- Molina Healthcare (OH)
- …with other Core Ops areas of responsibilities) within Medicare and Medicaid . Role is predicated on building relationships with vendors, stakeholders, functional ... Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and State regulations, including contract… more
- Datavant (Columbus, OH)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Coding Data Integration, you will own the data strategy and ... data. You will also support scalable, reliable, and performant project data ingestion pipelines and maintain databases that support...and management of client data for MA, ACA, and Medicaid plans, ensuring HIPAA and CMS compliance + **Standard… more
- 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 (Cincinnati, OH)
- …Analysis Professional (CBAP), or Certified Coding Specialist (CCS) certification. + Project Management Experience + Familiarity with Medicaid -specific Scorable ... tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met...years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health… 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 ... standards and directives regarding governmental/third party agencies (Medicare & Medicaid ) and/or third paLeads assigned negotiations of fee for service,… more
- Medical Mutual of Ohio (OH)
- …for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid ), including HEDIS audit submission, Consumer Assessment of Healthcare Providers ... application and coordinates implementation. + Supports interdepartmental and vendor project planning coordination and facilitation. Works with IT and Clinical… 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
- 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
- Public Consulting Group (Columbus, OH)
- …to meet with and support clients. **Duties And Responsibilities** + Serves as project manager and subject matter expert, independently managing complex projects, ... agency and school district clients in their efforts related to special education, Medicaid reimbursement, data management and use. While a remote role, it is… 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