• Senior Enterprise Business Analyst, PPD

    Brighton Health Plan Solutions, LLC (New York, NY)
    …cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider ... top payers across one or more domains (Enrollment & Benefit Administration, Claims processing & Reimbursements, Member & Provider...Certifications and or PMP a plus. About At Brighton Health Plan Solutions, LLC, our people are… more
    Brighton Health Plan Solutions, LLC (04/09/25)
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  • Pharmacy Benefits Program Director; HSO…

    Mount Sinai Health System (New York, NY)
    …6 years experience in the healthcare industry, with focus on Pharmacy Health Plan or Pharmacy Benefit Management . + Proven capabilities in strategic ... Therapeutics Committee. + Ensures the clinical integrity of the Health Plan pharmacy offering. + Partners with...growth. + Participate in meetings and presentations to review benefits management performance. + Act as pharmacy… more
    Mount Sinai Health System (04/28/25)
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  • Behavioral Health UR Clinician - LMSW/RN

    Independent Health (Buffalo, NY)
    Health Utilization Review Clinician will primarily be responsible for managing behavioral health benefits through utilization management functions as well ... clinical, managed care, and/or care coordination setting required. + Experience in a health plan /managed care setting, utilization management , case … more
    Independent Health (05/15/25)
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  • Medical Director, Clinical Review and Care…

    MVP Health Care (Rochester, NY)
    …+ Minimum of 5 years of clinical practice experience + Managed care, utilization management , or health plan operations experience preferred. + Experience ... environment + Previous medical director or clinical leadership experience within a health plan preferred + Strong organizational, communication, and writing… more
    MVP Health Care (06/04/25)
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  • Care Manager II - Health Home

    Monroe Plan for Medical Care (Mayville, NY)
    …and families who are recipients of government sponsored health insurance. Monroe Plan is the largest Care Management Agencies serving 28 counties and over ... healthcare for underserved populations. For over 50 years, Monroe Plan for Medical Care, a not-for-profit health ...$46,948 - $57,380. In addition to your salary, Monroe Plan offers a comprehensive benefits package (all… more
    Monroe Plan for Medical Care (05/21/25)
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  • Associate Plan Builder (Meritain…

    CVS Health (Amherst, NY)
    …+ Facilitating client facing review of plan setup walking through all benefits to assure alignment of benefit interpretation. + Consult and advise internal ... heart, each and every day. **Position Summary** The Associate Plan Builders will provide plan benefit...must possess an analytical system coding ability to translate plan benefits into system data coding. The… more
    CVS Health (06/04/25)
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  • Benefit Administration Pharmacist

    Independent Health (Buffalo, NY)
    …Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in ... organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration. **Overview**… more
    Independent Health (06/03/25)
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  • VP, Clinical System Implementation & Improvement

    Molina Healthcare (NY)
    …Conducts or coordinates post-implementation initiative review to measure results and report to health plan partners, senior management & stakeholders * ... management level experience or understanding of all areas of health plan operations: claims processing, customer service/call center, provider contracting,… more
    Molina Healthcare (06/07/25)
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  • Senior Claim Benefit Specialist - Remote

    CVS Health (Albany, NY)
    …be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan ** ... At CVS Health , we're building a world of health...management programs, confidential counseling and financial coaching. + ** Benefit solutions that address the different needs and preferences… more
    CVS Health (06/08/25)
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  • Senior Claim Benefit Specialist - Stop Loss…

    CVS Health (Amherst, NY)
    …be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan ** ... At CVS Health , we're building a world of health...management programs, confidential counseling and financial coaching. + ** Benefit solutions that address the different needs and preferences… more
    CVS Health (04/30/25)
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