- Care Plus NJ (Paramus, NJ)
- …you with more information as you continue with your interview process. Benefit eligibility is based on the specific requirements and criteria of each plan. Job ... patient accounts and reimbursement. The role requires strong knowledge of NJ Medicaid and Medicare billing, collaboration with clinical and executive teams, and… more
- Penn Medicine (Plainsboro, NJ)
- …signatures are obtained for the necessary regulatory forms and escalates to the management team when discrepancies are identified + Assists in tracking Notice of ... email request sent by the Care Coordination team and escalates to the management team as needed + Reports regulatory form deficiencies needed to complete… more
- Elevance Health (Woodbridge, NJ)
- …performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of business. **How You Will Make an ... limited to: + Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data mining and… more
- Ascendis Pharma (Princeton, NJ)
- …to be both strategic and tactical, demonstrating strong leadership, project management , and communication skills. As the Senior Manager, Contracting Operations, you ... include implementation of various systems and processes including vendor management , rebate validation, approval of vendor and customer payments, submission… more
- Baylor Scott & White Health (Trenton, NJ)
- …no matter where you are on your journey. For full details on coverage and eligibility , visit the Baylor Scott & White Benefits Hub to explore our offerings, which ... may include: + Eligibility on day 1 for all benefits + Dollar-for-dollar...cost reports for supported entities. Assists Reimbursement Managers and management in understanding reimbursement issues. Serves as a consultant… more
- CVS Health (East Orange, NJ)
- …members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , clinical coverage ... members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , clinical coverage… more
- CVS Health (Secaucus, NJ)
- …cost-effective care for our members. These strategies encompass utilization management , quality improvement, network coordination, and clinical policy development. ... Needs Programs (D-SNP/FIDE)** . + Evaluate non-MLTSS members for service eligibility and support needs, including adult/pediatric medical daycare, personal care… more
- Atlantic Health System (Morristown, NJ)
- …and Managing Physician in the day to day clinical operations and management of practice site. Lead service excellence initiatives in support of internal ... and external customers and coordinates staff involvement in community events. Assumes management responsibilities in the absence of the Practice Manager or Practice… more
- Atlantic Health System (Morristown, NJ)
- …system quality improvement initiatives with regulatory requirements. 4: Project Management : Develop, coordinate and deliver/implement project implementation plans at ... service line, departments, and programs for actionable improvement and program management outcomes and projects. 11. Education: Provide mentorship and education on… more
- Bristol Myers Squibb (Princeton, NJ)
- …Lead will manage forecasting and analytics for government channels, including Medicaid , Medicare, and other Federal customers. This role coordinates inputs and ... contracting and operations teams + Conduct adhoc analysis as required by management + Drive digital transformation by identifying opportunities to automate pricing… more
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