- Molina Healthcare (Albany, NY)
- **Job Description** **Job Summary** The Health Plan Operations , Payment Integrity Program Manager is an individual contributor role designed for a highly ... capable individual who serves as a key strategic partner in driving health plan financial performance. This role focuses on identifying, leading, and executing… more
- Healthfirst (NY)
- …+ Bachelors degree from an accredited institution + Experience in Healthcare/ Health Plan customer service, operations , vendor management, ... on trending audit finding results and summarizing details to Operations leadership to address identified areas for improvement. +...lines of business such as Medicare NY/NJ, Medicaid, Family Health Plus, Child Health Plus, NH Family… more
- Highmark Health (Albany, NY)
- …and Provider support teams, Actuary, Finance, Highmark Health Solutions, Health Plan Operations . **ESSENTIAL RESPONSIBILITIES** + Perform management ... business. This will require aligning new models to the health plan 's strategic objectives based on a...Plan , organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- Job Description: Summary: The Actuarial Analyst performs actuarial services in support of Health Plan operations and monitors and maintains financial ... Population Health Engagement, Marketing & Sales, etc., and how they impact Health Plan operations and financials. Level III (in addition to Level II… more
- Humana (Albany, NY)
- … health condition management, health outcomes, patient experience, and plan operations . **Location:** remote of hybrid if close to Louisville Reporting ... part of our caring community and help us put health first** Health Quality and Stars (HQS)...committed to caring for our customers and delivering high plan quality as rated by the Centers for Medicare… more
- Molina Healthcare (Buffalo, NY)
- …point of contact for the internal partners, ie Medicare Administration, Compliance and Health Plan Operations . Coordinates and facilitates meetings providing ... processing and maintenance of new members and re-enrollment. Processes and maintains health plan 's member and enrollment records, employer's monthly reports,… more
- Evolent (Albany, NY)
- …transformative growth opportunities at customer accounts + Strong knowledge of health plan operations , care/utilization management, claims processing, ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health … more
- Molina Healthcare (Yonkers, NY)
- …10 years' experience in Managed Care, specifically government programs and/or Medicare/Duals Health Plan Operations or equivalent combination of education ... program. Supports integrated duals product development in collaboration with enterprise and health plan teams. Supports integrated teams in continual process… more
- Healthfirst (NY)
- …using Agile methodologies. Exposure to Scaled Agile (SAFe) preferred. + Experience working with health plan operations and IT + Experience working as a ... by collaborating closely with peers, leaders, and staff throughout Operations to ensure the appropriate parties are contributing. +...+ Experience leading large scale change initiative in a health plan setting + Demonstrated understanding and… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Process Improvement Manager I- Health System Operations -Corporate-Full-Time Days-Hybrid** The Health Systems and Process Improvement ... (HSPI) Manager II leads improvement initiatives coordinated by Health System Operations , utilizing a wide range...and changes in project scope + Develops scope and plan for improvement initiatives, acquiring stakeholder buy-in and leadership… more
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