- Highmark Health (Trenton, NJ)
- …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 (Trenton, NJ)
- …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 (Trenton, NJ)
- …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
- Terumo Medical Corporation (Somerset, NJ)
- Sr. Compliance Manager - Monitoring & Transparency Date: Jun 6, 2025 Req ID: 4392 Location: Somerset, NJ, US, 08873 Company: Terumo Americas Holding, Inc. ... we go next!** **_Advancing healthcare with heart_** **Job Summary** The Senior Compliance Manager -Monitoring & Transparency, will support the Director -… more
- Prime Therapeutics (Trenton, NJ)
- … 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 (Trenton, NJ)
- …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
- Prime Therapeutics (Trenton, NJ)
- …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 (Trenton, NJ)
- …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
- Gentiva (Trenton, NJ)
- …lasting difference in people's lives every day. **Overview** We're looking for a **Patient Care Manager ** to join our team. **RN Clinical Manager - Hospice - FT ... not remote.** **- 2 years of Hospice RN Case Manager exp required** **- 1 year of Management/Supervisory exp...and ensuring adherence to company policies and procedures and compliance with local, state, and federal regulations and regulatory… more
- Humana (Trenton, NJ)
- …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 (Trenton, NJ)
- …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
- Datavant (Trenton, NJ)
- …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
- Centene Corporation (Trenton, NJ)
- …value, and assure integrity of records, information and systems in compliance with Company policies/standards and government regulations. + Prepare provider ... company IS system. + Monitor and oversee provider contract compliance and issue corrective action letters for non -...Experience in a healthcare or insurance environment, preferably in Medicaid . Previous experience as a lead in a functional… more
- Hunterdon Health Care System (Flemington, NJ)
- …experience + Chargemaster experience required + Experience working with Medicare, Medicaid , and private insurance contracts - understanding and interpreting for ... License, Registry or Certification: + Required: + None + Preferred: + Billing Compliance , CRCR + Knowledge, Skills and/or Abilities: + Required: + + Demonstrates… more
- Penn Medicine (Plainsboro, NJ)
- …**Summary** : + Under the direction of and in collaboration with the Manager of Patient Access Services (PAS) Emergency Department (ED) and Inpatient Admissions ... patients throughout the registration process + Provides assistance to staff to ensure compliance with hospital and departmental policy and procedure Assist ED and IP… more
- Humana (Trenton, NJ)
- …plans. Key Accountabilities We are seeking a highly skilled Lead Digital Program Manager to oversee the development and execution of a new eCommerce business. This ... independently, ensuring alignment with strategic objectives. The Lead Digital Program Manager will play a key role in establishing the structure, frameworks,… more
- Daiichi Sankyo Inc. (Basking Ridge, NJ)
- …disorders. **Summary:** The Associate Director, Oncology Value & Market Dynamics Training Manager is responsible for developing & deploying a strategic training plan ... individual will be required to have in-depth knowledge of payer policy, Medicare, Medicaid and the Oncology Care Model. This individual is ad subject knowledge… more
- Hackensack Meridian Health (Edison, NJ)
- …arrangements. The person in this role will work closely with the 340B Program Manager and other Pharmacy staff to ensure compliance and identify opportunities ... The **Pharmacy Analyst, 340B** will be responsible for ensuring 340B program compliance in HMH's 340B Discount Drug Program. This involves conducting daily and… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …Meridian Health (HMH). Conducts quality interviews with every patient to ensure compliance with patient safety rules and state and federal regulations. Gathers ... to validate patient identity. Conducts intensive screening of all Medicare, Medicaid and managed care patients to identify network status and coordination… more
- Allaire Rehab & Nursing (Edison, NJ)
- …manner after a referral is given by a hospital discharge planner, case manager , social worker, physician, or family member. Note: Timely refers to assessments ... to staff, to facilitate a smooth transition. + Maintain a waiting list in compliance with state and federal guidelines. + Maintain a working knowledge of Federal and… more