- Molina Healthcare (Buffalo, NY)
- …iteratively and adaptively when data is incomplete or spread across multiple systems , using sound judgment to build defensible audit datasets. + Present findings ... and progress updates to project leads and stakeholders, contributing to a collaborative, informed audit response process. **Job Qualifications** **Required Education** Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline… more
- CVS Health (Albany, NY)
- …Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. + Effective communication skills, both verbal and ... written. **Required Qualifications** + 2+ years of experience as a Registered Nurse + Must have active current and unrestricted RN licensure in state of residence **Preferred Qualifications** + 2+ years of clinical experience in med surg or specialty area +… more
- Trinity Health (Syracuse, NY)
- …and Inclusion** Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core ... Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and… more
- Molina Healthcare (Syracuse, NY)
- …product managers, and business analysts, to integrate AI solutions into existing systems and processes. * Research and Development: Stay current with the latest ... advancements in AI and machine learning and apply these insights to improve existing models and develop new methodologies. * Documentation and Reporting: Create comprehensive documentation of models, methodologies, and results; communicate findings clearly to… more
- Mount Sinai Health System (New York, NY)
- …Health System:** Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across ... eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges… more
- Molina Healthcare (Buffalo, NY)
- …product managers, and business analysts, to integrate AI solutions into existing systems and processes. * **Research and Development:** Stay current with the latest ... advancements in AI and machine learning and apply these insights to improve existing models and develop new methodologies. * **Documentation and Reporting:** Create comprehensive documentation of models, methodologies, and results; communicate findings clearly… more
- Molina Healthcare (Albany, NY)
- …of experience supporting HEDIS engine activity, risk adjustment targeting and reporting systems * 2+ years of data analysis experience utilizing technical skillsets ... and resources to answer nuanced Risk and Quality questions posed from internal and external partners * Familiarity with running queries in Microsoft Azure or SQL server * Healthcare experience and functional risk adjustment and/or quality knowledge * Mastery… more
- Molina Healthcare (Albany, NY)
- …**Education** * Bachelor's degree - Health Administration, Business, Information Systems , or related field (advanced degree a plus). **Experience** * ... 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with CMS CTM portal, SLA tracking, and program audits. * Deep knowledge of Medicare regulations affecting complaints, grievances, and member communications. *… more
- Molina Healthcare (Buffalo, NY)
- …Duties** + Handles and records inbound/outbound pharmacy calls in required systems from members, providers, pharmacists, pharmacies, and technicians to meet ... departmental and CMS standards. + Enforce HIPAA compliance standards and regulations while maintaining guidelines and other necessary information for our providers, members, technicians and pharmacists. + Provides clerical services and support to the… more
- Molina Healthcare (Syracuse, NY)
- …pricing, and financial reporting. + Extract and compile information from various systems to support executive decision-making. + Research and develop reports and ... analysis for senior management; effectively communicate results. + Assist in the preparation of forecasts/bids/filings related to risk adjustment. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree in Mathematics, Statistics, or Economics… more