- Highmark Health (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 (Raleigh, NC)
- … 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
- Chiesi (Cary, NC)
- …to shape a future ready the Government pricing organization. The Government Pricing Manager will report to the Lead, Government Pricing. The individual in this role ... timelines. + Responsibly for timely and accurate process of Medicaid rebates + Manage Medicaid bidding and...with health care regulations. + High accuracy rate and compliance with applicable legal requirements and policy and procedures… more
- Humana (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 (Raleigh, NC)
- …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
- COOLSOFT (Raleigh, NC)
- …: The Certification Data Analyst role reports to the Certification and Compliance Manager and participates in project team activities. The Certification ... leads the development of outcome statements and operational reporting for Medicaid Enterprise System (MES) projects. This role collaborates with Business Leads,… more
- Humana (Raleigh, NC)
- …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
- Fresenius Medical Center (Raleigh, NC)
- …nurse in accordance with organization policies, procedures, and training and in compliance with regulations set forth by the corporation, state, and federal ... ongoing performance of other PCT's. + Collaborates with the Clinical Manager and Education Coordinator in driving organization quality standards through education… more
- Elevance Health (Durham, NC)
- …+ Processes prior authorization requests from physicians' offices and ensures compliance with Medicare and Medicaid requirements; inform relevant parties ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- PruittHealth (Durham, NC)
- …staff. 9. Ensure compliance with all State, Federal, and Medicare and Medicaid regulations for the successful operation of a nursing home Beauty Shop. 10. Orders ... accurate inventory records. 11. Records and submits daily sales records to Director/ Manager . 12. Provides billing data to the Resident Finance Department on a… more
- CenterWell (Durham, NC)
- …primary care "on-call" program of CenterWell as needed. + Assures personal compliance with licensing, certification, and accrediting bodies. + Spend 100% of your ... and unrestricted DEA license + Medicare Provider Number + Medicaid Provider Number + Minimum of two to five...of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing… more