- CareStar, Inc. (Columbus, OH)
- Case Manager - Franklin & Surrounding Counties Company: CareStar, Inc. Location: Franklin County, OH (and surrounding areas) Job Type: Full-Time | Remote with Field ... about helping others live healthier, more independent lives. As a Case Manager , you'll work directly with individuals to assess their needs, develop personalized… more
- The Ohio State University (Dublin, OH)
- …third-party reimbursement activities. This includes the annual filing of Medicare and Medicaid cost reports for a large academic medical center with over 600 ... senior leadership. Supervisory Responsibility: This position directly supervises two manager -level employees, both of whom are responsible for Finance Reimbursement.… more
- Sumitomo Pharma (Columbus, OH)
- …dynamic, highly motivated, and experienced individual for the position of Sr. Manager , Medicaid Contract Administration. This position is responsible for ... managing the Medicaid rebate team in receiving, processing, validating, trouble-shooting ...with internal departments (Internal Audit, Commercial Insights, Contracting, SOX Compliance , and Legal) to clarify policy compliance … more
- Humana (Columbus, OH)
- …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
- OhioHealth (Columbus, OH)
- …Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position will be ... responsible for ensuring the appropriate governmental (Medicare and Medicaid ) reimbursement is received for OhioHealth. * This position is primarily responsible for… more
- Molina Healthcare (Columbus, OH)
- …for operational and strategic analysis. Maintains existing portfolio of compliance and operational reports. KNOWLEDGE/SKILLS/ABILITIES + Collaborates with customers ... and plans for closing gaps.Performs other duties as assigned by the Analytics Manager . + Completes training courses set forth by Analytics team manager .… more
- Molina Healthcare (Columbus, OH)
- …integration, and a strong understanding of data governance and compliance in healthcare environments. **Knowledge/Skills/Abilities:** * Architect and implement ... Deploy, monitor, and troubleshoot Hadoop-based infrastructure using tools such as Cloudera Manager , Ambari, and Zookeeper. * Enforce data quality, security, and … more
- Prime Therapeutics (Columbus, OH)
- … 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
- Molina Healthcare (Columbus, OH)
- **Job Summary:** The Subrogation Manager is responsible for overseeing all aspects of healthcare subrogation operations across Medicaid , Medicare, and ... protocols to support efficient and compliant subrogation operations across Medicaid , Medicare, and Marketplace populations. + Collaborate with legal, claims,… more
- Molina Healthcare (Columbus, OH)
- **Job Description** **Job Summary** The Payment Integrity Program Manager - Health Plan is a subject matter expert, individual contributor role designed for a highly ... complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination,… more
- Help at Home (Delaware, OH)
- …with Prime Home Care, a Help at Home company.** Now hiring ** ** a ** Clinical Manager ** in your community - make a lasting impact for someone in need! **What We ... in the preparation and implementation of policies and procedures which meet Medicare, Medicaid , accrediting bodies, state, and local laws. + Assists the HR Team in… more
- Humana (Columbus, OH)
- …put health first** Humana Healthy Horizons in Ohio is seeking a Field Care Manager to assess and evaluate member's needs and requirements to achieve and/or maintain ... future with a Fortune 500 Company! The Field Care Manager Nurse 2 (Care Manager Plus, Physical...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Gentiva (Columbus, OH)
- **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 (Columbus, OH)
- …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
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Manager , Technology Solutions devises an effective strategy for executing and delivering on IT ... business initiatives. The Manager , We are seeking a highly skilled and motivated...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Molina Healthcare (Columbus, OH)
- …Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Negotiates agreements ... Tighter knit proximity ongoing after contract. * In conjunction with Director/ Manager , Provider Contracts, negotiates Complex Provider contracts including but not… more
- Humana (Columbus, OH)
- …us put health first** We're seeking a strategic, results-driven Lead Product Manager to design and deliver innovative clinical solutions that improve health outcomes ... a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Molina Healthcare (Columbus, OH)
- …needs, support to other business units + Strong business knowledge related to Medicaid and Medicare lines of business + Reviews enrollment issue trends and provides ... + Ensures compliant with regulatory and company guidelines, including HIPAA compliance + This position primarily focuses on project/program management related to… more
- Cardinal Health (Columbus, OH)
- …* Process all patient applications in accordance to set policy, procedures and PHI compliance * Speak with manufacturer field team members on case updates via phone ... benefits management experience preferred with specific knowledge of Medicare, Medicaid and commercially insured payer common practices and policies, preferred… more
- CVS Health (Columbus, OH)
- …and within budgeted costs. + Apply advanced knowledge of the Medicare and Medicaid regulatory landscape to ensure program compliance with federal and state ... Director, DSNP Program Management you will support the General Manager in all aspects of the management and financial...liaison between Aetna and state regulators to assure State Medicaid Agency Contract execution is completed annually as required… more
