- Molina Healthcare (TX)
- …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality ... excellent problem-solving skills. **PREFERRED QUALIFICATIONS:** + 1 year of experience in Medicare and in Medicaid managed care + Experience with data reporting,… more
- Datavant (Austin, TX)
- …work environment. + Keep up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide guidance and make strategic ... or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and HEDIS experience. +… more
- Humana (Austin, TX)
- …of our caring community and help us put health first** We are seeking a Senior Accreditation Professional who will work in a team environment on Humana's health plan ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Prime Therapeutics (Austin, TX)
- …decision we make. **Job Posting Title** Clinical Pharmacist (Algo), Professional- Senior - REMOTE **Job Description** Maintains the inventory of clinical algorithms. ... based upon relevant source data (eg clinical criteria, client criteria, Medicare LCD). Provides support for clinical client inquiries and internal partners.… more
- Humana (Austin, TX)
- …shaping the future of healthcare through AI excellence. We are seeking a Senior Data Scientist to develop reliable, interpretable, and steerable AI systems. Our goal ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- CVS Health (Austin, TX)
- …all with heart, each and every day. **Position Summary** **The Medicaid Senior Manager, Network Management:** * Negotiates, executes, conducts high level review and ... * Highly organized and self-driven. **Preferred Qualifications** * Knowledge of Medicare and commercial programs and related subject matter. **Education** Bachelor's… more
- CVS Health (Austin, TX)
- …role? Join Aetna/CVS Health, a Fortune 4 company, as the Network Management Senior Manager. In this role, you will manage negotiations, conduct high-level reviews ... and developing yourself and others) skills **Required Qualifications** * Commercial, Medicare , and/or Medicaid knowledge * 5+ years related experience, proven and… more
- CVS Health (Austin, TX)
- …of 3 years managing/leading a team. + Experience working in Medicare , Medicaid, or Commercial Health Insurance. **Preferred Qualifications** + Experience working ... in credentialing operations. + Strong written and verbal communication. **Education** + Bachelor's degree preferred or a combination of professional work experience and education. **Pay Range** The typical pay range for this role is: $67,900.00 - $199,144.00… more
- Cardinal Health (Austin, TX)
- …with long- and short-range changes in the reimbursement environment including Medicare , Medicaid, Managed Care, and Commercial plans while planning for various ... scenarios that may impact the manufacturer's product **TRAINING AND WORK SCHEDULES:** Your new hire training will take place 8:00am-5:00pm CST, mandatory attendance is required. This position is full-time (40 hours/week). Employees are required to have… more
- Molina Healthcare (Fort Worth, TX)
- …Directory (including ongoing execution, QA and maintenance of supporting tables), Medicare Provider Directory preparation, and FQHC/RHC reports. + Generates other ... provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, Network Access Fee, etc.).; and mailing label extract generation. + Develops and maintains documentation and guidelines for all… more