- Humana (Lansing, MI)
- …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
- CVS Health (Lansing, MI)
- …Member Services teams, as well as management of tools, etc. Ensure compliance with state mandated processes and procedures by maintaining contractual oversight of ... projects based on resource requirements. **Required Qualifications** Strong knowledge of Medicaid to include experience with the Member Call Centers Experience with… more
- CenterWell (Lansing, MI)
- …a part of our caring community and help us put health first** The Medicaid Drug Strategy Pharmacist Lead requires a broad understanding of pharmacy, managed care, ... drug strategies to mitigate cost trend and improve health outcomes. The Medicaid Drug Strategy Pharmacist Lead work assignments involve moderately complex to complex… more
- Molina Healthcare (Sterling Heights, MI)
- …should be knowledgeable of and have experience with South Carolina Medicaid **Job Summary** Provides subject matter expertise and responsibility for oversight, ... goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits &… more
- CVS Health (Lansing, MI)
- …accreditation from the National Health Care Anti-Fraud Association (AHFI) + Experience In Medicaid Compliance , Medicaid Investigations, MCO Medicaid FWA ... Healthcare Program Integrity, Medicaid Special Investigation or Medicaid / Medicare / Commercial Compliance role...Investigation or Medicaid / Medicare / Commercial Compliance role + Strong verbal and written communication skills.… more
- Prime Therapeutics (Lansing, MI)
- … 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
- Molina Healthcare (Detroit, MI)
- …goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits & ... complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination,… more
- Molina Healthcare (Grand Rapids, MI)
- **Job Description** **Job Summary** The Health Plan Operations, Payment Integrity Program Manager is an individual contributor role designed for a highly capable ... complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination,… more
- Molina Healthcare (Grand Rapids, MI)
- **Job Summary:** The Subrogation Manager is responsible for overseeing all aspects of healthcare subrogation operations across Medicaid , Medicare, and ... protocols to support efficient and compliant subrogation operations across Medicaid , Medicare, and Marketplace populations. + Collaborate with legal, claims,… more
- Humana (Lansing, MI)
- …an assigned area in Wayne or Macomb county, to conduct in home visits with Medicare/ Medicaid members.** The Field Care Manager Nurse 2 employs a variety of ... and help us put health first** The Field Care Manager Nurse 2 assesses and evaluates member's needs and...with health promotion, coaching and wellness + Experience with Medicaid Long Term Care + Previous managed care experience… more