- CVS Health (MI)
- …coordinate, monitor and evaluate options to facilitate appropriate healthcare services/ benefits for members. + Gathers clinical information and applies the ... Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external… more
- CVS Health (OH)
- …preferred + Auditing experience + Managed care experience + Medicaid and/or Medicare experience + Systems experience: MedCompass and/or QNXT + Critical thinking ... a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix… more
- US Tech Solutions (May, OK)
- …evaluates potential quality of care issues based on clinical policies and benefit determinations. Considers all documented system information as well as any ... comprehensive knowledge of complex delegation arrangements, contracts ,clinical criteria, benefit plan structure, regulatory requirements, company policy and other… more
- AmeriHealth Caritas (Newtown Square, PA)
- …who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other ... of trends. + Support the Network team with validation of Medicaid/ Medicare /Exchange pricing, collaborating with internal partners as well as external consultants… more
- Humana (Washington, DC)
- …is based upon company and/or individual performance. **Description of Benefits ** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers ... competitive benefits that support whole-person well-being. Associate benefits ...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- WellSpan Health (York, PA)
- …health diagnosis and/or developmental disorders + Ability to work under stress. ** Benefits Offered:** + Comprehensive health benefits + Flexible spending and ... + Childcare referral service via Wellthy For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org) (https://www.joinwellspan.org/ benefits… more
- Health Care Service Corporation (Nashville, TN)
- …PC proficiency to include MS Office products * Knowledge and/or experience with: + . Medicare Part A/B/D + . Provider workflows & Provider application - Symplr + . ... disability, protected veteran status, or any other legally protected characteristics. To learn more about available benefits , please click… more
- Waystar (Atlanta, GA)
- …hospitals and health systems, and is connected to over 5K commercial and Medicaid/ Medicare payers. We are deeply committed to living out our organizational values: ... + Competitive total rewards (base salary + bonus, if applicable) + Customizable benefits package (3 medical plans with Health Saving Account company match) + We… more
- MetroLink (Los Angeles, CA)
- …Date 09/19/2025 Closing Date 10/10/2025 5:00 PM Pacific + Description + Benefits + Questions SUMMARY The Southern California Regional Rail Authority, the operator ... as appropriate + Ensure high-quality work output of departmental and consultant staff + Establish, monitor, and reinforce department policies and procedures,… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Responsibilities** **Group ... renewal, renewal alternate, and prospect cases using the department's tool that analyzes benefits , for input into the rating system. . Gathers necessary data and… more