- Elevance Health (Grand Prairie, TX)
- ** Medicaid Formulary Pharmacist Clinical - CarelonRx** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and ... and formulary management. **How you will make an impact:** + Leads Medicaid formulary management processes. + Responsible for all member, stakeholder, and provider… more
- Elevance Health (Grand Prairie, TX)
- **Director Pharmacy Account - Medicaid ** **Location:** This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while ... a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care CarelonRx's Medicaid Sales and Account Management organization is looking to hire a… more
- Humana (Austin, TX)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
- Cognizant (Austin, TX)
- **About the role** **Schedule:** M-F **Traveling Required:** 40% As a Medicaid Eligibility Delivery Director, you will make an impact by overseeing access, ... experience. + Minimum of ten (10) years of experience in state Medicaid and Medicare eligibility, enrollment operations, health plan administration, or regulatory… more
- Humana (Austin, TX)
- …caring community and help us put health first** Own and manage Medicaid claims analytics dataset using Databricks. Ensure data accuracy, completeness, and readiness ... in identification of cost drivers, utilization patterns, and anomalies in Medicaid medical claims data. The Actuary, Analytics/Forecasting ensures data integrity by… more
- Prime Therapeutics (Austin, TX)
- …passion and drives every decision we make. **Job Posting Title** North Carolina Medicaid Account Manager - Remote Raleigh, NC **Job Description** The Senior Account ... responsible for providing complex level support for the North Carolina Medicaid business by driving communications, client-facing initiatives, and product and… more
- Health Care Service Corporation (Richardson, TX)
- …for planning, managing and controlling the activities of a team of Medicaid analysts that provides business intelligence support for business segments; leading ... as Managed Healthcare Professional (MHP) or Certified Employee Benefit Specialist (CEBS) * Medicaid experience **This is a Flex (Hybrid) role: 3 days in office; 2… more
- Molina Healthcare (TX)
- …and clinical performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **JOB QUALIFICATIONS** ... + 3 - 5 years supervisory experience + Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans + Experience with Databricks… more
- Molina Healthcare (Fort Worth, TX)
- …**Job Summary** Responsible for being the SME (Subject Matter Expert) for Medicaid risk adjustment programs in multiple states. Maintain risk adjustment model, ... available to lead national risk adjustment studies. Prior experience in Medicaid risk adjustment is not required. **KNOWLEDGE/SKILLS/ABILITIES** + Analyze risk score… more
- Guidehouse (Lewisville, TX)
- …from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare/ Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 & CMS ... 1500 + Complete all business-related requests and correspondence from patients and insurance companies. + Responsible for working on 40-70 Accounts Per Day + Complete all assigned projects in a timely manner. + Assist client and patients in all requested… more