- Evolent (Trenton, NJ)
- …is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified ... and management staff, other CR's (Clinical Reviewers), providers, office staff and Field Medical Directors. **What You Will Be Doing:** + Functions in a clinical… more
- Highmark Health (Trenton, NJ)
- …related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, ... with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts… more
- CenterWell (Trenton, NJ)
- …delivery of associate-facing contact center technologies that support Pharmacy and Medicare Part D operations. This enterprise-wide platform empowers associates to ... a related field. **Preferred Qualifications:** + Understanding of pharmacy operations and Medicare Part D. + Experience with contact center platforms and CRM… more
- Atlantic Health System (Morristown, NJ)
- …+ Serves as an advocate for patients. + Responsible for ensuring study is compliance with local and federal laws and regulations + Study Implementation. Ensures ... and SOPs. + Recruitment and Enrollment + Quality and Compliance : Performs and oversees data collection and documentation in...Our facilities and sites of care include: + Morristown Medical Center, Morristown, NJ + Overlook Medical … more
- Humana (Trenton, NJ)
- …and demographic diversity. **Preferred Qualifications** + Special Needs Plan (SNP) in Medicare and/or Medicaid + Medical Social Work experience + Experience ... working with members with medical and behavioral health co-morbidities. + Experience advocating for...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Humana (Trenton, NJ)
- …key part in driving Humana's long-term vision to achieve leading growth in Medicare and individual products. The MarketPoint strategy team was created to help ... to take the Interagency Language Rating (ILR) test as provided by the Federal Government. Travel: While this is a remote position, occasional travel to Humana's… more
- Atlantic Health System (Newton, NJ)
- …quality improvement, outcomes measurement, and statistical analysis to increase compliance rates as measured by nationally standardized benchmarks and definitions ... management, training, data management, and activities to support regulatory compliance . Principal Accountabilities: 1. Project Management: Facilitates/assists with quality… more
- Teva Pharmaceuticals (Parsippany, NJ)
- …and Drafting: + Author and manage the lifecycle of National pharmacy and medical benefit payer contracts, including Commercial, Medicare and Managed Medicaid + ... position ensures contract strategy aligns with organizational goals and compliance standards, facilitating appropriate patient access to therapies through… more
- Humana (Trenton, NJ)
- …skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management ... a related field + Health Plan experience + Previous Medicare /Medicaid Experience a plus + Call center or triage...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- CenterWell (Trenton, NJ)
- …quality and cost improvement for high-risk senior populations in full risk Medicare arrangements. This individual will help assess the value of each opportunity ... the Advisor will collaborate across functions (particularly Data, Technology, Analytics, Medical Economics, and Finance) to optimize strategies that address current… more