- Guidehouse (Mclean, VA)
- …and researching financial trends + Document and communicate findings and support development of recommendations and follow-up steps to respond to findings + ... with experience and knowledge of validating, loading, processing and analyzing Medicaid data and detailed member data across various states, public health… more
- CenterWell (Washington, DC)
- …broad understanding of pharmacy, managed care, PBM, market and regulatory insights to support the development of Medicaid formulary and medical drug strategies ... in-depth evaluation of variable factors. The Clinical Pharmacy Lead uses clinical and financial data driven methods to develop and influence drug strategies for the … more
- Humana (Washington, DC)
- …determination of the appropriate courses of action. The Finance Professional 2 will support Medicaid /Duals and continue to grow as more states are brought ... health first** The Finance Professional 2 analyzes and forecasts financial , economic, and other data to provide ...and Rx claims, membership, and premium related data to provide reports to Medicaid Finance CFOs as… more
- Elevance Health (Chantilly, VA)
- RN Nurse Case Manager l - Medicaid (JR152160) **Location** : This role requires associates to be **in-office 4 days per week** , fostering collaboration and ... connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of… more
- Humana (Fairfax, VA)
- …Healthy Horizons in Virginia Medicaid network. This role supports provider onboarding, training, education, and inquiry/issue support resolution. This role ... with onboarding, including hosting orientation session(s) + Respond to assigned provider inquiries and support prompt issue resolution, including, where… more
- Humana (Washington, DC)
- …Professional who initiates, negotiates, and executes physician, hospital, and other provider contracts and agreements related to Medicaid health plans. ... and independent determination of the appropriate courses of action. The Provider Contracting Professional responsibilities include (but not limited to): + Analyzes… more
- Elevance Health (Ashburn, VA)
- …reimbursement and provider utilization patterns. + Conducts proactive outreach to support the understanding of managed care policies and procedures, as well as ... metrics, provider assignments and oversight of daily activities and provide feedback to manager on performance management, day-to-day training, guidance, and… more
- Elevance Health (Ashburn, VA)
- …strongly preferred. + Provider Credentialing Process experience preferred. + Provider set-up and configuration experience. + Medicaid , Medicare, and ... ** Provider Network Manager Senior** Carelon Behavioral Health _Location:...week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured… more
- Humana (Washington, DC)
- …to the National Contracting, Ancillary Contracting, Behavioral Health Contracting and Provider Analytics teams in support of Humana's Insurance Business. ... services for Humana to meet both regulatory and sales support need. + Align strategy and priority between different...and personal attributes are sought: + Experience analyzing the financial viability of complex provider contracts to… more
- AmeriHealth Caritas (Washington, DC)
- …organization project or program.; + ;Will develop/implement/manage programs and projects that support /impact high dollar and member; provider groups.; + ;The AE ... provider -targeted) and is assigned to train, mentor, and support new AEs. The AE II will;assist;AE I's in...with high impact, high dollar, extremely visible, and critical provider groups.; + ; Medicaid experience;is required.; +… more
- Humana (Washington, DC)
- …and drive data-informed decisions. + Design and optimize Power BI dashboards that provide real-time insights and key financial metrics to senior leadership. + ... us put health first** CenterWell's Home Solutions Organization is a leading provider of home-based care and post-acute value-based services. The Home Health Business… more
- Humana (Washington, DC)
- …part of our caring community and help us put health first** The Senior Financial Analytics Professional manages data to support and influence decisions on ... strategic planning, and specific business performance issues. The Senior Financial Analytics Professional work assignments involve moderately complex to complex… more
- Humana (Washington, DC)
- …opportunity exists to join Humana's Group Medicare Underwriter team as a Financial Underwriter. This position underwrites for medical and pharmacy and will compute ... rates for both renewing and prospective group accounts. The Financial Underwriter will perform a variety of research and analytical work assignments which are often… more
- Prime Therapeutics (Washington, DC)
- …lines of business (commercial, Medicare and Medicaid ). **Responsibilities** + Build, support , and maintain financial and actuarial models + Perform and ... or PBM + Previous experience pricing Commercial, Medicare or Medicaid lines of businesses + 1 year of experience...achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to… more
- CenterWell (Washington, DC)
- …for reporting, implementation, and maintenance of Humana's Healthy Horizon Medicaid business. The Senior Pharmacy Contracting Professional work assignments involve ... regarding pharmacy claims and network composition to identify contracting needs to provide adequate coverage for Humana Health Horizons membership. The individual in… more
- Somatus (Mclean, VA)
- …opportunities + And more! The Senior Vice President of Finance will lead financial activities that support critical operational stakeholders. The key areas of ... for solution architecture and project management of new implementations + Develop provider quality and financial incentives and contractual relationships with… more
- Public Consulting Group (Washington, DC)
- …of financial , residential, and asset verification. + Financial software to support the reporting of public provider costs to determine Medicaid ... PCG Health team helps our clients meet the complex financial , regulatory, and operational challenges of today's changing health...of today's changing health care landscape, so they can provide the best care, most effectively, to those they… more
- Amazon (Arlington, VA)
- …providers, and technology companies (including with respect to Commercial, Medicare and Medicaid programs) - Provide strategic counsel on healthcare regulatory ... matters - Support business development initiatives in the payer and provider space - Collaborate with the privacy, information security and compliance teams on… more
- Somatus (Falls Church, VA)
- …with patients on care planning that addresses everything from work, travel and financial concerns to emotional support . Provide individuals, families, and ... a village of passionate and tenacious innovators to revolutionize an industry and support individuals living with a chronic disease to fulfill our purpose of… more
- Humana (Washington, DC)
- …approaches to assignments. This role will be part of the new Product Support Team for Clinical Medicaid Operations. **Core Responsibilities:** + Troubleshoot and ... Solutions Professional drives technical solutions and collaborates with various support teams to remediate application/service disruptions and performance issues.… more