- Molina Healthcare (OH)
- …and processing. This role will focus on identifying, reviewing, and validating Medicaid secondary payments to ensure alignment with internal configuration rules and ... adjudication, QNXT system navigation, and strong analytical acumen. Experience in Medicaid managed care is required, and a background in payment integrity-either… more
- Molina Healthcare (OH)
- …intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid ). Executes health plan's member and community quality focused interventions ... Duties** + Acts as a lead specialist to provide project , program, and/or initiative related direction and guidance for...to identify opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may… more
- Datavant (Columbus, OH)
- …of professional, educational and life experiences to realize our bold vision for healthcare . **Role Overview** As a Product Manager , Risk Adjustment Coding Data ... in health data exchange. Our vision is that every healthcare decision is powered by the right data, at...data. You will also support scalable, reliable, and performant project data ingestion pipelines and maintain databases that support… more
- Prime Therapeutics (Columbus, OH)
- …**Job Posting Title** Manager of Clinical Operations **Job Description** The Manager Operations is responsible for operations and project support capacity ... teams. **Responsibilities** + Manage operations (via capacity and workload planning, project support planning, or project leadership) for immediate client… more
- Butler County Regional Transit Authority (Cincinnati, OH)
- …of the Director of Finance & Administration, the Finance and Accounting Manager oversees all financial operations and ensures compliance with federal, state, and ... local regulations. This position maintains grant and project compliance, supervises financial transactions, and prepares timely and accurate reports. The role… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …approaches to payer contracting, payer relationships, network participation and other strategic project from time to time. + Participates in short- and long-term ... knowledge and understanding of the current trends and developments in healthcare reimbursement and development of specific payer strategies, including investigation… more
- Medical Mutual of Ohio (OH)
- …and Medicaid ), including HEDIS audit submission, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS). Supports data ... strategies and goals in alignment with regulatory specification for the annual Healthcare Effectiveness Data and Information Set (HEDIS) lifecycle processes for all… more
- Elevance Health (Mason, OH)
- …Primary duties may include, but are not limited to: + Build and maintain project plan and schedule for projects that support the quality strategy, contributes to ... ensuring project deliverables are met, assist in documentation and ...Capabilities, & Experiences:** + Knowledge of Ohio Medicare and Medicaid regulations strongly preferred. + Quality improvement background preferred.… more
- Elevance Health (Mason, OH)
- …background. **Preferred Skills, Capabilities, and Experience:** + Experience with large-scale healthcare or state Medicaid programs preferred. + Experience in ... teams and leadership. The ideal candidate will have deep experience in healthcare , banking, consulting, or private equity. Strong presentation skills are essential,… more
- Humana (Columbus, OH)
- …campus and datacenters. The primary responsibility of the Network Operations Manager will be to provide the highest quality network infrastructure environment ... forecasting and planning needs. + Communicate status updates to Manager of IT and other Senior business leaders where...through CCNP or the equivalent** + 5+ years of project leadership experience. + 8+ years of Layer 2/… more