- Ford Motor Company (Santa Fe, NM)
- …Data Engineer with hands on experience using Lean and Agile methodologies to build and deliver various Purpose Built Data Products. Data Engineer will be part of the ... CDM portfolio and will collaborate with Product Managers, Designers and Product Owners to build, validate and release Data Products. Work with other foundational teams in defining the strategy, roadmap and Technical foundational capabilities on GCP + Provide… more
- Humana (Santa Fe, NM)
- …The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national ... guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services. After completion… more