- Highmark Health (Hartford, CT)
- …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
- Sumitomo Pharma (Hartford, CT)
- …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 (Hartford, CT)
- …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 (Hartford, CT)
- … 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
- CVS Health (Hartford, CT)
- …day. **Job Summary** We are seeking a highly skilled and detail-oriented Senior Manager to join our Population Health Intelligence team. This role will support ... teams including Clinical Operations, Medical Economics, and Quality to support Medicaid analytics. + Translate business questions into data requirements and deliver… more
- Prime Therapeutics (Hartford, CT)
- …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 (Hartford, CT)
- …of our caring community and help us put health first** The Print Project Manager will be involved in the procurement and production of printed materials and ... in job focus. + Understanding of Centers for Medicare & Medicaid Services (CMS) guidelines **Additional Information** Location: Remote Nationwide **_Hirevue… more
- Molina Healthcare (Springfield, MA)
- …of illness and the site of service. **KNOWLEDGE/SKILLS/ABILITIES** The Manager , Healthcare Services provides operational management and oversight of integrated ... more direct report supervisors, facilitates integrated, proactive HCS management, ensuring compliance with state and federal regulatory and accrediting standards and… more
- Humana (Hartford, CT)
- …of our caring community and help us put health first** The Lead Product Manager Conceives of, develops, delivers, and manages products for customer use. The Lead ... Product Manager works on problems of diverse scope and complexity...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Humana (Hartford, CT)
- …of our caring community and help us put health first** The Lead Product Manager conceives of, develops, delivers, and manages products for customer use. The Lead ... Product Manager works on problems of diverse scope and complexity...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Datavant (Hartford, CT)
- …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 (Hartford, CT)
- …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 ... the future of care delivery at scale. **Location:** remote The Lead Product Manager partners across various multi-disciplinary teams at Humana to design, define and… more
- Humana (Hartford, CT)
- …and help us put health first** We are seeking a dynamic and results-driven Sales Manager to lead our Agnostic Call Center Sales Team within the IFG line of business. ... in a fast-paced, remote sales environment. The Agnostic Sales Manager leads and grows an internal sales team for...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Lundbeck (Springfield, MA)
- …anticipate and effectively address payer access issues (IDNs, Medicare, Medicaid , Commercial) using Lundbeck resources. **Pharmaceutical Environment/ Compliance ** ... Multi-Specialty Account Manager - Springfield, MA Requisition ID: 6437 Location:...the primary care and neurology settings. As an Account Manager , you lead the promotion of our psychiatry portfolio,… more
- Humana (Hartford, CT)
- …and help us put health first** We are seeking a customer-obsessed Lead Product Manager to own the strategy, development, and delivery of core features within our ... 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
- CVS Health (Hartford, CT)
- …Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. ... at interdisciplinary case conferences + Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational… more
- Otsuka America Pharmaceutical Inc. (Hartford, CT)
- …Drive post-prescribing performance through strategic planning and execution + Ensure compliance adherence through in-field visits, call and case monitoring, aligning ... performance analysis + Change management and program implementation + Regulatory compliance and risk management Preferred Skills + Comprehensive knowledge of… more
- CVS Health (Hartford, CT)
- …supporting multiple lines of Aetna business, including Commercial, Group Medicare, and Medicaid . Your success will hinge on your ability to collaborate and ... across the Aetna Marketing organization and the enterprise. + Ensure compliance with all branding, operational, legal, and regulatory mandates. **Required… more
- Fallon Health (Springfield, MA)
- …who have MassHealth Standard, and may have Medicare. It combines MassHealth ( Medicaid ) and Medicare benefits, including prescription drug coverage. At Fallon Health, ... be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE- in the region. **Brief summary of purpose:** This… more
- Hartford HealthCare (Farmington, CT)
- …HCPCS and ICD-10 coding conventions required. Experience with interpreting Medicare, Medicaid and third-party billing and compliance regulations necessary. ... adjustment program requirements and ICD 10 coding guidelines. Reporting to Manager of Audit and Education *_Position Responsibilities:_* *Key Areas of… more