- CVS Health (Trenton, NJ)
- …we do it all with heart, each and every day. **Position Summary** The Medicare Performance Management Lead Business Consultant will facilitate and support ... drive the markets bid strategy. + An analyst of Medicare business performance, meaning that the role...liaison between senior management and local market leaders. + Lead process Improvement opportunities relating to Medicare … more
- Humana (Trenton, NJ)
- …**Additional Information** Typically reports to a Regional Vice President of Health Services, Lead , or Corporate Medical Director , depending on size of region or ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will...line of business . The Medical Director conducts Utilization Management… more
- CVS Health (Trenton, NJ)
- …We are looking for a Principal Data Scientist to join our Aetna Medicare (STARS Portfolio) team at CVS Health. This high-level individual contributor will partner ... closely with the Executive Director of Aetna STARS Analytics to drive hands on...excellence across the most complex projects in the portfolio, lead a culture of technical rigor and excellence, and… more
- Humana (Trenton, NJ)
- …a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing ... courage to innovate **Additional Information** Typically reports to a Lead Medical Director , depending on size of..., depending on size of team or line of business . The Medical Director conducts Utilization Management… more
- Humana (Trenton, NJ)
- …**Additional Information** Typically reports to a Regional Vice President of Health Services, Lead , or Corporate Medical Director , depending on size of region or ... conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will...line of business . The Medical Director conducts Utilization Management… more
- Humana (Trenton, NJ)
- …and collaborates with other team members, other departments, Humana colleagues and the lead medical director . After completion of mentored training, daily work ... adapt and the courage to innovate **Additional Information** Typically reports to a Lead Medical Director . The Medical Director conducts post-service,… more
- Prime Therapeutics (Trenton, NJ)
- …to influence in a way that challenges process, improves results, and drives business outcomes. **Responsibilities** + Lead the development and execution of ... It fuels our passion and drives every decision we make. **Job Posting Title** Director of Service Delivery **Job Description** The Director Service Delivery is… more
- CenterWell (Trenton, NJ)
- …the medical coder experience. + Oversees coding operations by identifying business partner needs and develops solutions. + Responsible for overall performance ... across multiple sites and geographies, with concrete impact on business outcomes + Ability to travel up to 20%...up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track record… more
- Humana (Trenton, NJ)
- …and data literacy by delivering robust cyber and data governance training + Lead the development and execution of cyber training and awareness activities to reduce ... encourage speaking up, cultivate development, and align to Humana's Values and EIP's business strategy + Build, develop, and execute against an EIP culture roadmap… more
- The Cigna Group (Philadelphia, PA)
- …to protect formulary and trend solutions from unintended conflicts across commercial, Medicare , and product offerings that depend on those contracts. + Support of ... the PBM's ability to serve clients and patients + Lead a team of multiple direct reports and their...in an applicable area of study, which could include business /product strategy, business development, pharmacy, or healthcare… more
- Humana (Trenton, NJ)
- …a Lead , you will be responsible for deconstructing complex business challenges, conducting targeted research and analysis, and developing sound, data-driven ... identifying key go-to-market priorities, assessing the performance of strategic initiatives and business areas, evolving key facets of the Medicare Advantage… more
- CenterWell (Trenton, NJ)
- …reports. Write basic SQL queries to pull data and build reports. Coordinate with Business Intelligence Lead and support ad hoc reporting. * Develop basic ... will be responsible for supporting the CenterWell ACO and Medicare payment model programs via the Center for ...with Finance and Data teams * Coordinate with ACO Lead overseeing the IPA / Affiliate business … more
- Virtua Health (Moorestown, NJ)
- …all external parties to ensure an outstanding customer experience. * Consults with Lead Physicians, Director of Practice Management, Medical Directors and staff ... Locations: Job Information: Summary: In collaboration with assigned practice(s) Lead Physicians, directs and coordinates administrative and clinical services for… more
- Virtua Health (Pennsauken, NJ)
- …all external parties to ensure an outstanding customer experience. Consults with Lead Physicians, Director of Practice Management, Medical Directors and staff ... Locations: Job Information: Job Summary: In collaboration with assigned practice(s) Lead Physicians, directs and coordinates administrative and clinical services for… more
- Datavant (Trenton, NJ)
- …incoming Risk Adjustment Analytics Manager will be stepping into a role on the Business Analytics team and overseeing a core group of its analysts. We are looking ... manager will collaborate with other managers and the department director to set strategy and mobilize the team to...operating proactively vs reactively. The primary functions of the Business Analytics team are to create analytic solutions that… more
- Fresenius Medical Center (Cherry Hill, NJ)
- …the leadership of the clinical facility ensuring all clinical, operational, and business objectives are met. The Facility Administrator is authorized to make daily ... + Provide support to the Medical Executive Committee as requested by the Medical Director and in accordance with the Medical Staff Bylaws. + Maintain compliance with… more
- Prime Therapeutics (Trenton, NJ)
- …the organization to validate regulatory reporting requirements are met and that business operations are aligned with expectations of applicable regulatory guidance + ... Lead project management efforts for highly sensitive Compliance initiatives...Benefit Management (PBM), Third Party Administrator, Utilization Review Organization, Business , State registrations, etc); compile required internal reports, perform… more
- Prime Therapeutics (Trenton, NJ)
- …of innovative actuarial modeling concepts, and provide pricing support for all lines of business . This position will also lead complex projects that are highly ... analyses, and the Request For Proposal (RFP) process + Lead , manage, and review data analyses, reporting, and projections...healthcare organization or PBM + Previous experience pricing Commercial, Medicare or Medicaid lines of businesses + 5 years… more