- COOLSOFT (Raleigh, NC)
- …Services Business Unit in the development and implementation of the Medicaid Enterprise Modular Pharmacy Business Management (PBM) Solution. The PBM Business ... the new PBM, in collaboration with the existing pharmacy team. Knowledge of Medicaid Pharmacy Benefits Management processes, intended outcomes, and pain points… more
- Commonwealth Care Alliance (Boston, MA)
- …evaluation and improvement efforts. Through reporting, data analysis, and partnership management , the LTSS Program Manager ensures that providers meet contractual, ... partners. The ideal candidate demonstrates strong organizational, analytical, and relationship- management skills, with the ability to engage diverse stakeholders to… more
- COOLSOFT (Harrisburg, PA)
- …Scale Project Management Open Date 19-Nov-2025 Close Date Job type Contract Duration 7 Months Compensation DOE Status requirement Job interview type Email ... ECM Large Scale Project Management Manager (Jobs in Harrisburg, PA) Requirement id...HHS DC worked with the Centers for Medicare & Medicaid Services (CMS), and other federal partners responsible for… more
- Commonwealth Care Alliance (Boston, MA)
- …Mgmt - Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term services and ... of UM processes and functions. - Ensures compliance with all contract requirements, state and federal regulatory requirements and all applicable accreditation… more
- COOLSOFT (Columbia, SC)
- …Health Information Technology NIST Open Date 18-Nov-2025 Close Date Job type Contract Duration 12 Months Compensation DOE Status requirement Job interview type Email ... Info : SCDHHS Note: * Interview Process: 1 round, Virtual/Online * Duration of the Contract : 12 months * Possibility for Extension: Yes * Work Location: Onsite - 5… more
- Commonwealth Care Alliance (Boston, MA)
- … contract performance metrics + Experience with Medicare Advantage, Medicaid ; and dually eligible populations **Desired Experience** + Experience managing or ... on CCA's Population Health goals; including Medicare Star measures, Medicaid -Medicare Plan withhold measures, quality performance metrics incorporated into other… more
- Sun Pharmaceuticals, Inc (Princeton, NJ)
- …policies, procedures, and the sales cycle. Prior role as a Business User in the implementation of a Contract Management System is a plus. Proactive with ... contracts. Prior Pharmaceutical Experience is required. Intermediate to advanced knowledge of Contract Management Systems, such as Vistex (or other comparable… more
- Tidelands Health (Myrtle Beach, SC)
- …processes and systems required to accomplish timely, accurate, and compliant record management and coding. + Supervise and coordinate all activities of the medical ... coders to include effective management of staffing schedule to achieve timely coding, provider...timely coding, provider and coder audits, identification of and implementation of proactive denial mitigants, and staff engagement. +… more
- Elevance Health (Indianapolis, IN)
- ** Medicaid Contract Implementation Management Director** **Location** : Indianapolis, IN **Hybrid 2:** This role requires associates to be in-office 3 ... employment, unless an accommodation is granted as required by law._ The ** Medicaid Contract Implementation Management Director** is responsible for… more
- Elevance Health (Indianapolis, IN)
- ** Medicaid Contract Implementation Management Manager** **Location** : Indianapolis, Indiana **Hybrid 1:** This role requires associates to be in-office ... employment, unless an accommodation is granted as required by law._ The ** Medicaid Contract Implementation Management Manager** is responsible for… more
- CareFirst (Baltimore, MD)
- …for directing all aspects related to the monitoring of performance under the Medicaid contract and regulatory requirements and the overall state of compliance ... compliance. Directs the activities related to the design, development, implementation and maintenance of compliance programs across all major...of at least 5 years Medicare Part C and/or Medicaid compliance experience. + 3 years Management … more
- Humana (Louisville, KY)
- …provides support to assigned health plan and/or specialty companies relative to Medicaid product implementation , operations, contract compliance, and federal ... Qualifications** + Bachelor's degree + 3 + years' experience with Medicaid /Medicare/Employer Group operations/Category Management /Supplier Management + 3… more
- NTT DATA North America (Albany, NY)
- …and artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure and connectivity. We ... adaptable, and forward-thinking organization, apply now. We are currently seeking a Senior Medicaid Solution Architect to join our team in Albany, New York (US-NY),… more
- Highmark Health (Pittsburgh, PA)
- …The incumbent develops the strategic direction and insurers it's execution for revenue management , federal and state regulatory and contract compliance, care ... the health plan. Collaborate on the development and oversee implementation and reporting of the annual short- and long-term...Degree in Government **EXPERIENCE** **Required** + 10 years of Medicaid Experience + 10 years in Management … more
- CVS Health (Chicago, IL)
- … Managed Care business segment environment with exposure to benefits and/or contract interpretation * Medicaid Regulatory Standards for Network Access, ... operational efficiency, and overall enhancing the provider experience. Drives the implementation of internal and external solutions to achieve provider satisfaction,… more
- Ascendis Pharma (Princeton, NJ)
- …wholesalers, and pharmacy benefit managers (PBMs). This role requires expertise in contract management and reimbursement dynamics, coupled with strong leadership ... provide input to department's overall yearly budget. Requirements Key Responsibilities: Contract Management : Develop, implement, and maintain robust processes… more
- AdventHealth (Maitland, FL)
- …well as, the building and maintenance of rates and terms into designated contract management systems for AdventHealth Florida Division and Ancillaries. Precision ... Demonstrates ability to build, maintain and test in complex contract management systems with a high degree...and coordinates with Payer to ensure timely execution of contract rate implementation . * Ensures hospital staff,… more
- Mount Sinai Health System (New York, NY)
- …are a plus. **Experience Requirements** + Minimum 3-5 years of experience in contract management , coding, and analysis in a healthcare setting. + Experience ... interpret complex contract terms and financial data. + Proficient in contract management systems, modeling software, and financial reporting tools. +… more
- UTMB Health (Galveston, TX)
- … contract outcomes and drive data[1]informed decisions. * Lead contract implementation efforts, including communication, education, and ongoing oversight. ... influence cross-functional teams. * Familiarity with tools such as Microsoft Excel, contract management software, and healthcare data systems (eg, Epic, etc.).… more
- State of Indiana (Indianapolis, IN)
- …through contract oversight, strong attention to detail, effective time management , and critical thinking skills. Salary Statement: The salary for this position ... Senior Contract Compliance Officer Date Posted: Nov 13, 2025...the Family & Social Services Administration: The Office of Medicaid Policy and Planning (OMPP) is a division within… more
