- Highmark Health (Albany, NY)
- …Business Solutions leadership in strategic activities to expand IT capabilities for Medicaid growth in the dental market by: Applying SME knowledge to analytical ... strategic thinking to identify business needs for growing and sustaining the Medicaid business. Apply SME knowledge and oversee multiple teams' activities related to… more
- Molina Healthcare (Syracuse, NY)
- **Job Description** **Job Summary** Provides lead level support as a highly capable business analyst who serves as a key strategic partner in driving health plan ... Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits,… more
- Humana (Albany, NY)
- …of this evolution is Humana's Insurance Segment, which provides Medicare Advantage, Medicaid , and other health plans to millions. By integrating insurance with care ... role in defining the future of Humana's Medicare and Medicaid businesses, which generate the majority of the company's...experience to join this team. As an Insurance Strategy Lead , you will directly contribute to high-impact strategy projects,… more
- Humana (Albany, NY)
- …a part of our caring community and help us put health first** As a Lead AI/ML DevOps Engineer at Humana, you will be responsible for leading the development, ... of AI/ML solutions. Additionally, you will focus on streamlining the deployment process , ensuring the scalability and reliability of AI/ML models, and monitoring… more
- Humana (Albany, NY)
- …Operations, you will shape strategic direction, influence senior stakeholders, and lead a high-performing team of marketers. You'll drive collaborative go-to-market ... teams and external vendors, and ensure compliance with CMS, Medicaid , and Pharmacy marketing regulations. **Key Responsibilities** **Campaign Strategy, Execution… more
- New York State Civil Service (Albany, NY)
- …State NY Zip Code 12224 Duties Description Criminal Justice Division Medicaid Fraud Control Unit - Albany-areaDeputy Director, Electronic Investigative Support ... at ag.ny.gov/job-postings/otherThe Office of the New York State Attorney General's (OAG) Medicaid Fraud Control Unit (MFCU) is seeking an experienced IT manager to… more
- Highmark Health (Albany, NY)
- …the key BU's for the Organization's value-based reimbursement programs and continuous improvement models. Lead or support key strategic initiatives across ... providers enrolled in the Organization's value-based reimbursement programs and continuous improvement models. The incumbent plays different potential roles on a… more
- Molina Healthcare (Rochester, NY)
- …in collaboration with the clinical lead , the medical director, and quality improvement staff. + Facilitates conformance to Medicare, Medicaid , NCQA and other ... necessity. + Participates in and maintains the integrity of the appeals process , both internally and externally. Responsible for the investigation of adverse… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …compliance and/or governance on more complex special projects and audits. + Offers process improvement suggestions and participates in the solution of more ... the Food and Drug Administration (FDA), and Centers for Medicare and Medicaid Services (CMS). Provides routine interaction and coordination with the BCBS Association… more
- New York State Civil Service (Albany, NY)
- …team and the Medical Director to finalize determinations from the review process .. Leading continuous improvement activities ensuring clinical quality assurance ... and clinical data to inform and enhance policies, training, and continuous improvement efforts in the service authorization process .. Consulting with OPWDD… more