- Highmark Health (Richmond, VA)
- …including the growing number of laws and regulations governing managed care organizations. The Manager , Medicaid Compliance & Operations acts as a trusted ... contracts. The position actively manages the day-to-day operations of the Medicaid Compliance Program, and contributes to the operational workflow for … more
- Humana (Richmond, VA)
- …development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root ... a part of our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence… more
- Prime Therapeutics (Richmond, VA)
- …Posting Title** Manager , Compliance - Remote **Job Description** The Compliance Manager works closely with designated business areas, Legal, and other ... Expertise in their areas of focus (Affordable Care Act, Medicare, Medicaid , Corporate Compliance , Compliance Assessment or Services etc.) + Develop and… more
- Prime Therapeutics (Richmond, VA)
- … with federal laws, state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each State Medicaid ... passion and drives every decision we make. **Job Posting Title** Manager Rebate Pharmacy Operations **Job Description Summary** This position provides administrative… more
- Humana (Glen Allen, VA)
- …our caring community and help us put health first** The Field Care Manager , Behavioral Health performs primarily face to face and telephonic assessments with ... members. The Field Care Manager serves as the primary point of contact. providing...behavioral health outcomes, reducing care gaps, and supporting Virginia's Medicaid population with comprehensive, integrated behavioral health care management..… more
- Elevance Health (Richmond, VA)
- …Alternate locations may be considered.** **Position Overview:** The Vendor Implementation Manager is responsible for Provider Network 3rd party delegated dental, ... vendors, vendor operational enhancement and issue management for multiple states and for Medicaid and Medicare lines of business. **How You Will Make an Impact:** +… more
- Humana (Richmond, VA)
- …health outcomes for our dual members - members that qualify for both Medicare and Medicaid . The Lead Product Manager sits in the center of strategy, design, ... first** We are looking for a dynamic Lead Product Manager to develop clinical solutions for our members and...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Humana (Richmond, VA)
- …of our caring community and help us put health first** The Field Care Manager , ARTS assesses and evaluates member's needs and requirements to achieve and/or maintain ... the care and wellbeing of members. The Field Care Manager , Behavioral Health 2 work assignments are varied and...needs. + Will follow processes, and procedures to ensure compliance with regulatory requirements by the Virginia Department of… more
- Prime Therapeutics (Richmond, VA)
- …our passion and drives every decision we make. **Job Posting Title** Client Quality Manager Stars and Quality - Remote **Job Description** The Senior Client Quality ... Manager ensures the successful planning, implementation and execution of...provides leadership and subject matter expertise on Medicare Stars, Medicaid quality and the Commercial/Health Insurance Marketplace Quality Rating… more
- Prime Therapeutics (Richmond, VA)
- …and ability to adjust focus **Reporting Structure** + Reports to Sr Professional, Manager , Director or Senior Director in the Compliance department Potential pay ... our passion and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Interpretation and Advising) - Remote **Job Description** The Senior … more
- Humana (Richmond, VA)
- …of Case Management team on cases with support needs. Ensures regulatory compliance by aligning care management policies, procedures, and processes to maintain ... initiatives to maintain focus on performance goals and standards, quality and compliance measures with development of action plans to improve results. + Ensures… more
- Bon Secours Mercy Health (Richmond, VA)
- …an environment where associates want to work and help communities thrive. **Practice Manager I - Physician Office - Patterson Avenue Family Practice - Richmond, VA** ... development, financial performance, patient, provider and staff satisfaction and billing compliance . Assist with the development of operational plans & budgets and… more
- Humana (Richmond, VA)
- …we expand our cloud capabilities, we are looking for a Principal Product Manager to lead our multi-CSP strategy, drive cross-domain collaboration, and optimize our ... customer onboarding experience. As a Principal Cloud Platform Product Manager , you will own the vision, strategy, and execution for our multi-cloud platform-focusing… more
- Prime Therapeutics (Richmond, VA)
- …management in the areas of problem identification and resolution, process improvements, compliance with Centers for Medicare & Medicaid Services (CMS) ... passion and drives every decision we make. **Job Posting Title** Vendor Program Manager Senior **Job Description** The Vendor Program Manager is responsible for… more
- HCA Healthcare (Richmond, VA)
- …invested over 156,000 hours volunteering in our communities. As a Patient Access Manager with Johnston Willis Hospital, you can be a part of an organization ... to succeed in our organization. We are looking for an enthusiastic Patient Access Manager to help us reach our goals. Unlock your potential! **Job Summary and… more
- Gentiva (Chesterfield County, VA)
- …in people's lives every day. **Overview** We're looking for a **Patient Care Manager ** to join our team.You will report directly to the Executive Director, ... Administrator, or Senior Patient Care Manager . You will be responsible for maintaining a high...and ensuring adherence to company policies and procedures and compliance with local, state, and federal regulations and regulatory… more
- Datavant (Richmond, VA)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Analytics Products, you will contribute to the strategy and ... and support value-based client delivery across Medicare Advantage, ACA, and Medicaid programs. The ideal candidate combines deep healthcare analytics expertise with… more
- CVS Health (Richmond, VA)
- …of Care: - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. ... Suite applications (Outlook, Word, Excel, SharePoint, Teams) **Preferred Qualifications** * Medicaid experience. * Waiver experience * Foster care experience *… more
- CVS Health (Richmond, VA)
- …into actionable insights to support fraud, waste, and abuse (FWA) detection and Medicaid regulatory & compliance reporting. This is an individual contributor ... in Medicaid claims and provider activity. + Prepare timely and accurate Medicaid regulatory & compliance reports in accordance with prescribed guidelines and… more
- CenterWell (Richmond, VA)
- …food insecurity, navigation of and application for benefits including, Medicaid , HCBS, working to reduce costs associated with prescription medications, ... + Bachelor's Degree in applicable discipline + Familiarity with state Medicaid guidelines and application processes + Experience working with seniors' complex… more