• Payment Integrity Program Manager - Health Plan…

    Molina Healthcare (Carson City, NV)
    …operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay ... of the role. + Validates findings and test assumptions through data, but lead with contextual knowledge of claims processing, provider contracts, and operational… more
    Molina Healthcare (10/30/25)
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  • Behavioral Health Medical Director - Medicare

    Humana (Helena, MT)
    …**Additional Information** Typically reports to an Associate Vice President of Health Services , Lead , or Corporate Medical Director, depending on size of ... a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and...sex, sexual orientation, gender identity or religion. We also provide free language interpreter services . See our… more
    Humana (11/11/25)
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  • Program Area Director - Applied Health Care…

    NORC (Washington, DC)
    …Area Director for our Applied Health Care Economics team. The incumbent will lead evaluation and health services research projects requiring application of ... on research design, methodology, data analysis, and interpretation for Medicare and Medicaid demonstration evaluations and health services research. + Leading… more
    NORC (11/14/25)
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  • Team Lead Medical Assistant - MMG Park…

    McLaren Health Care (Detroit, MI)
    …agencies, such as HIPAA, PCMH, OSHA, CLIA and the Centers for Medicare and Medicaid Services (CMS) * Respond to emergency situations quickly and appropriately * ... of the staff (Medical Assistants and Patient Access Representatives). S/he will provide feedback to the staff and recommend corrective action to the Manager… more
    McLaren Health Care (11/22/25)
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  • Market President, New Hampshire

    AmeriHealth Caritas (Manchester, NH)
    …the state's Medicaid agency is essential. The Market President will lead the effective and efficient operations of this Health Plan directly and/or indirectly ... medical services meets or exceeds appropriate industry standards. + Provide personal leadership that encourages employee productivity and responsiveness to the… more
    AmeriHealth Caritas (11/12/25)
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  • MCO Director Payment Integrity

    AmeriHealth Caritas (Newtown Square, PA)
    …alignment and mitigate audit risk _Provider Support & Stakeholder Engagement_ + Lead the development of provider engagement strategies that promote transparency ... performance across all ACFC lines of business and products ( Medicaid , Medicare, Exchange, PBM, BH). This role ensures that...Desk function to ensure prompt triage and resolution of provider and internal inquiries + Monitor service more
    AmeriHealth Caritas (11/21/25)
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  • Program Operations Specialist 1

    New York State Civil Service (Schenectady, NY)
    …Compliance mailbox and answering questions as they pertain to other service reviews,- Reviewing Medicaid Compliance Liaison's self-disclosures, quarterly ... current Eligibility Letter from the NYS Department of Civil Service , www.cs.ny.gov/rp55/, and be able to provide ...referral service that connects employees with local service providers and support services to address… more
    New York State Civil Service (11/14/25)
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  • Delegation Partnerships Performance Manager

    Commonwealth Care Alliance (Boston, MA)
    011230 CA- Provider Engagement & Performance Position Summary: The Provider Delegation Performance Manager is responsible for overseeing and improving the ... involves close collaboration with program leadership, operations teams, and external provider partners. The ideal candidate will have excellent organizational and… more
    Commonwealth Care Alliance (10/18/25)
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  • PWP Coordinator

    Starfish Family Services, Inc. (Livonia, MI)
    …Childhood services within the home and community settings in accordance with the Medicaid Provider Manual for the State of Michigan and agency guidelines. 9. ... will assist in program development, marketing, staff training and service monitoring for the clinic's Infant Mental Health program....program. 7. Assist in coordination and referrals of support services to families in the program. 8. Provide more
    Starfish Family Services, Inc. (11/11/25)
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  • RN Case Manager - Value Based Service Org…

    University of Southern California (Alhambra, CA)
    …collaboration with the interdisciplinary team, the Case Manager provides care coordination services evaluating options and services required to meet an ... quality management, discharge planning assessment, and coordination of post-hospital care services , including transfers to an alternative level of care. As more… more
    University of Southern California (11/19/25)
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