• Medicare Compliance Manager

    Molina Healthcare (Rochester, NY)
    …experience in health plan setting in government programs management (Contract Manager ) **Preferred Experience** 7-9 years To all current Molina employees: If ... apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer… more
    Molina Healthcare (07/25/25)
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  • Director, Appeals & Grievances ( Medicare

    Molina Healthcare (Rochester, NY)
    …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with ... the standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of… more
    Molina Healthcare (07/18/25)
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  • Manager , Provider Engagement - VBP…

    Centene Corporation (Queens, NY)
    …team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. **Position Purpose:** ... outcomes, advancing quality and ensuring equity in healthcare delivery today. The Manager , Value-Based Payments Initiatives (VBP) will lead and support the expansion… more
    Centene Corporation (07/09/25)
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  • Senior Process Consultant ( Medicare )…

    Molina Healthcare (Syracuse, NY)
    …process improvement efforts. Will lead re-engineering team and act as project manager in some cases. + Develops training curriculum to educate leaders and ... apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer… more
    Molina Healthcare (07/19/25)
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  • RN Care Manager - Remote

    Humana (Albany, NY)
    …of the business there is limited day to day flexibility in care manager 's schedule. **Duties:** + Telephonically assess Medicare , Medicaid, and/or and Group ... community and help us put health first** The Care Manager , Telephonic Nurse 2 employs a variety of strategies,...learn about a "Day in the Life" of our remote RN Care Managers. Day In The Life RN… more
    Humana (08/22/25)
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  • RN Care Manager Remote with field…

    Molina Healthcare (NY)
    …and the site of service. This position will be supporting our Washington State Medicare plan. We are seeking a candidate with previous Case Management experience and ... of MS Suite, organized and analytical thinking. Experience with Medicare /Medicaid, MS 365 and familiarity with claims is highly...and familiarity with claims is highly preferred. The Case Manager must be able to work in a high-volume… more
    Molina Healthcare (08/08/25)
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  • Manager , Enrollment - REMOTE

    Molina Healthcare (Buffalo, NY)
    …needed + Primary point of contact for the internal partners, ie Medicare Administration, Compliance and Health Plan Operations. Coordinates and facilitates meetings ... Experience** 5-7 years Enrollment-related experience in Managed care or Medicare setting **Preferred Education** Graduate Degree or equivalent combination of… more
    Molina Healthcare (08/01/25)
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  • Manager , Operations -System Operations…

    Molina Healthcare (Syracuse, NY)
    …type management responsibility. 5 years progressive experience supporting a Medicaid,. Medicare and Marketplace or large claims processing environment with ... apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer… more
    Molina Healthcare (07/31/25)
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  • RN Lead, HCS (Clinical) Remote with field…

    Molina Healthcare (Syracuse, NY)
    …diverse communities! Hours: Monday - Friday 8:00 AM to 5:00 PM EST Remote position with 25% field travel MA RN license **KNOWLEDGE/SKILLS/ABILITIES** + Assists in ... that involve clinical HCS staff. Communicates findings to the Supervisor or Manager , HCS Department for resolution. + Maintains a minimal caseload as determined… more
    Molina Healthcare (08/15/25)
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  • Senior Specialist, Member & Community…

    Molina Healthcare (NY)
    …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality ... to identify opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may...skills. **PREFERRED QUALIFICATIONS:** + 1 year of experience in Medicare and in Medicaid managed care + Experience with… more
    Molina Healthcare (07/31/25)
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