- CenterWell (Harrisburg, PA)
- …and monitoring the Tele Sales Agents who are responsible for converting Medicare eligible callers to patients. The Care Delivery Call Quality Professional is ... quality auditing experience + Understanding of value-based primary care and/or Medicare Advantage + Familiarity with healthcare systems and patient satisfaction… more
- Cognizant (Harrisburg, PA)
- …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
- UPMC (Pittsburgh, PA)
- …clinical management of the designated line of business (Commercial, Exchange, Medicare , Medicaid, Exchange, and/or CHIP) from a pharmacy formulary and operational ... US School of Pharmacy. + Experience in pharmacy benefit management, insurance , and managed care preferred and be knowledgeable in therapeutic interventions… more
- Otsuka America Pharmaceutical Inc. (Harrisburg, PA)
- …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
- Aveanna Healthcare (Bartonsville, PA)
- …a real difference. Why Join Us? + Health, Dental, Vision & Company-Paid Life Insurance + Paid Time Off + Career Advancement Opportunities + 15% Employee Stock ... all-inclusive and may evolve as organizational needs change. + As a Medicare /Medicaid provider, employees must meet all required health and vaccination standards,… more
- Evolent (Harrisburg, PA)
- …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
- Evolent (Harrisburg, PA)
- …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
- AmeriHealth Caritas (West Chester, PA)
- …preferred. + Knowledge/experience with government market lines of business (Medicaid, Medicare ) is preferred. ;Some knowledge/ experience with Medicaid/ Medicare ... schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition… more
- ABBTECH Professional Resources, Inc. (Harrisburg, PA)
- …SAFe Product Owner or SAFe Agilist. Experience working with the Centers for Medicare and Medicaid Services (CMS) and/or health insurance /heath care experience * ... requests Salesforce Business Analyst to remotely to support the Centers for Medicare & Medicaid Services (CMS) activities. As a Salesforce Business Analyst… more
- Evolent (Harrisburg, PA)
- …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