- Otsuka America Pharmaceutical Inc. (Princeton, NJ)
- …contracting and in-depth understanding of GPO/PBM/National and Regional Health Plan business models, Medicare Part D, Medicare Part B, 340B, and the changing ... basic life, accidental death & dismemberment, short-term and long-term disability insurance , tuition reimbursement, student loan assistance, a generous 401(k) match,… more
- Evolent (Trenton, NJ)
- …current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the ... Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of disciplinary or legal action by a state medical… more
- Cognizant (Trenton, NJ)
- …based on the review of clinical documentation in accordance with Medicare , Medicaid, and third-party guidelines. . Effectively document and log claims/appeals ... Reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines. . Review retro-authorizations in… more
- CVS Health (NJ)
- …healthcare as it should be'', providing personalized primary care for older adults on Medicare , with the goal of keeping patients healthy and living life to the ... Mission-focused career impacting change and measurably improving health outcomes for medicare patients + Paid vacation, sick time, and investment/retirement 401K… more
- Cardinal Health (Trenton, NJ)
- …a call center or customer service environment, preferred + Clear knowledge of Medicare , Medicaid & Commercial payer policies and guidelines for coverage, preferred + ... Knowledge of Diagnostic Medical Expense and Medicare Administrative Contractor practices, preferred + Clear understanding of Medical, Supplemental, and pharmacy … more
- CenterWell (Trenton, NJ)
- …innovation for chronically and temporarily homebound, polychronic, and high-risk Medicare patients within a full-risk, value-based framework. The Medical Director ... with clinicians, executives, and operational leaders. + Advanced knowledge of Medicare regulations, value-based care principles, and best practices for complex care… more
- Evolent (Trenton, NJ)
- …current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the ... Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or legal action by a state… more
- Prime Therapeutics (Trenton, NJ)
- …all provider and member materials and communications, and product ownership for Medicare and Medicaid formularies + Provide consultation and recommendations to the ... to the plan + Provide clinical guidance and support for client's Health Insurance Marketplace business + Manage incoming requests for information from the plan… more
- Elevance Health (Morristown, NJ)
- …actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of business. **How You Will Make an Impact** Primary duties ... Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data mining and data-driven analyses… more
- Evolent (Trenton, NJ)
- …current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the ... Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or legal action by a state… more