- Molina Healthcare (TX)
- …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 (El Paso, TX)
- …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 (Austin, TX)
- …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 (Austin, TX)
- …**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
- Centene Corporation (Austin, TX)
- …End-to-end development, filing and execution of the Medicare Supplemental benefits. Program Manager III will own a complex portfolio of designs, and directly ... annually. Directly responsible for developing CMS filing guides for benefits. Program Manager III is responsible for development, aspects of contract and rate… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Case Manager (CM) Certified position is a registered nurse (RN) responsible for comprehensively planning for case management of a targeted ... service line. This position works with the physicians and interprofessional healthcare team to facilitate and maintain compassionate, efficient quality care and… more
- Humana (Austin, TX)
- …community and help us put health first** The Special Investigations Unit Manager leads and monitors investigations of allegations of fraudulent and abusive ... practices. The Manager , Fraud and Waste works within specific guidelines and...communication skills, written and verbal + Strong organizational and project management skills + Strong Analytical skills + Core… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Case Manager (CM) Advanced position is a registered nurse (RN) responsible for promoting the achievement of optimal clinical and resource ... level at all the objectives delineated in the Case Manager and Case Manager Certified job roles...families and works with the leadership team for special project activities related but not limited to, throughput, readmissions,… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient ... initiates discussion with attending physicians, coordinates with the external case manager to facilitate discharge planning, seeks assistance from the physician… more
- American Heart Association (Dallas, TX)
- …us. The American Heart Association has an excellent opportunity for a **Senior** ** Healthcare Quality Measures Manager ** based out of our National Center office. ... + In collaboration with volunteers and staff (measures, research, and Healthcare Information Technology (HIT) staff) operationalizes quality measure concepts and… more