• Lead Specialist, Appeals & Grievances - Remote

    Molina Healthcare (Buffalo, NY)
    …accordance with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Serves as team lead for a small ... benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory… more
    Molina Healthcare (08/24/25)
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  • Lead Director Network Platform Solutions

    CVS Health (Albany, NY)
    …Examples include ensuring data standards are synchronized across Medicaid and Medicare platforms, ensuring duals workflows are support across systems, ensuring duals ... experience in strategy and delivery leadership roles + 5+ years of Medicare /Medicaid and/or Duals experience + Proven success navigating large scale cross functional… more
    CVS Health (08/24/25)
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  • Senior Product Owner

    CenterWell (Albany, NY)
    …delivery of associate-facing contact center technologies that support Pharmacy and Medicare Part D operations. This enterprise-wide platform empowers associates to ... a related field. **Preferred Qualifications:** + Understanding of pharmacy operations and Medicare Part D. + Experience with contact center platforms and CRM… more
    CenterWell (08/23/25)
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  • Sr Compliance RCM & Coding Auditor

    Humana (Albany, NY)
    …experience in revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims) + Experience with Auditing and monitoring of ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ​… more
    Humana (08/23/25)
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  • Customer Development Manager (Pharmacy Channel)

    Nestle (Holbrook, NY)
    …grocery, drug, and/or mass retail channel(s) is required. + Knowledge of the Medicare Advantage business model preferred. + Experience in consumer goods and health & ... market share for the company and its customers. + Knowledge of the Medicare Advantage business model preferred. **SKILLS:** + Ability to manage multiple priorities… more
    Nestle (08/23/25)
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  • AVP, Encounters

    Molina Healthcare (Syracuse, NY)
    …oversight of processes that track, evaluate, and submit encounter deletions for Medicare Advantage, ACA, and Medicaid lines of business. This role has ... minimum in Director level role or above. + Extensive understanding of Medicare Advantage, ACA and Medicaid risk adjustment processes, including encounter data… more
    Molina Healthcare (08/22/25)
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  • Registered Nurse 1 (Psychiatric) (Bronx ATC)

    New York State Civil Service (Bronx, NY)
    …eligibility for full and unconditional participation in the Medicaid and Medicare program. Failure to maintain licensure, certification and Medicaid/ Medicare ... eligibility will result in the termination of employment. Additional Comments Salary:$45.51OASAS ATC's are Tobacco-Free facilities.Background Investigation Requirements: Prospective appointees will be: 1) Checked against the Staff Exclusion List (SEL)… more
    New York State Civil Service (08/22/25)
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  • Sr Mgr,Digital Product

    CVS Health (Albany, NY)
    …medical costs and provides an unmatched experience for adults on Medicare in medically underserved communities. By providing holistic, comprehensive and integrated ... health platform to support the delivery of high quality care to the Medicare population. As a Senior Product Manager within the Patient Experience and Service… more
    CVS Health (08/22/25)
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  • Teacher 2/ Teacher 3/ Teacher 4 (NY Helps),…

    New York State Civil Service (New York, NY)
    …Comments: These positions are eligible for a Downstate Adjustment of $4,000.Medicaid/ Medicare Requirements: In order to be eligible for appointment and to ... individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal or Federally assisted program).… more
    New York State Civil Service (08/22/25)
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  • Senior Financial Analytics Professional

    Humana (Albany, NY)
    …are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. **Equal ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ​… more
    Humana (08/22/25)
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